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Boada A, Pons-Vigués M, Real J, Grezner E, Bolíbar B, Llor C. Previous antibiotic exposure and antibiotic resistance of commensal Staphylococcus aureus in Spanish primary care. Eur J Gen Pract 2018. [PMID: 29542385 PMCID: PMC5917310 DOI: 10.1080/13814788.2018.1444748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Commensal flora of healthy people is becoming an important reservoir of resistant bacteria. OBJECTIVES To evaluate the relationship of previous antibiotic-dispensed and resistance pattern of strains of Staphylococcus aureus in primary care patients. METHODS A cross-sectional study was carried out in seven primary care centres in Catalonia, Spain, from October 2010 to May 2011, as part of the APRES (The appropriateness of prescribing antibiotics in primary care in Europe concerning antibiotic resistance) study. Outpatients aged 4 or more who did not present an infectious disease and had not taken antibiotic or had not been hospitalised in the previous 3 months were invited to participate. Nasal swabs were collected for S. aureus culture, and antimicrobial susceptibility testing was carried out. Antibiotics dispensed boxes in the previous 4 years were extracted from Information System for Research in Primary Care. RESULTS A total of 4,001 nasal swabs were collected, and 3,969 were tested for identification, 765 S. aureus were tested for resistance. Resistance rates to penicillin, azithromycin and methicillin were 87.1%, 11.6% and 1.3%, respectively, and a total of 10 MRSA strains were isolated (1.3%). Penicillin-resistant staphylococci were statistically significantly associated with the previous number of packages of penicillin dispensed (OR, 1.18; 95% CI, 1.04-1.35). CONCLUSION Although no causal inference is possible, an association was observed between previous antibiotic dispensation and isolation of resistant organisms in community-dwelling individuals, mainly between packages of penicillin and penicillin-resistant staphylococci.
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Affiliation(s)
- Albert Boada
- a Equip d'Atenció Primària Guinardó, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat , Institut Català de la Salut , Barcelona , Spain.,b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
| | - Mariona Pons-Vigués
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,c Universitat Autònoma de Barcelona (UAB) , Bellaterra (Cerdanyola del Vallès) , Spain.,d Universitat de Girona , Girona , Catalunya , Spain
| | - Jordi Real
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,e Centro de Investigacion Biomedica en Red de Diabetes y Enfermedades Metabolicas Asociadas , Barcelona , Spain.,f Universitat Internacional de Catalunya , Epidemiologia i Salut Pública , Barcelona , Catalunya , Spain
| | - Elisabet Grezner
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,g Institut Catala De La Salut, Laboratori Clínic L'Hospitalet , Barcelona , Catalunya , Spain
| | - Bonventura Bolíbar
- b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain.,c Universitat Autònoma de Barcelona (UAB) , Bellaterra (Cerdanyola del Vallès) , Spain
| | - Carl Llor
- a Equip d'Atenció Primària Guinardó, Gerència d'Àmbit d'Atenció Primària Barcelona Ciutat , Institut Català de la Salut , Barcelona , Spain.,b Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) , Barcelona , Spain
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Gustin MP, Ohannessian R, Giard M, Caillat-Vallet E, Savey A, Vanhems P. Use of surveillance data to calculate the sample size and the statistical power of randomized clinical trials testing Staphylococcus aureus vaccine efficacy in orthopedic surgery. Vaccine 2017; 35:6934-6937. [PMID: 29089192 DOI: 10.1016/j.vaccine.2017.10.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 10/19/2017] [Accepted: 10/20/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients undergoing primary total hip arthroplasty (THA) would be a worthy population for anti-staphylococcal vaccines. The objective is to assess sample size for significant vaccine efficacy (VE) in a randomized clinical trial (RCT). METHODS Data from a surveillance network of surgical site infection in France between 2008 and 2011 were used. The outcome was S. aureus SSI (SASSI) within 30 days after surgery. Statistical power was estimated by simulations repeated for theoretical VE ranging from 20% to 100% and for sample sizes from 250 to 8000 individuals per arm. RESULTS 18,688 patients undergoing THA were included; 66 (0.35%) SASSI occurred. For a 1% SASSI rate, the sample size would be at least 1316 patients per arm to detect significant VE of 80% with 80% power. CONCLUSION Simulations with real-life data from surveillance of hospital acquired infections allow estimation of power for RCT and sample size to reach the required power.
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Affiliation(s)
- Marie-Paule Gustin
- Laboratory of Emerging Pathogens, International Center for Infectiology Research (CIRI), University of Lyon 1, Lyon, France; Institute of Pharmacy, Department of Public Health, University of Lyon 1, Lyon, France; Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.
| | - Robin Ohannessian
- Laboratory of Emerging Pathogens, International Center for Infectiology Research (CIRI), University of Lyon 1, Lyon, France
| | - Marine Giard
- Laboratory of Emerging Pathogens, International Center for Infectiology Research (CIRI), University of Lyon 1, Lyon, France; Coordination Center for Healthcare-associated Infection Prevention and Control in South-Eastern France (CCLIN Sud-Est), Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Emmanuelle Caillat-Vallet
- Coordination Center for Healthcare-associated Infection Prevention and Control in South-Eastern France (CCLIN Sud-Est), Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Anne Savey
- Laboratory of Emerging Pathogens, International Center for Infectiology Research (CIRI), University of Lyon 1, Lyon, France; Coordination Center for Healthcare-associated Infection Prevention and Control in South-Eastern France (CCLIN Sud-Est), Hospices Civils de Lyon, Saint-Genis-Laval, France
| | - Philippe Vanhems
- Laboratory of Emerging Pathogens, International Center for Infectiology Research (CIRI), University of Lyon 1, Lyon, France; Infection Control and Epidemiology Unit, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France; Innovative Clinical Research Network in VACcinology (iREIVAC), Lyon, France
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Haucke K, Kuhn M, Lübke-Becker A, Mählmann K, Lischer C. Two Regimes of Perioperative Antimicrobial Prophylaxis for Equine Castration: Clinical Findings, Acute-Phase Proteins, and Bacterial Cultures. J Equine Vet Sci 2017. [DOI: 10.1016/j.jevs.2017.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kietpeerakool C, Chumworathayi B, Thinkhamrop J, Ussahgij B, Lumbiganon P. Antibiotics for infection prevention after excision of the cervical transformation zone. Cochrane Database Syst Rev 2017; 1:CD009957. [PMID: 28109160 PMCID: PMC6464760 DOI: 10.1002/14651858.cd009957.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Excision of the transformation zone of the cervix is the most commonly used approach to treat cervical precancerous lesions (cervical intraepithelial neoplasia (CIN)) to reduce the risk of developing cervical cancer. As the excision of the transformation zone leaves a raw area on the cervix, there is a risk of infection following the procedure. The incidence of infection after cold knife conization (CKC) is 36%, whereas the incidence for large loop excision of the transformation zone (LLETZ, also known as loop electrical excision procedure (LEEP)) is much lower (0.8% to 14.4%). Prophalytic antibiotics may prevent an infection developing and are often prescribed for CKC. However, there are no formal recommendations regarding the use of prophylactic antibiotics for infection prevention in women undergoing surgical excisional treatment for cervical precancerous lesions. OBJECTIVES To evaluate the effectiveness and safety of antibiotics for infection prevention following excision of the cervical transformation zone. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (2016, Issue 4), MEDLINE, Embase, LILACS to May 2016. We also checked registers of clinical trials, citation lists of included studies, key textbooks and previous systematic reviews for potentially relevant studies SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the effectiveness and safety of prophylactic antibiotics versus a placebo or no treatment in women having excision of the cervical transformation zone, regardless of the type of surgical excisional method used. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. Two review authors independently selected potentially relevant trials, extracted data, and assessed risk of bias, compared results and resolved disagreements by discussion. We contacted investigators for additional data, where possible. MAIN RESULTS Of the 370 records that we identified as a result of the search (excluding duplicates), we regarded six abstracts and titles as potentially relevant studies. Of these six studies, three met the inclusion criteria involving 708 participants; most trials were at moderate or high risk of bias (risk mainly due to lack of blinding and high rate of incomplete data). We did not identify any ongoing trials. Although all included studies had been published in peer-reviewed journals at the time of the search and data extraction, numerical data regarding the outcome measured in one trial involving 77 participants were insufficient for inclusion in a meta-analyses.The difference in the rates of prolonged vaginal discharge or presumed cervicitis (one study; 348 participants; risk ratio (RR), 1.29; 95% confidence interval (CI) 0.72 to 2.31; low-quality evidence) and severe vaginal bleeding (two studies; 638 participants; RR 1.21; 95% CI 0.52 to 2.82; very low-quality evidence) among the two comparison groups did not reach the level for clinically important effect. In addition, there was no difference in adverse events related to antibiotics i.e. nausea/vomiting, diarrhoea, and headache among the two comparison groups (two studies; 638 participants; RR 1.69; 95% CI 0.85 to 3.34; very low-quality evidence). There were no differences in the incidence of fever (RR, 2.23; 95% CI 0.20 to 24.36), lower abdominal pain (RR, 1.03; 95% CI 0.61 to 1.72), unscheduled medical consultation (RR 2.68, 95% CI 0.97 to 7.41), and additional self-medication (RR 1.22; 95% CI 0.56 to 2.67) between the two comparison groups (one study; 290 participants; low to very low-quality evidence). AUTHORS' CONCLUSIONS As only limited data are available from three trials with overall moderate to high risk of bias, there is insufficient evidence to support use of antibiotics to reduce infectious complications following excision of the cervical transformation zone. In addition, there were minimal data about antibiotic-related adverse events and no information on the risk of developing antibiotic resistance. Antibiotics given for infection prevention after excision of the cervical transformation zone should only be used in the context of clinical research, to avoid unnecessary prescription of antibiotics and to prevent further increases in antibiotic resistance.
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Affiliation(s)
- Chumnan Kietpeerakool
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Bandit Chumworathayi
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Jadsada Thinkhamrop
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Butsakorn Ussahgij
- Khon Kaen UniversityMedical Library, Faculty of Medicine123 Mittraparp HighwayKhon KaenThailand40002
| | - Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
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McMurray CL, Hardy KJ, Calus ST, Loman NJ, Hawkey PM. Staphylococcal species heterogeneity in the nasal microbiome following antibiotic prophylaxis revealed by tuf gene deep sequencing. MICROBIOME 2016; 4:63. [PMID: 27912796 PMCID: PMC5134057 DOI: 10.1186/s40168-016-0210-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 11/22/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND Staphylococci are a major constituent of the nasal microbiome and a frequent cause of hospital-acquired infection. Antibiotic surgical prophylaxis is administered prior to surgery to reduce a patient's risk of postoperative infection. The impact of surgical prophylaxis on the nasal staphylococcal microbiome is largely unknown. Here, we report the species present in the nasal staphylococcal microbiome and the impact of surgical prophylaxis revealed by a novel culture independent technique. Daily nasal samples from 18 hospitalised patients, six of whom received no antibiotics and 12 of whom received antibiotic surgical prophylaxis (flucloxacillin and gentamicin or teicoplanin +/- gentamicin), were analysed by tuf gene fragment amplicon sequencing. RESULTS On admission to hospital, the species diversity of the nasal staphylococcal microbiome varied from patient to patient ranging from 4 to 10 species. Administration of surgical prophylaxis did not substantially alter the diversity of the staphylococcal species present in the nose; however, surgical prophylaxis did impact on the relative abundance of the staphylococcal species present. The dominant staphylococcal species present in all patients on admission was Staphylococcus epidermidis, and antibiotic administration resulted in an increase in species relative abundance. Following surgical prophylaxis, a reduction in the abundance of Staphylococcus aureus was observed in carriers, but not a complete eradication. CONCLUSIONS Utilising the tuf gene fragment has enabled a detailed study of the staphylococcal microbiome in the nose and highlights that although there is no change in the heterogeneity of species present, there are changes in abundance. The sensitivity of the methodology has revealed that the abundance of S. aureus is reduced to a low level by surgical prophylaxis and therefore reduces the potential risk of infection following surgery but also highlights that S. aureus does persist.
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Affiliation(s)
- Claire L McMurray
- Heart of England NHS Foundation Trust, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK.
- Institute of Microbiology and Infection, School of Immunity and Infection, The College of Medical and Dental Sciences, The University of Birmingham, Birmingham, B15 2TT, UK.
| | - Katherine J Hardy
- Public Health England Birmingham Laboratory, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
- Institute of Microbiology and Infection, School of Immunity and Infection, The College of Medical and Dental Sciences, The University of Birmingham, Birmingham, B15 2TT, UK
| | - Szymon T Calus
- Institute of Microbiology and Infection, School of Immunity and Infection, The College of Medical and Dental Sciences, The University of Birmingham, Birmingham, B15 2TT, UK
- Present address: Infrastructure and Environment Research Division, School of Engineering, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Nicholas J Loman
- Institute of Microbiology and Infection, School of Immunity and Infection, The College of Medical and Dental Sciences, The University of Birmingham, Birmingham, B15 2TT, UK
| | - Peter M Hawkey
- Public Health England Birmingham Laboratory, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK
- Institute of Microbiology and Infection, School of Immunity and Infection, The College of Medical and Dental Sciences, The University of Birmingham, Birmingham, B15 2TT, UK
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Sendi P, Uçkay I, Suvà D, Vogt M, Borens O, Clauss M. Antibiotic Prophylaxis During Dental Procedures in Patients with Prosthetic Joints. J Bone Jt Infect 2016; 1:42-49. [PMID: 28529852 PMCID: PMC5423560 DOI: 10.7150/jbji.16318] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Accepted: 07/13/2016] [Indexed: 11/06/2022] Open
Abstract
In patients with artificial joints, the need for antimicrobial prophylaxis during dental procedures is often raised. The present document describes the pathogenic mechanisms and epidemiological data on the subject of periprosthetic joint infections (PJI) after dental procedures. The document reflects the opinion and recommendations of the expert group 'Infection' of Swiss Orthopaedics. Microorganisms belonging to oral flora can seed haematogenously to an artificial joint. The proof of a causative relation with dental procedures is not possible, because the responsible bacteraemia can originate from the oral cavity at any time, irrespective of when the dental procedure occurs. Good oral hygiene is associated with a lower risk for PJI. Transient bacteraemia occurs during daily oral hygiene activity (e.g., tooth brushing) and thus the cumulative risk for a haematogenous PJI from tooth brushing is higher than that from a dental procedure. PJI after a dental procedure are rarely reported. On the basis of an epidemiological model, several thousand patients with artificial joints must receive antimicrobial prophylaxis to prevent a single PJI. Considering this ratio, the number of adverse events due to the antimicrobial compound exceeds the benefit of administering it by a large magnitude. Therefore, as a rule for the vast majority of cases, antimicrobial prophylaxis during dental procedures is not recommended. It is important that a patient has a good oral health status before joint implantation and that good oral hygiene is continuously maintained in patients with artificial joints.
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Affiliation(s)
- Parham Sendi
- Department of Infectious Diseases, Bern University Hospital, University of Bern
- Institute for Infectious Diseases, Faculty of Medicine, University of Bern
| | - Ilker Uçkay
- Service of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva
- Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva
| | - Domizio Suvà
- Orthopedic Surgery Service, Geneva University Hospitals and Faculty of Medicine, University of Geneva
| | - Markus Vogt
- Infectious Diseases Service, Cantonal Hospital Zug, Baar
| | - Olivier Borens
- Orthopedic Septic Surgical Unit, Department of Surgery and Anesthesiology, Lausanne University Hospital, Lausanne
| | - Martin Clauss
- Clinic for Orthopedics and Trauma Surgery and Interdisciplinary Septic Surgical Unit, Kantonsspital Baselland Liestal, Switzerland
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Gallo J, Panacek A, Prucek R, Kriegova E, Hradilova S, Hobza M, Holinka M. Silver Nanocoating Technology in the Prevention of Prosthetic Joint Infection. MATERIALS (BASEL, SWITZERLAND) 2016; 9:E337. [PMID: 28773461 PMCID: PMC5503077 DOI: 10.3390/ma9050337] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 02/06/2023]
Abstract
Prosthetic joint infection (PJI) is a feared complication of total joint arthroplasty associated with increased morbidity and mortality. There is a growing body of evidence that bacterial colonization and biofilm formation are critical pathogenic events in PJI. Thus, the choice of biomaterials for implanted prostheses and their surface modifications may significantly influence the development of PJI. Currently, silver nanoparticle (AgNP) technology is receiving much interest in the field of orthopaedics for its antimicrobial properties and a strong anti-biofilm potential. The great advantage of AgNP surface modification is a minimal release of active substances into the surrounding tissue and a long period of effectiveness. As a result, a controlled release of AgNPs could ensure antibacterial protection throughout the life of the implant. Moreover, the antibacterial effect of AgNPs may be strengthened in combination with conventional antibiotics and other antimicrobial agents. Here, our main attention is devoted to general guidelines for the design of antibacterial biomaterials protected by AgNPs, its benefits, side effects and future perspectives in PJI prevention.
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Affiliation(s)
- Jiri Gallo
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
| | - Ales Panacek
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Robert Prucek
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Eva Kriegova
- Department of Immunology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Hněvotínská 3, Olomouc 779 00, Czech Republic.
| | - Sarka Hradilova
- Regional Centre of Advanced Technologies and Materials, Palacký University Olomouc, Šlechtitelů 27, Olomouc 783 71, Czech Republic.
| | - Martin Hobza
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
| | - Martin Holinka
- Department of Orthopaedics, Faculty of Medicine and Dentistry, Palacký University Olomouc, I. P. Pavlova 6, Olomouc 779 00, Czech Republic.
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