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Pereira AP, Antunes P, Peixe L, Freitas AR, Novais C. Current insights into the effects of cationic biocides exposure on Enterococcus spp. Front Microbiol 2024; 15:1392018. [PMID: 39006755 PMCID: PMC11242571 DOI: 10.3389/fmicb.2024.1392018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/04/2024] [Indexed: 07/16/2024] Open
Abstract
Cationic biocides (CBs), such as quaternary ammonium compounds and biguanides, are critical for controlling the spread of bacterial pathogens like Enterococcus spp., a leading cause of multidrug-resistant healthcare-associated infections. The widespread use of CBs in recent decades has prompted concerns about the potential emergence of Enterococcus spp. populations exhibiting resistance to both biocides and antibiotics. Such concerns arise from their frequent exposure to subinhibitory concentrations of CBs in clinical, food chain and diverse environmental settings. This comprehensive narrative review aimed to explore the complexity of the Enterococcus' response to CBs and of their possible evolution toward resistance. To that end, CBs' activity against diverse Enterococcus spp. collections, the prevalence and roles of genes associated with decreased susceptibility to CBs, and the potential for co- and cross-resistance between CBs and antibiotics are reviewed. Significant methodological and knowledge gaps are identified, highlighting areas that future studies should address to enhance our comprehension of the impact of exposure to CBs on Enterococcus spp. populations' epidemiology. This knowledge is essential for developing effective One Health strategies that ensure the continued efficacy of these critical agents in safeguarding Public Health.
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Affiliation(s)
- Ana P Pereira
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Patrícia Antunes
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Luísa Peixe
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Ana R Freitas
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
- 1H-TOXRUN, One Health Toxicology Research Unit, University Institute of Health Sciences, CESPU CRL, Gandra, Portugal
| | - Carla Novais
- UCIBIO-Applied Molecular Biosciences Unit, Laboratory of Microbiology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, Porto, Portugal
- Associate Laboratory i4HB - Institute for Health and Bioeconomy, Faculty of Pharmacy, University of Porto, Porto, Portugal
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Ntshonga P, Gobe I, Koto G, Strysko J, Paganotti GM. Biocide resistance in Klebsiella pneumoniae: a narrative review. Infect Prev Pract 2024; 6:100360. [PMID: 38571564 PMCID: PMC10988060 DOI: 10.1016/j.infpip.2024.100360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
Klebsiella pneumoniae is among the World Health Organization's list of priority pathogens, notorious for its role in causing healthcare-associated infections and neonatal sepsis globally. Containment of K. pneumoniae transmission depends on the continued effectiveness of antimicrobials and of biocides used for topical antisepsis and surface disinfection. Klebsiella pneumoniae is known to disseminate antimicrobial resistance (AMR) through a large auxiliary genome made up of plasmids, transposons and integrons, enabling it to evade antimicrobial killing through the use of efflux systems and biofilm development. Because AMR mechanisms are also known to impart tolerance to biocides, AMR is frequently linked with biocide resistance (BR). However, despite extensive research on AMR, there is a gap in knowledge about BR and the extent to which AMR and BR mechanisms overlap remains debatable. The aim of this paper is to review and summarise the current knowledge on the determinants of BR in K. pneumoniae and highlight content areas that require further inquiry.
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Affiliation(s)
- Pearl Ntshonga
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Irene Gobe
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Garesego Koto
- School of Allied Health Professions, Faculty of Health Sciences, University of Botswana, Gaborone, Botswana
| | - Jonathan Strysko
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Department of Paediatric and Adolescent Health, Princess Marina Hospital, Gaborone, Botswana
- Department of Global Medicine, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Giacomo Maria Paganotti
- Botswana-University of Pennsylvania Partnership, Gaborone, Botswana
- Division of Infectious Diseases, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biomedical Sciences, University of Botswana, Gaborone, Botswana
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Shakerimoghaddam A, Moghaddam AD, Barghchi B, Pisheh Sanani MG, Azami P, Kalmishi A, Sabeghi P, Motavalli F, Khomartash MS, Mousavi SH, Nikmanesh Y. Prevalence of Pseudomonas aeruginosa and its antibiotic resistance in patients who have received Hematopoietic Stem-Cell Transplantation; A globally Systematic Review. Microb Pathog 2023; 184:106368. [PMID: 37769854 DOI: 10.1016/j.micpath.2023.106368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 10/03/2023]
Abstract
Gram-negative bacteria are infectious and life-threatening agents after hematopoietic stem cell transplantation (HSCT). So, this study aimed to investigate the prevalence of Pseudomonas aeruginosa and its antibiotic resistance in patients who have received Hematopoietic Stem-Cell Transplantation through a systematic review. The systematic search was done with key words; Pseudomonas aeruginosa, hematopoietic stem cell transplantation from 2000 to the end of July 2023 in Google Scholar and PubMed/Medline, Scopus, and Web of Science. Twelve studies were able to include our study. Quality assessment of studies was done by Appraisal tool for Cross-Sectional Studies. The most of the included studies were conducted as allo-HSCT. Infections such as respiratory infection, urinary infection and bacteremia have occurred. The rate of prevalence with P. aeruginosa has varied between 3 and 100%. The average age of the participants was between 1 and 74 years. The rate of prevalence of P. aeruginosa resistant to several drugs has been reported to be variable, ranging from 20 to 100%. The highest antibiotic resistance was reported against cefotetan (100%), and the lowest was related to tobramycin (1.8%) followed by amikacin, levofloxacin and ciprofloxacin with the prevalence of 16.6%. Our findings showed a high prevalence and antibiotic resistance rate of P. aeruginosa in Hematopoietic stem cell transplantation. Therefore, more serious health measures should be taken in patients after transplantation.
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Affiliation(s)
- Ali Shakerimoghaddam
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | - Arasb Dabbagh Moghaddam
- Infectious Diseases Research Center, Aja University of Medical Sciences, Tehran, Iran; Department of Public Health & Nutrition, Aja University of Medical Sciences, Tehran, Iran
| | - Bita Barghchi
- Medical School, Islamic Azad University, Tehran, Branch, Tehran, Iran
| | | | - Pouria Azami
- Cardiovascular Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abolfazl Kalmishi
- Department of Internal and Surgical Nursing Faculty of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Paniz Sabeghi
- Medical School, Shiraz University of Medical Sciences, Shiraz Branch, Shiraz, Iran
| | - Farhad Motavalli
- Medical Biotechnology Research Center, AJA University of Medical Sciences, Tehran, Iran
| | | | - Seyyed Hossein Mousavi
- Department of Cardiology, School of Medicine, AJA University of Medical Sciences, Tehran, Iran
| | - Yousef Nikmanesh
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
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Huang W, Qiao F, Cai L, Zong Z, Zhang W. Effect of daily chlorhexidine bathing on reducing infections caused by multidrug-resistant organisms in intensive care unit patients: A semiexperimental study with parallel controls. J Evid Based Med 2023; 16:32-38. [PMID: 36779575 DOI: 10.1111/jebm.12515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 01/17/2023] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To assess the effectiveness of daily bathing by chlorhexidine bathing on multidrug-resistant organisms in ICU, especially on carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and carbapenem-resistant Enterobacteriaceae (CRE). METHODS Semiexperimental study which employed both precontrols and a parallel control was conducted. In the intervention period (from July 1 to December 31, 2016), strengthened infection control measures and daily bathing with 2% CHG-impregnated wipes once daily was performed in the ICU. Fifty-seven non-ICU wards with the occurrence of multidrug-resistant organisms (MDRO) infections during the same time were selected as parallel control group (only CHG bathing was not performed). The net effect of the 2% CHG daily bathing was evaluated by the difference in difference (DID) model. RESULTS The DID model analysis showed that CHG bathing reduced the incidence of CRAB- and CRPA-caused infections in ICU by 1.56 and 2.15 cases/1000 patient days, and bathing of every 19 patients (95CI% 13 to 41) and 39 patients (95CI% 24 to 110) were able to prevent one case of HAIs of total MDROs and CRPA, respectively. However, CHG bathing showed no effect on MRSA, VRE, and CRE (p > 0.05). CONCLUSION Daily bathing with 2% CHG-impregnated wipes can reduce HAIs caused by CRAB and CRPA, while it is not effective for the prevalence of infections caused by MRSA, VRE, and CRE.
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Affiliation(s)
- Wenzhi Huang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P. R. China
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Fu Qiao
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Lin Cai
- Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Zhiyong Zong
- Department of Infection Control, West China Hospital, Sichuan University, Chengdu, P. R. China
- Center of Infectious Disease, West China Hospital, Sichuan University, Chengdu, P. R. China
| | - Wei Zhang
- Institute of Hospital Management, West China Hospital, Sichuan University, Chengdu, P. R. China
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Van den Poel B, Saegeman V, Schuermans A. Increasing usage of chlorhexidine in health care settings: blessing or curse? A narrative review of the risk of chlorhexidine resistance and the implications for infection prevention and control. Eur J Clin Microbiol Infect Dis 2022; 41:349-362. [DOI: 10.1007/s10096-022-04403-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 01/11/2022] [Indexed: 12/18/2022]
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Reis MAO, de Almeida MCS, Escudero D, Medeiros EA. Chlorhexidine gluconate bathing of adult patients in intensive care units in São Paulo, Brazil: Impact on the incidence of healthcare-associated infection. Braz J Infect Dis 2022; 26:101666. [PMID: 35032443 PMCID: PMC9387476 DOI: 10.1016/j.bjid.2021.101666] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/12/2021] [Accepted: 12/05/2021] [Indexed: 11/26/2022] Open
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Prevalence of resistance genes to biocides in antibiotic-resistant Pseudomonas aeruginosa clinical isolates. Mol Biol Rep 2021; 49:2149-2155. [PMID: 34854015 DOI: 10.1007/s11033-021-07032-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 11/26/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Biocides are frequently used as preservative, disinfectant and sterilizer against many microorganisms in hospitals, industry and home. However, the reduced susceptibility rate of Pseudomonas aeruginosa (P. aeruginosa) strains to biocides is increasing. The aim of this study was to evaluate the antimicrobial activity of four frequently used biocides against P. aeruginosa and to determine the prevalence of genes involved in biocide resistance. METHODS A total of 76 clinical isolates of P. aeruginosa strains were used in the present study. The minimum inhibitory concentrations (MICs) of four biocides, i.e. chlorhexidine digluconate, benzalkonium chloride, triclosan and formaldehyde, against P. aeruginosa strains were determined using agar dilution method. In addition, the prevalence of biocide resistance genes was determined using the polymerase chain reaction (PCR) method. RESULTS In the present study, the highest MIC90 and MIC95 (epidemiological cut-off) values were observed for benzalkonium chloride (1024 μg/mL), followed by formaldehyde (512 μg/mL), triclosan (512 μg/mL) and chlorhexidine digluconate (64 μg/mL). Furthermore, the prevalence of qacEΔ1, qacE, qacG, fabV, cepA and fabI genes were 73.7% (n = 56), 26.3% (n = 20), 11.8% (n = 9), 84.2% (n = 64), 81.5% (n = 62) and 0% (n = 0), respectively. A significant association was observed between the presence of biocide resistance genes and MICs (p < 0.05). Furthermore, there was no significant association between the presence of biocide resistance genes and antibiotic resistance (p > 0.05), except for levofloxacin and norfloxacin antibiotics and qacE and qacG genes (p < 0.05). CONCLUSION Our results revealed that chlorhexidine digluconate is the most effective biocide against P. aeruginosa isolates in Ardabil hospitals. However, we recommend continuous monitoring of the antimicrobial activity of biocides and the prevalence of biocide-associated resistance genes for a better prevention of microorganism dissemination and infection control in hospitals.
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Higashino HR, Marchi AP, Ruedas Martins RC, Bubach Carvalho L, Vieira Perdigão Neto L, Farrel Côrtes M, Nivaldo de Oliveira F, Tarsia Duarte EL, Guimaraes T, Rossi F, Ferreira AM, Rocha V, Costa SF. Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing. J Med Microbiol 2021; 70. [PMID: 34665114 DOI: 10.1099/jmm.0.001422] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRK) infections are a growing concern in immunocompromised patients. The aim of the present study was to evaluate the impact of CRK colonization and infection in overall mortality for haematopoietic stem-cell transplant (HSCT) patients. We also aimed to investigate resistance and virulence profiles of CRK isolates and assess their epidemiological and genetic relatedness. Patients in the HSCT unit were screened for colonization with CRK with weekly rectal swab or stool cultures and placed under contact precautions. We defined CRK colonization as positive culture from a swab or stool sample grown in MacConkey agar with meropenem at 1 µg ml-1. Demographic and clinical data were retrieved from the patients' charts and electronic records. According to resistance mechanisms and pulsed field gel electrophoresis profile, isolates were selected based on whole-genome sequencing (WGS) using MiSeq Illumina. Outcomes were defined as overall mortality (death up to D+100), and infection-related death (within 14 days of infection). We report a retrospective cohort of 569 haematopoietic stem-cell transplant patients with 105 (18.4 %) CRK colonizations and 30 (5.3 %) infections. blaKPC was the most frequent carbapenemase in our cohort with three isolates co-harbouring blaKPC and blaNDM. We found no difference in virulence profiles from the CRK isolates. There were also no significant differences in virulence profiles among colonization and infection isolates regarding genes encoding for type 1 and 3 fimbriae, siderophores, lipopolysaccharide and colibactin. In clonality analysis by PFGE and WGS, isolates were polyclonal and ST340 was the most prevalent. Overall survival at D+100 was 75.4 % in in CRK-colonized (P=0.02) and 35.7 % in infected patients and significantly lower than non-colonized patients (85.8 %; P<0.001). We found a higher overall mortality associated with colonization and infection; KPC was the main resistance mechanism for carbapenems. The polyclonal distribution of isolates and findings of CRK infection in patients not previously colonized suggest the need to reinforce antibiotic stewardship.
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Affiliation(s)
- Hermes Ryoiti Higashino
- Departamento de Doenças Infecciosas e Parasitarias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Ana Paula Marchi
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Roberta Cristina Ruedas Martins
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Laina Bubach Carvalho
- Comissão de Controle de Infecção Hospitalar do Hospital das Clínicas HCFMUSP, São Paulo, Brazil
| | - Lauro Vieira Perdigão Neto
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Departmento de Patologia, Divisão de Microbiologia do Laboratório Central - LIM/03, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Marina Farrel Côrtes
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Fernando Nivaldo de Oliveira
- Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - Edson Luiz Tarsia Duarte
- Departamento de Doenças Infecciosas e Parasitarias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Thais Guimaraes
- Comissão de Controle de Infecção Hospitalar do Hospital das Clínicas HCFMUSP, São Paulo, Brazil
| | - Flavia Rossi
- Departmento de Patologia, Divisão de Microbiologia do Laboratório Central - LIM/03, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Aliana M Ferreira
- Departmento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanderson Rocha
- Departmento de Hematologia, Hemoterapia e Terapia Celular, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Silvia Figueiredo Costa
- Departamento de Doenças Infecciosas e Parasitarias, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Investigação Médica em Protozoologia, Bacteriologia e Resistência Antimicrobiana - LIM/49, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Chlorhexidine Gluconate Bathing Reduces the Incidence of Bloodstream Infections in Adults Undergoing Inpatient Hematopoietic Cell Transplantation. Transplant Cell Ther 2021; 27:262.e1-262.e11. [PMID: 33781532 DOI: 10.1016/j.jtct.2021.01.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 12/09/2020] [Accepted: 01/03/2021] [Indexed: 11/20/2022]
Abstract
Bloodstream infections (BSIs) occur in 20% to 45% of inpatient autologous and allogeneic hematopoietic cell transplant (HCT) patients. Daily bathing with the antiseptic chlorhexidine gluconate (CHG) has been shown to reduce the incidence of BSIs in critically ill patients, although very few studies include HCT patients or have evaluated the impact of compliance on effectiveness. We conducted a prospective cohort study with historical controls to assess the impact of CHG bathing on the rate of BSIs and gut microbiota composition among adults undergoing inpatient HCT at the Duke University Medical Center. We present 1 year of data without CHG bathing (2016) and 2 years of data when CHG was used on the HCT unit (2017 and 2018). Because not all patients adhered to CHG, patients were grouped into four categories by rate of daily CHG usage: high (>75%), medium (50% to 75%), low (1% to 49%), and none (0%). Among 192 patients, univariate trend analysis demonstrated that increased CHG usage was associated with decreased incidence of clinically significant BSI, defined as any BSI requiring treatment by the medical team (high, 8% BSI; medium, 15.2%; low, 15.6%; no CHG, 30.3%; P = .003), laboratory-confirmed BSI (LCBI; P = .03), central line-associated BSI (P = .04), and mucosal barrier injury LCBI (MBI-LCBI; P = .002). Multivariate analysis confirmed a significant effect of CHG bathing on clinically significant BSI (P = .023) and MBI-LCBI (P = .007), without consistently impacting gut microbial diversity. Benefits of CHG bathing were most pronounced with >75% daily usage, and there were no adverse effects attributable to CHG. Adherence to daily CHG bathing significantly decreases the rate of bloodstream infection following HCT.
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Abstract
Objective The aim of the study was to summarize the latest evidence for patient bathing with a 2% to 4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Methods We searched 3 databases (CINAHL, MEDLINE, and Cochrane) for a combination of the key words “chlorhexidine bathing” and MeSH terms “cross-infection prevention,” “drug resistance, multiple, bacterial,” and “drug resistance, microbial.” Articles from January 1, 2008, to December 31, 2018, were included, as well as any key articles published after December 31. Results Our findings focused on health care–associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine bathing reduces MRSA acquisition and carriage, but not all studies found significant reductions in MRSA infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage, and one study showed lower VRE infections in the bathing group. Two studies found that bathing reduced CRE carriage (no studies examined CRE infections). Two very large studies (more than 140,000 total patients) found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already well controlled by other means. Conclusions There is a high level of evidence supporting chlorhexidine bathing to reduce MDRO acquisition; less evidence is available on reducing infections. Chlorhexidine bathing is low cost to implement, and adverse events are rare and resolve when chlorhexidine use is stopped. There is evidence of chlorhexidine resistance, but not at concentrations in typical use. Further research is needed on chlorhexidine bathing’s impact on outcomes, such as mortality and length of stay.
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Baraldi MM, Gnatta JR, Padoveze MC. Risks and benefits of using chlorhexidine gluconate in handwashing: A systematic literature review. Am J Infect Control 2019; 47:704-714. [PMID: 30642673 DOI: 10.1016/j.ajic.2018.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 11/24/2018] [Accepted: 11/26/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Antimicrobial soaps containing chlorhexidine gluconate (CHG) are indicated for hand hygiene (HH) in specific situations. This study aimed to identify whether the continuous use of CHG for HH affects the reduction of healthcare-associated infections (HAI), the selection of microorganisms resistant to CHG, or hands skin damage. METHODS Systematic review was performed using the protocol of the Joanna Briggs Institute, including clinical trials and observational comparative studies. Search was conducted via PubMed, Medline, CINAHL, LILACS, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, Google Scholar, and gray literature. To evaluate outcomes, 3 independent reviews were conducted: HAI rates, presence of resistance genes or higher minimum inhibitory or bactericidal concentration, and damage to skin integrity. RESULTS Studies showed no significant difference in HAI rates when using CHG for HH. Among 13 studies, 10 suggested an association with use of and tolerance to CHG. The use of CHG was associated with skin reaction events. CONCLUSIONS Strong evidence regarding the risks and benefits of CHG for HH is still lacking. Due to potential risk of selecting mutants carrying genes for cross-resistance to CHG and antibiotics, it is advisable to reserve the use of CHG for purposes other than HH.
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Affiliation(s)
- Marcia Maria Baraldi
- School of Nursing, University of São Paulo and Hospital Alemão Oswaldo Cruz São Paulo, São Paulo, Brazil.
| | | | - Maria Clara Padoveze
- Department of Collective Health Nursing, School of Nursing, University of São Paulo, São Paulo, Brazil
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12
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Abbo LM, Grossi PA. Surgical site infections: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13589. [PMID: 31077619 DOI: 10.1111/ctr.13589] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 05/06/2019] [Indexed: 02/06/2023]
Abstract
These guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of post-operative surgical site infections (SSIs) in solid organ transplantation. SSIs are a significant cause of morbidity and mortality in SOT recipients. Depending on the organ transplanted, SSIs occur in 3%-53% of patients, with the highest rates observed in small bowel/multivisceral, liver, and pancreas transplant recipients. These infections are classified by increasing invasiveness as superficial incisional, deep incisional, or organ/space SSIs. The spectrum of organisms implicated in SSIs in SOT recipients is more diverse than the general population due to other important factors such as the underlying end-stage organ failure, immunosuppression, prolonged hospitalizations, organ transportation/preservation, and previous exposures to antibiotics in donors and recipients that could predispose to infections with multidrug-resistant organisms. In this guideline, we describe the epidemiology, clinical presentation, differential diagnosis, potential pathogens, and management. We also provide recommendations for the selection, dosing, and duration of peri-operative antibiotic prophylaxis to minimize post-operative SSIs.
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Affiliation(s)
- Lilian M Abbo
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine and Jackson Health System, Miami, Florida
| | - Paolo Antonio Grossi
- Infectious Diseases Section, Department of Medicine and Surgery, University of Insubria, Varese, Italy
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Díaz E, Turégano C. Daily skin antisepsis and hygiene in the critically ill patient. Med Intensiva 2018; 43 Suppl 1:13-17. [PMID: 30482557 DOI: 10.1016/j.medin.2018.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 09/08/2018] [Accepted: 09/20/2018] [Indexed: 11/26/2022]
Abstract
Hygiene and skin care of patients admitted to the Intensive Care Unit (ICU) are part of basic care. For some years there has been evidence of skin colonization by multiresistant gramnegative and grampositive pathogens. The increase in nosocomial infections due to multiresistant microorganisms has led to evaluation of the role of the use of antiseptics, mainly chlorhexidine, as a strategy for reducing the number of such infections. This article reviews the current situation of this strategy, as well as the positioning of the authors in relation to the spreading of its use in ICUs. This article is part of a supplement entitled "Antisepsis in the critical patient", which is sponsored by Becton Dickinson.
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Affiliation(s)
- E Díaz
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España.
| | - C Turégano
- Servicio de Medicina Intensiva, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
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14
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Ariza‐Heredia EJ, Chemaly RF. Update on infection control practices in cancer hospitals. CA Cancer J Clin 2018; 68:340-355. [PMID: 29985544 PMCID: PMC7162018 DOI: 10.3322/caac.21462] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 04/12/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
Therapies in oncology have evolved rapidly over the last years. At the same pace, supportive care for patients receiving cancer therapy has also evolved, allowing patients to safely receive the newest advances in treatment in both an inpatient and outpatient basis. The recognition of the role of infection control and prevention (ICP) in the outcomes of patients living with cancer has been such that it is now a requirement for hospitals and involves multidisciplinary groups. Some unique aspects of ICP for patients with cancer that have gained momentum over the past few decades include catheter-related infections, multidrug-resistant organisms, community-acquired viral infections, and the impact of the health care environment on the horizontal transmission of organisms. Furthermore, as the potential for infections to cross international borders has increased, alertness for outbreaks or new infections that occur outside the area have become constant. As the future approaches, ICP in immunocompromised hosts will continue to integrate emerging disciplines, such as antibiotic stewardship and the microbiome, and new techniques for environmental cleaning and for controlling the spread of infections, such as whole-genome sequencing. CA Cancer J Clin 2018;000:000-000. © 2018 American Cancer Society.
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Affiliation(s)
- Ella J. Ariza‐Heredia
- Associate Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
| | - Roy F. Chemaly
- Professor, Department of Infectious Diseases, Infection Control, and Employee HealthThe University of Texas MD Anderson Cancer CenterHoustonTX
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15
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10-year trends in vancomycin-resistant enterococci among allogeneic hematopoietic cell transplant recipients. J Infect 2018; 77:38-46. [DOI: 10.1016/j.jinf.2018.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 02/20/2018] [Accepted: 02/25/2018] [Indexed: 12/20/2022]
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16
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Ergul AB, Gokcek I, Ozcan A, Cetin S, Gultekin N, Torun YA. Use of a chlorhexidine-impregnated dressing reduced catheter-related bloodstream infections caused by Gram-positive microorganisms. Pak J Med Sci 2018; 34:347-351. [PMID: 29805406 PMCID: PMC5954377 DOI: 10.12669/pjms.342.14810] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective: We compared the protective effects of secure Chlorhexidine Gluconate (CHG)-containing dressings with those of non-antimicrobial transparent dressings. Methods: This prospective, comparative, single-center clinical study was conducted in a tertiary pediatric intensive care unit from October 2014 to March 2017. The inclusion criterion was catheterization of the jugular vein for ≥48 hour. The study was conducted in two phases. Non-antimicrobial standard dressings were applied both before and after the CHG- dressing phase to negate any coincidental temporal effect. During the standard-dressing phases, the dressings did not include any antimicrobial; transparent CHG-impregnated dressings were applied during the test phase. All patients were divided into two groups by the type of dressing applied (standard and CHG-containing dressings). Results: The standard- and CHG-dressing groups contained 68 and 63 patients, respectively. The median durations of catheterization were 13 (8–22) and 14 (2–28) days, respectively (p>0.05). The Catheter-Related Bloodstream Infection (CRBSI) rate was somewhat lower in the CHG-dressing group (20.6 vs. 26.5%), but the difference was not statistically significant (p>0.05). In the CHG-dressing group, CRBSIs caused by Gram-positive microorganisms totaled 0%, but the figure was 8.8% in the control group (p=0.028). Conclusions: CHG dressings reduced CRBSIs caused by Gram-positive microorganisms.
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Affiliation(s)
- Ayse Betul Ergul
- Ayse Betul Ergul, M.D. Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Ikbal Gokcek
- Ikbal Gokcek, M.D. Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Alper Ozcan
- Alper Ozcan, M.D. Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Serife Cetin
- Nurkan Gultekin, Nurse, Department of Pediatric Intensive Care Unit, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Nurkan Gultekin
- Serife Cetin, Nurse, Department of Infection Control, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - Yasemin Altuner Torun
- Dr. Yasemin Altuner Torun, Associate, Professor. Department of Pediatric Hematology, University of Health Sciences, Kayseri Training and Research Hospital, Kayseri, Turkey
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17
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Ferreira AM, Moreira F, Guimaraes T, Spadão F, Ramos JF, Batista MV, Filho JS, Costa SF, Rocha V. Epidemiology, risk factors and outcomes of multi-drug-resistant bloodstream infections in haematopoietic stem cell transplant recipients: importance of previous gut colonization. J Hosp Infect 2018. [PMID: 29530743 DOI: 10.1016/j.jhin.2018.03.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Bloodstream infections (BSI) are a major complication in the early phase of a haematopoietic stem cell transplant (HSCT). AIM To describe the incidence and risk factors for BSI occurring in the pre-engraftment phase of HSCT, and its impact on mortality. METHODS Clinical variables of 232 HSCT patients were analysed retrospectively between 2014 and 2015. Univariate Cox regression analyses were performed to test the association between each covariate and the outcome. Covariates with P < 0.10 on univariate analysis were included in a multiple Cox regression analysis using a backward elimination method. FINDINGS The cumulative incidence of BSI was 25.4%, mainly caused by Gram-negative bacteria (GNB) (55.2%). Approximately 40.5% of the patients had gut colonization by multi-drug-resistant (MDR) bacteria (vancomycin-resistant enterococcus and carbapenem-resistant GNB). Among patients colonized by MDR GNB, 20% developed an overt BSI due to MDR bacteria with the same pattern of sensitivity. Of the 13 deaths related to infection, 10 were patients with BSI caused by MDR GNB. The independent risk factors for BSI were gut colonization by MDR bacteria including GNB (P < 0.001) and duration of neutropenia >10 days (P = 0.005), and those associated with BSI caused by MDR bacteria were age >62 years (P = 0.03), use of total parenteral nutrition (TPN) (P < 0.001) and previous gut colonization by MDR GNB (P = 0.002). CONCLUSIONS Previous gut colonization by MDR was an independent risk factor for BSI, together with TPN and age, and had an impact on outcome. These findings suggest that gut decolonization may be a potential strategy to prevent BSI.
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Affiliation(s)
- A M Ferreira
- Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil.
| | - F Moreira
- Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - T Guimaraes
- Infection Control Committee of Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - F Spadão
- Infection Control Committee of Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - J F Ramos
- Department of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - M V Batista
- Department of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - J S Filho
- Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - S F Costa
- Laboratory of Bacteriology, Tropical Medicine Institute, University of Sao Paulo, Sao Paulo, Brazil; Department of Infectious Diseases, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil
| | - V Rocha
- Department of Haematology, Haemotherapy and Cellular Therapy, Hospital das Clínicas, Faculdade de Medicina, University of Sao Paulo, Sao Paulo, Brazil; Haematology Department, NHS BT, Oxford University, Oxford, UK
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Benamu E, Deresinski S. Vancomycin-resistant enterococcus infection in the hematopoietic stem cell transplant recipient: an overview of epidemiology, management, and prevention. F1000Res 2018; 7:3. [PMID: 29333263 PMCID: PMC5750719 DOI: 10.12688/f1000research.11831.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2017] [Indexed: 12/13/2022] Open
Abstract
Vancomycin-resistant enterococcus (VRE) is now one of the leading causes of nosocomial infections in the United States. Hematopoietic stem cell transplantation (HSCT) recipients are at increased risk of VRE colonization and infection. VRE has emerged as a major cause of bacteremia in this population, raising important clinical questions regarding the role and impact of VRE colonization and infection in HSCT outcomes as well as the optimal means of prevention and treatment. We review here the published literature and scientific advances addressing these thorny issues and provide a rational framework for their approach.
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Affiliation(s)
- Esther Benamu
- Division of Infectious Diseases, Department of Medicine, University of Colorado, Aurora, USA
| | - Stanley Deresinski
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, USA
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19
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Measures to Prevent and Control Vancomycin-Resistant Enterococci: Do They Really Matter? Infect Control Hosp Epidemiol 2017; 38:507-509. [DOI: 10.1017/ice.2016.329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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