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Umemura T, Kato H, Asai N, Hagihara M, Hirai J, Yamagishi Y, Mikamo H. Comparison of efficacy and safety between daptomycin plus β-lactam and daptomycin monotherapy for bloodstream infections due to gram-positive cocci: A systematic review and meta-analysis. Heliyon 2024; 10:e29811. [PMID: 38681574 PMCID: PMC11046193 DOI: 10.1016/j.heliyon.2024.e29811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/15/2024] [Indexed: 05/01/2024] Open
Abstract
Objectives We performed a comprehensive systematic review and meta-analysis to evaluate the clinical or microbiological outcomes and safety of a combination of daptomycin (DAP) and β-lactams compared to DAP monotherapy in patients with blood stream infection (BSI) due to gram-positive cocci (GPC). Methods We searched Scopus, PubMed, EMBASE, CINAHL, and Ityuushi databases up to January 30, 2023. Outcomes included all-cause mortality, clinical failure, and creatine phosphokinase (CPK) elevation. Results Six cohorts or case-control studies fulfilled the inclusion criteria and were included in the final meta-analysis. Combination therapy of DAP and β-lactams significantly reduced the mortality and clinical failure rate for all BSI due to GPC compared with the DAP monotherapy (mortality, odds ratio [OR] = 0.63, 95 % confidence interval [CI] = 0.41-0.98; clinical failure, OR = 0.42, 95 % CI = 0.22-0.81). In contrast, no significant difference was noted in the incidence of CPK elevation between the two groups (OR = 0.85, 95 % CI = 0.39-1.84). Conclusion Altogether, combination therapy of DAP and β-lactams can improve the prognosis for patients with BSI due to GPC compared with DAP alone. Therefore, it should be considered as an option for the empirical treatment of BSI caused by GPC.
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Affiliation(s)
- Takumi Umemura
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
| | - Hideo Kato
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
- Department of Pharmacy, Mie University Hospital, 2-174, Tsu, Mie, Japan
- Department of Clinical Pharmaceutics, Division of Clinical Medical Science, Mie University Graduate School of Medicine, 2-174, Tsu, Mie, Japan
| | - Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
| | - Mao Hagihara
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
- Department of Molecular Epidemiology and Biomedical Sciences, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
| | - Jun Hirai
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, 1-1, Yazakokarimata, Nagakute, Aichi, Japan
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Song F, Sheng J, Tan J, Xie H, Wang X, Guo W. Characterization of an Enterococcus faecalis bacteriophage SFQ1 as a potential therapeutic agent. Front Microbiol 2023; 14:1210319. [PMID: 37426023 PMCID: PMC10324664 DOI: 10.3389/fmicb.2023.1210319] [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: 04/22/2023] [Accepted: 06/07/2023] [Indexed: 07/11/2023] Open
Abstract
Enterococcus faecalis is a well-established resident of the human gastrointestinal tract and is also a major cause of human infections. Unfortunately, therapeutic options for E. faecalis infections remain limited, particularly with the emergence of vancomycin-resistant strains in hospital settings. Consequently, there has been a renewed interest in phage therapy as an alternative to antibiotics. In this study, we have isolated a bacteriophage, vB_EfaS-SFQ1, from hospital sewage, which effectively infects E. faecalis strain EFS01. Phage SFQ1 is a siphovirus and exhibits a relatively broad host range. Furthermore, it has a short latent period of approximately 10 min and a large burst size of about 110 PFU/cell at a multiplicity of infection (MOI) of 0.01, and it could effectively disrupt the biofilms formed by E. faecalis. Thus, this study provides a detailed characterization of E. faecalis phage SFQ1, which has great potential for treating E. faecalis infections.
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Affiliation(s)
- Fuqiang Song
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, China
| | - Jun Sheng
- Department of Orthopaedics, The General Hospital of Western Theater Command, Chengdu, China
| | - Jishan Tan
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, China
| | - Huajie Xie
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, China
| | - Xiaoyu Wang
- Department of Clinical Pharmacy, The General Hospital of Western Theater Command, Chengdu, China
| | - Wenqiong Guo
- School of Nursing, Chengdu Medical College, Chengdu, China
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3
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Leigh RJ, McKenna C, McWade R, Lynch B, Walsh F. Comparative genomics and pangenomics of vancomycin-resistant and susceptible Enterococcus faecium from Irish hospitals. J Med Microbiol 2022; 71. [DOI: 10.1099/jmm.0.001590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction.
Enterococcus faecium
has emerged as an important nosocomial pathogen, which is increasingly difficult to treat due to the genetic acquisition of vancomycin resistance. Ireland has a recalcitrant vancomycin-resistant bloodstream infection rate compared to other developed countries.
Hypothesis/Gap statement. Vancomycin resistance rates persist amongst
E. faecium
isolates from Irish hospitals. The evolutionary genomics governing these trends have not been fully elucidated.
Methodology. A set of 28 vancomycin-resistant isolates was sequenced to construct a dataset alongside 61 other publicly available Irish genomes. This dataset was extensively analysed using in silico methodologies (comparative genomics, pangenomics, phylogenetics, genotypics and comparative functional analyses) to uncover distinct evolutionary, coevolutionary and clinically relevant population trends.
Results. These results suggest that a stable (in terms of genome size, GC% and number of genes), yet genetically diverse population (in terms of gene content) of
E. faecium
persists in Ireland with acquired resistance arising via plasmid acquisition (vanA) or, to a lesser extent, chromosomal recombination (vanB). Population analysis revealed five clusters with one cluster partitioned into four clades which transcend isolation dates. Pangenomic and recombination analyses revealed an open (whole genome and chromosomal specific) pangenome illustrating a rampant evolutionary pattern. Comparative resistomics and virulomics uncovered distinct chromosomal and mobilomal propensity for multidrug resistance, widespread chromosomal point-mutation-mediated resistance and chromosomally harboured arsenals of virulence factors. Interestingly, a potential difference in biofilm formation strategies was highlighted by coevolutionary analysis, suggesting differential biofilm genotypes between vanA and vanB isolates.
Conclusions. These results highlight the evolutionary history of Irish
E. faecium
isolates and may provide insight into underlying infection dynamics in a clinical setting. Due to the apparent ease of vancomycin resistance acquisition over time, susceptible
E. faecium
should be concurrently reduced in Irish hospitals to mitigate potential resistant infections.
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Affiliation(s)
- Robert J. Leigh
- Department of Biology, Maynooth University, Mariavilla, Maynooth, Co. Kildare, Ireland
| | - Chloe McKenna
- Department of Biology, Maynooth University, Mariavilla, Maynooth, Co. Kildare, Ireland
| | - Robert McWade
- Department of Microbiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, D07 R2WY, Ireland
| | - Breda Lynch
- Department of Microbiology, Mater Misericordiae University Hospital, Eccles St., Dublin 7, D07 R2WY, Ireland
| | - Fiona Walsh
- Department of Biology, Maynooth University, Mariavilla, Maynooth, Co. Kildare, Ireland
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4
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Huang L, Guo W, Lu J, Pan W, Song F, Wang P. Enterococcus faecalis Bacteriophage vB_EfaS_efap05-1 Targets the Surface Polysaccharide and ComEA Protein as the Receptors. Front Microbiol 2022; 13:866382. [PMID: 35432223 PMCID: PMC9009173 DOI: 10.3389/fmicb.2022.866382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022] Open
Abstract
Enterococcus faecalis is a Gram-positive opportunistic pathogen that causes nosocomial infections in humans. Due to the growing threat of antibiotic resistance of E. faecalis, bacteriophage therapy is a promising option for treating of E. faecalis infection. Here, we characterized a lytic E. faecalis bacteriophage vB_EfaS_efap05-1 with a dsDNA genome of 56,563 bp. Phage vB_EfaS_efap05-1 had a prolate head and a tail, and belongs to Saphexavirus which is a member of Siphoviridae. Efap05-1 uses either surface polysaccharide or membrane protein ComEA as the receptor because the mutation of both genes (ComEA and UDP-glucose 4-epimerase galE) prevents phage adsorption and leads to phage resistance, and complementation of ComEA or galE could recover its phage sensitivity. Our results provided a comprehensive analysis of a new E. faecalis phage and suggest efap05-1 as a potential antimicrobial agent.
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Affiliation(s)
- Lingqiong Huang
- Yunnan Provincial Key Laboratory for Zoonosis Control and Prevention, Yunnan Institute of Endemic Diseases Control and Prevention, Dali, China
- School of Public Health, Dali University, Dali, China
| | - Wenqiong Guo
- School of Nursing, Chengdu Medical College, Chengdu, China
| | - Jiahui Lu
- School of Clinical Medicine, Chengdu Medical College, Chengdu, China
| | - Wuliang Pan
- School of Pharmacy, Chengdu Medical College, Chengdu, China
| | - Fuqiang Song
- Department of Medical Laboratory, The General Hospital of Western Theater Command, Chengdu, China
- *Correspondence: Fuqiang Song,
| | - Peng Wang
- Yunnan Provincial Key Laboratory for Zoonosis Control and Prevention, Yunnan Institute of Endemic Diseases Control and Prevention, Dali, China
- Peng Wang,
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Biehl LM, Higgins PG, Stemler J, Gilles M, Peter S, Dörfel D, Vogel W, Kern WV, Gölz H, Bertz H, Rohde H, Klupp EM, Schafhausen P, Salmanton-García J, Stecher M, Wille J, Liss B, Xanthopoulou K, Zweigner J, Seifert H, Vehreschild MJGT. Impact of single-room contact precautions on acquisition and transmission of vancomycin-resistant enterococci on haematological and oncological wards, multicentre cohort-study, Germany, January-December 2016. Euro Surveill 2022; 27:2001876. [PMID: 35027104 PMCID: PMC8759111 DOI: 10.2807/1560-7917.es.2022.27.2.2001876] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 08/18/2021] [Indexed: 06/14/2023] Open
Abstract
BackgroundEvidence supporting the effectiveness of single-room contact precautions (SCP) in preventing in-hospital acquisition of vancomycin-resistant enterococci (haVRE) is limited.AimWe assessed the impact of SCP on haVRE and their transmission.MethodsWe conducted a prospective, multicentre cohort study in German haematological/oncological departments during 2016. Two sites performed SCP for VRE patients and two did not (NCP). We defined a 5% haVRE-risk difference as non-inferiority margin, screened patients for VRE, and characterised isolates by whole genome sequencing and core genome MLST (cgMLST). Potential confounders were assessed by competing risk regression analysis.ResultsWe included 1,397 patients at NCP and 1,531 patients at SCP sites. Not performing SCP was associated with a significantly higher proportion of haVRE; 12.2% (170/1,397) patients at NCP and 7.4% (113/1,531) patients at SCP sites (relative risk (RR) 1.74; 95% confidence interval (CI): 1.35-2.23). The difference (4.8%) was below the non-inferiority margin. Competing risk regression analysis indicated a stronger impact of antimicrobial exposure (subdistribution hazard ratio (SHR) 7.46; 95% CI: 4.59-12.12) and underlying disease (SHR for acute leukaemia 2.34; 95% CI: 1.46-3.75) on haVRE than NCP (SHR 1.60; 95% CI: 1.14-2.25). Based on cgMLST and patient movement data, we observed 131 patient-to-patient VRE transmissions at NCP and 85 at SCP sites (RR 1.76; 95% CI: 1.33-2.34).ConclusionsWe show a positive impact of SCP on haVRE in a high-risk population, although the observed difference was below the pre-specified non-inferiority margin. Importantly, other factors including antimicrobial exposure seem to be more influential.
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Affiliation(s)
- Lena M Biehl
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Paul G Higgins
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Jannik Stemler
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Meyke Gilles
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
- German Centre for Infection Research, partner site Tübingen, Germany
| | - Daniela Dörfel
- Department of Haematology, Oncology and Immunology, Siloah hospital, Hannover, Germany
| | - Wichard Vogel
- Department of Oncology, Haematology, Immunology and Rheumatology, Internal Medicine II, University Hospital Tübingen, Tübingen, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hanna Gölz
- Institute for Medical Microbiology and Hygiene, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Hartmut Bertz
- Department of Haematology, Oncology and Stem Cell Transplantation, University Medical Centre, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
- German Centre for Infection Research, partner site Hamburg-Lübeck-Borstel, Germany
| | - Eva-Maria Klupp
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Centre Hamburg-Eppendorf, Germany
| | - Philippe Schafhausen
- Department of Oncology and Haematology, Hubertus Wald Tumorzentrum/University Cancer Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - Jon Salmanton-García
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Melanie Stecher
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Blasius Liss
- Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany
- Department of Internal medicine I, School of Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- Department of Hospital Hygiene and Infection Control, University Hospital of Cologne, Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Maria J G T Vehreschild
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
- German Centre for Infection Research, partner site Bonn-Cologne, Germany
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6
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Carrillo-Larco RM, Anza-Ramírez C, Saal-Zapata G, Villarreal-Zegarra D, Zafra-Tanaka JH, Ugarte-Gil C, Bernabé-Ortiz A. Type 2 diabetes mellitus and antibiotic-resistant infections: a systematic review and meta-analysis. J Epidemiol Community Health 2021; 76:75-84. [PMID: 34326183 PMCID: PMC8666814 DOI: 10.1136/jech-2020-216029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/05/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Type 2 diabetes mellitus (T2DM) has been associated with infectious diseases; however, whether T2DM is associated with bacterial-resistant infections has not been thoroughly studied. We ascertained whether people with T2DM were more likely to experience resistant infections in comparison to T2DM-free individuals. METHODS Systematic review and random-effects meta-analysis. The search was conducted in Medline, Embase and Global Health. We selected observational studies in which the outcome was resistant infections (any site), and the exposure was T2DM. We studied adult subjects who could have been selected from population-based or hospital-based studies. I2 was the metric of heterogeneity. We used the Newcastle-Ottawa risk of bias scale. RESULTS The search retrieved 3370 reports, 97 were studied in detail and 61 (449 247 subjects) were selected. Studies were mostly cross-sectional or case-control; several infection sites were studied, but mostly urinary tract and respiratory infections. The random-effects meta-analysis revealed that people with T2DM were twofold more likely to have urinary tract (OR=2.42; 95% CI 1.83 to 3.20; I2 19.1%) or respiratory (OR=2.35; 95% CI 1.49 to 3.69; I2 58.1%) resistant infections. Although evidence for other infection sites was heterogeneous, they consistently suggested that T2DM was associated with resistant infections. CONCLUSIONS Compelling evidence suggests that people with T2DM are more likely to experience antibiotic-resistant urinary tract and respiratory infections. The evidence for other infection sites was less conclusive but pointed to the same overall conclusion. These results could guide empirical treatment for patients with T2DM and infections.
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Affiliation(s)
- Rodrigo M Carrillo-Larco
- Department of Epidemiology and Biostatistics, Imperial College London School of Public Health, London, UK .,CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Cecilia Anza-Ramírez
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - David Villarreal-Zegarra
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Cesar Ugarte-Gil
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Peru.,Universidad Peruana Cayetano Heredia Instituto de Medicina Tropical Alexander von Humboldt, Lima, Peru.,Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
| | - Antonio Bernabé-Ortiz
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru.,Universidad Cientifica del Sur, Lima, Peru
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Importance of Susceptibility Rate of 'the First' Isolate: Evidence of Real-World Data. ACTA ACUST UNITED AC 2020; 56:medicina56100507. [PMID: 32998192 PMCID: PMC7600976 DOI: 10.3390/medicina56100507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 01/04/2023]
Abstract
Background and objectives: For proper antimicrobial therapy, cumulative antibiograms should be representative of geographic region and be accurate. Clinical and Laboratory Standards Institute (CLSI) guidelines recommend that only the first isolates (FI) of a species per patient are used when reporting cumulative antibiograms. However, >50% of hospitals in the United States report antibiograms of all isolates. We compared antibiograms from the FI with those from total isolates (TI). Materials and Methods: Antimicrobial data of all isolates identified in the Microbiology unit of Ilsan Paik Hospital in 2019 were retrospectively acquired from the hospital information system. The susceptibility rates to antimicrobials of Escherichia coli, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, Enterococcus faecium, and Enterococcus faecalis were analyzed by FI and TI, respectively. Isolate counts and susceptibility rates of each species for the reported antimicrobials were compared. Results: The numbers of isolates by FI/TI were as follows: 1824/2692 E. coli, 480/1611 A. baumannii, and 662/1306 K. pneumoniae, and 407/953 P. aeruginosa for gram-negative bacteria and 649/1364 S. aureus, 211/313 E. faecium, and 323/394 E. faecalis for gram-positive bacteria. All antimicrobial agents showed higher susceptibility rates when calculated as FI than as TI in gram-negative bacteria except colistin: 3.7% for E. coli, 14.5% for A. baumannii, 8.3% for K. pneumoniae, and 7.9% for P. aeruginosa. In S. aureus, 8/11 antimicrobial agents revealed higher susceptibility rates for FI than for TI. E. faecalis and E. faecium showed lower susceptibility rates for 7/10 antimicrobial agents for FI than for TI. The oxacillin susceptibility rates of S. aureus were 36.6%/30.2% with FI/TI and vancomycin susceptibility rates for E. faecium were 54.1% and 49.5%, respectively. Conclusions: When comparing cumulative antibiograms by FI with TI using real-world data, there is a large gap for critical species requiring hospital infection control. Although FI calculation is difficult, antibiograms must be calculated as FI for proper preemptive antimicrobial therapy because FI provides proper antimicrobial susceptibility data.
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White NM, Barnett AG, Hall L, Mitchell BG, Farrington A, Halton K, Paterson DL, Riley TV, Gardner A, Page K, Gericke CA, Graves N. Cost-effectiveness of an Environmental Cleaning Bundle for Reducing Healthcare-associated Infections. Clin Infect Dis 2020; 70:2461-2468. [PMID: 31359053 PMCID: PMC7286366 DOI: 10.1093/cid/ciz717] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/29/2019] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) remain a significant patient safety issue, with point prevalence estimates being ~5% in high-income countries. In 2016-2017, the Researching Effective Approaches to Cleaning in Hospitals (REACH) study implemented an environmental cleaning bundle targeting communication, staff training, improved cleaning technique, product use, and audit of frequent touch-point cleaning. This study evaluates the cost-effectiveness of the environmental cleaning bundle for reducing the incidence of HAIs. METHODS A stepped-wedge, cluster-randomized trial was conducted in 11 hospitals recruited from 6 Australian states and territories. Bundle effectiveness was measured by the numbers of Staphylococcus aureus bacteremia, Clostridium difficile infection, and vancomycin-resistant enterococci infections prevented in the intervention phase based on estimated reductions in the relative risk of infection. Changes to costs were defined as the cost of implementing the bundle minus cost savings from fewer infections. Health benefits gained from fewer infections were measured in quality-adjusted life-years (QALYs). Cost-effectiveness was evaluated using the incremental cost-effectiveness ratio and net monetary benefit of adopting the cleaning bundle over existing hospital cleaning practices. RESULTS Implementing the cleaning bundle cost $349 000 Australian dollars (AUD) and generated AUD$147 500 in cost savings. Infections prevented under the cleaning bundle returned a net monetary benefit of AUD$1.02 million and an incremental cost-effectiveness ratio of $4684 per QALY gained. There was an 86% chance that the bundle was cost-effective compared with existing hospital cleaning practices. CONCLUSIONS A bundled, evidence-based approach to improving hospital cleaning is a cost-effective intervention for reducing the incidence of HAIs.
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Affiliation(s)
- Nicole M White
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Adrian G Barnett
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Lisa Hall
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
- School of Public Health, University of Queensland, Brisbane, Western Australia
| | - Brett G Mitchell
- Discipline of Nursing, Avondale College of Higher Education, Wahroonga, New South Wales, Western Australia
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Western Australia
| | - Alison Farrington
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Kate Halton
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - David L Paterson
- University of Queensland Centre for Clinical Research, Royal Brisbane and Women’s Hospital, Crawley, Western Australia
| | - Thomas V Riley
- School of Biomedical Sciences, The University of Western Australia, Crawley, Western Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia
- School of Veterinary and Life Sciences, Murdoch University, Western Australia,, Cairns, Queensland, Australia
| | - Anne Gardner
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Katie Page
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
| | - Christian A Gericke
- School of Clinical Medicine, University of Queensland, Cairns, Queensland, Brisbane, Australia
- College of Public Health, Medical and Veterinary Sciences, and College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia
| | - Nicholas Graves
- Australian Centre for Health Services Innovation, Institute of Health and Biomedical Innovation, Brisbane, Queensland, Western Australia
- School of Public Healt, New South Wales,h and Social Work, Queensland University of Technology, Brisbane, Western Australia
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9
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Sommer L, Hackel T, Hofmann A, Hoffmann J, Hennebach E, Köpke B, Sydow W, Ehrhard I, Chaberny IF. [Multi-Resistant Bacteria in Patients in Hospitals and Medical Practices as well as in Residents of Nursing Homes in Saxony - Results of a Prevalence Study 2017/2018]. DAS GESUNDHEITSWESEN 2020; 83:624-631. [PMID: 32380560 DOI: 10.1055/a-1138-0489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of this study was to determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), multi-resistant gram-negative bacteria (MRGN) and vancomycin-resistant enterococci (VRE) in three study groups (hospital patients, residents in nursing homes for the elderly and patients in GP practices) and additionally, risk factors for carriage of multidrug-resistant organisms (MDRO). METHODS Screening for MDRO was performed as a point prevalence study by obtaining nasal, pharyngeal and rectal swabs or stool samples from voluntary participants in 25 hospitals, 14 nursing homes for the elderly as well as 33 medical practices in 12 of 13 districts of Saxony. Suspicious isolates were further examined phenotypically and partially by molecular methods. The participants completed a questionnaire on possible risk factors for MDRO colonisation; the data were statistically evaluated by correlation analyses. RESULTS In total, 1,718 persons, 629 from hospitals, 498 from nursing homes and 591 from medical practices, were examined. MDRO was detected in 8.4% of all participants; 1.3% persons tested positive for MRSA, 5.2% for 3MRGN, 0.1% for 4MRGN and 2.3% for VRE. Nine persons were colonized with more than one MDRO. The following independent risk factors could be significantly associated with the detection of MDRO: presence of a degree of care (MDRO), male sex (MDRO/VRE), current antibiosis (MDRO/VRE), antibiosis within the last 6 months (MDRO/MRSA/MRGN/VRE), current tumour disease (MDRO/3MRGN), peripheral artery disease (PAD) (MRSA) as well as urinary incontinence (3MRGN). CONCLUSIONS To our knowledge, this study represents the first survey of prevalence of different multiresistant pathogen groups in 3 study groups including outpatients in Germany. 3MRGN were the pathogens most frequently detected and were also found in patients of younger age groups. VRE were found almost exclusively in specific clinics. In addition to current and past antibiotic therapy, in particular the presence of PAD for MRSA detection, urinary incontinence for 3MRGN detection and a current tumour disease for MDRO and 3MRGN detection were determined as independent risk factors.
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Affiliation(s)
- Lydia Sommer
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Tilo Hackel
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Axel Hofmann
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Julia Hoffmann
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Ekkehard Hennebach
- SG IT, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Beate Köpke
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Wiebke Sydow
- Ref. 23, Sächsisches Staatsministerium für Soziales und Gesellschaftlichen Zusammenhalt, Dresden
| | - Ingrid Ehrhard
- Abt. 1, Landesuntersuchungsanstalt für das Gesundheits- und Veterinärwesen Sachsen, Dresden
| | - Iris F Chaberny
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Universitatsklinikum Leipzig, Leipzig
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van den Honert MS, Gouws PA, Hoffman LC. A Preliminary Study: Antibiotic Resistance Patterns of Escherichia coli and Enterococcus Species from Wildlife Species Subjected to Supplementary Feeding on Various South African Farms. Animals (Basel) 2020; 10:ani10030396. [PMID: 32121124 PMCID: PMC7142571 DOI: 10.3390/ani10030396] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 02/01/2023] Open
Abstract
Simple Summary Supplementary feeding of wildlife allows more opportunity for disease and antibiotic resistant genes to be transferred directly between species due to increased herd density, more frequent direct contact at feeding and water points and increased human contact. The feed itself can also be a direct source of antibiotic compounds and of antibiotic resistant bacteria. This study aimed to determine whether the practice of wildlife supplementary feeding could have an influence on the antibiotic resistance of the bacteria harboured by the supplementary fed wildlife, and thus play a potential role in the dissemination of antibiotic resistance throughout nature. Overall, the E. coli and Enterococcus isolates from the supplementary fed wildlife were found to be more frequently resistant to the selection of antibiotics than from those which were not supplementary fed. Game farmers should be knowledgeable of the ingredients that are used in the game feed that is used to feed both their livestock and wildlife, as certain feed ingredients, such as antibiotics or bone meal, can have a detrimental effect on health and safety. Game farmers should also be aware that farm history can have an impact on the animals which graze on the pastures with regards to antibiotic resistance transfer. Abstract Studies have shown that antibiotic resistance among wild animals is becoming a public health concern, owing to increased contact and co-habitation with domestic animals that, in turn, results in increased human contact, indirectly and directly. This type of farming practice intensifies the likelihood of antibiotic resistant traits in microorganisms transferring between ecosystems which are linked via various transfer vectors, such as rivers and birds. This study aimed to determine whether the practice of wildlife supplementary feeding could have an influence on the antibiotic resistance of the bacteria harboured by the supplementary fed wildlife, and thus play a potential role in the dissemination of antibiotic resistance throughout nature. Escherichia coli and Enterococcus were isolated from the faeces of various wildlife species from seven different farms across South Africa. The Kirby-Bauer disk diffusion method was used according to the Clinical and Laboratory Standards Institute 2018 guidelines. The E. coli (F: 57%; N = 75% susceptible) and Enterococcus (F: 67%; N = 78% susceptible) isolates from the supplementary fed (F) wildlife were in general, found to be more frequently resistant to the selection of antibiotics than from those which were not supplementary fed (N), particularly towards tetracycline (E. coli F: 56%; N: 71%/Enterococcus F: 53%; N: 89% susceptible), ampicillin (F: 82%; N = 95% susceptible) and sulphafurazole (F: 68%; N = 98% susceptible). Interestingly, high resistance towards streptomycin was observed in the bacteria from both the supplementary fed (7% susceptible) and non-supplementary fed (6% susceptible) wildlife isolates. No resistance was found towards chloramphenicol and ceftazidime.
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Affiliation(s)
- Michaela Sannettha van den Honert
- Centre for Food Safety, Department of Food Science, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa
- Department of Animal Sciences, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
| | - Pieter Andries Gouws
- Centre for Food Safety, Department of Food Science, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa
- Correspondence:
| | - Louwrens Christiaan Hoffman
- Department of Animal Sciences, University of Stellenbosch, Private Bag X1, Matieland 7602, South Africa;
- Centre for Nutrition and Food Sciences, Queensland Alliance for Agriculture and Food Innovation, The University of Queensland, Coopers Plains, QLD 4108, Australia
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Yangzom T, Kumar Singh TS. Study of vancomycin and high-level aminoglycoside-resistant Enterococcus species and evaluation of a rapid spot test for enterococci from Central Referral Hospital, Sikkim, India. J Lab Physicians 2019; 11:192-199. [PMID: 31579233 PMCID: PMC6771325 DOI: 10.4103/jlp.jlp_5_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND: Enterococcus is an important pathogen, and with its emergence of resistance to multiple antimicrobials, the management of infection is becoming increasingly difficult. AIM: The aim of the study is to determine the prevalence, antibiotic resistance, and risk factors associated with enterococcal infection or colonization. MATERIALS AND METHODS: In this prospective study, samples from inpatients were screened for resistant enterococci. Antibiotic susceptibility testing was performed using the disc diffusion method and minimum inhibitory concentration by the agar dilution method. A modification of a test tube method of sodium chloride-esculin hydrolysis to a spot test was evaluated for its rapidity and reliability in the presumptive diagnosis of enterococci. STATISTICAL ANALYSIS USED: Fisher's exact test was used for continuous (Student's t-test) and categorical variables. Multivariate analysis was performed with logistic regression using IBM SPSS 20.0 software (Armonk, NY, USA). RESULTS: Enterococcus species were isolated from 182 samples: Enterococcus faecalis (68.7%), Enterococcus faecium (20.9%), Enterococcus gallinarum (6%), and Enterococcus durans (4.4%). Maximum resistance was to ciprofloxacin (59.3%) and least to linezolid (0.5%). The isolation rate of vancomycin-resistant enterococci (VRE) was 13.7%; 30.2% and 20.9% were of high-level gentamicin and streptomycin, respectively. All 182 Enterococcus species gave positive results within 30–60 min by the rapid spot test. CONCLUSIONS: Overall, high-level aminoglycoside resistance (HLAR) was observed more than glycopeptide resistance. Surveillance strategies need to be upgraded and implemented in order to prevent the emergence and further spread of not only VRE but also HLAR enterococci in the hospital. The spot test gave reliable and rapid results in presumptive identification of enterococci.
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Affiliation(s)
- Tsering Yangzom
- Department of Microbiology, Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
| | - T Shanti Kumar Singh
- Department of Microbiology, Central Referral Hospital, Sikkim Manipal Institute of Medical Sciences, Sikkim Manipal University, Tadong, Sikkim, India
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Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2018; 61:1310-1361. [DOI: 10.1007/s00103-018-2811-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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13
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Madoshi B, Mtambo M, Muhairwa A, Lupindu A, Olsen J. Isolation of vancomycin‐resistant
Enterococcus
from apparently healthy human animal attendants, cattle and cattle wastes in Tanzania. J Appl Microbiol 2018; 124:1303-1310. [DOI: 10.1111/jam.13722] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 01/02/2018] [Accepted: 01/16/2018] [Indexed: 02/02/2023]
Affiliation(s)
- B.P. Madoshi
- Department of Veterinary Medicine and Public Health Sokoine University of agriculture MorogoroTanzania
- Livestock Training Agency – Mpwapwa Campus Mpwapwa DodomaTanzania
| | - M.M.A. Mtambo
- Tanzania Industrial Research Developments Organisation TIRDO Complex DSM Tanzania
| | - A.P. Muhairwa
- Department of Veterinary Medicine and Public Health Sokoine University of agriculture MorogoroTanzania
| | - A.M. Lupindu
- Department of Veterinary Medicine and Public Health Sokoine University of agriculture MorogoroTanzania
| | - J.E. Olsen
- Department of Veterinary and Animal Sciences Faculty of Health and Medical Sciences University of Copenhagen Frederiksberg C Denmark
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Advances in prevention and treatment of vancomycin-resistant Enterococcus infection. Curr Opin Infect Dis 2018; 29:577-582. [PMID: 27584589 DOI: 10.1097/qco.0000000000000311] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW This article reviews data, particularly from the last 2 years, addressing the prevention and treatment of vancomycin-resistant Enterococcus (VRE). We focus on infection control, particularly active screening, use of contact precautions as well as pharmacologic options for therapy. This is timely given the evolving priorities in efforts towards the prevention and treatment of multidrug-resistant organisms globally. RECENT FINDINGS Key findings include new data regarding the impact of contact precautions on the incidence of VRE colonization and bloodstream infection, new laboratory screening methods, and novel decolonization strategies and treatments. SUMMARY Additional and specific measures beyond standard precautions for infection prevention of VRE remain controversial. Horizontal measures such as chlorhexidine bathing appear beneficial, as are nontouch environmental cleaning methods. Treatment options for invasive disease have improved considerably in the last decade. Decolonization strategies require further research. Overall, the threat of VRE seems exaggerated.
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15
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Frickmann H, Köller K, Veil I, Weise M, Ludyga A, Schwarz NG, Warnke P, Podbielski A. On the Role of Enterococci in the Bloodstream: Results of a Single-Center, Retrospective, Observational Study at a German University Hospital. Eur J Microbiol Immunol (Bp) 2017; 7:284-295. [PMID: 29403657 PMCID: PMC5793698 DOI: 10.1556/1886.2017.00030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 09/07/2017] [Indexed: 02/01/2023] Open
Abstract
This study assesses the clinical relevance of vancomycin-susceptible enterococci in bacteremic patients and compares it with bacteremia due to Staphylococcus aureus and Escherichia coli. During a 5-year-study interval, clinical and diagnostic features of patients with enterococcal bacteremia were compared to those of patients with E. coli or S. aureus bacteremia. Each patient was only counted once per hospital stay. During the 5-year study interval, data from 267 patients with enterococcal bacteremia and from 661 patients with bacteremia due to E. coli or S. aureus were evaluated. In spite of a comparable risk of death, patients with enterococci more frequently needed catecholamines and invasive ventilation. Furthermore, enterococci were more frequently associated with a mixed bacterial flora in bloodstream infections. While fatal sepsis due to E. coli and S. aureus was associated with typical shock symptoms, this association was not confirmed for enterococci. Although enterococcal bacteremia is associated with a risk of dying comparable to that with bacteremia due to E. coli and S. aureus, a lower pathogenic potential of enterococci in bloodstream has to be acknowledged. Enterococci in the bloodstream are more likely to be an epiphenomenon of impending death than its major cause.
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Affiliation(s)
- Hagen Frickmann
- Department of Tropical Medicine at the Bernhard Nocht Institute, Bundeswehr Hospital Hamburg, Hamburg, Germany.,Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Kerstin Köller
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Irina Veil
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Mirjam Weise
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | | | - Norbert Georg Schwarz
- Infectious Disease Epidemiology, Bernhard Nocht Institute for Tropical Medicine Hamburg, Hamburg, Gemany
| | - Philipp Warnke
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
| | - Andreas Podbielski
- Institute for Medical Microbiology, Virology and Hygiene, University Medicine Rostock, Rostock, Germany
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16
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Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis. Infect Control Hosp Epidemiol 2016; 38:203-215. [DOI: 10.1017/ice.2016.254] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUNDInformation about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics.OBJECTIVETo systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes.METHODSWe searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data.RESULTSFive studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more).CONCLUSIONSVRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.Infect Control Hosp Epidemiol. 2017;38:203–215
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17
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Khalifa L, Shlezinger M, Beyth S, Houri-Haddad Y, Coppenhagen-Glazer S, Beyth N, Hazan R. Phage therapy against Enterococcus faecalis in dental root canals. J Oral Microbiol 2016; 8:32157. [PMID: 27640530 PMCID: PMC5027333 DOI: 10.3402/jom.v8.32157] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/13/2016] [Accepted: 07/27/2016] [Indexed: 12/16/2022] Open
Abstract
Antibiotic resistance is an ever-growing problem faced by all major sectors of health care, including dentistry. Recurrent infections related to multidrug-resistant bacteria such as methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, and vancomycin-resistant enterococci (VRE) in hospitals are untreatable and question the effectiveness of notable drugs. Two major reasons for these recurrent infections are acquired antibiotic resistance genes and biofilm formation. None of the traditionally known effective techniques have been able to efficiently resolve these issues. Hence, development of a highly effective antibacterial practice has become inevitable. One example of a hard-to-eradicate pathogen in dentistry is Enterococcus faecalis, which is one of the most common threats observed in recurrent root canal treatment failures, of which the most problematic to treat are its biofilm-forming VRE strains. An effective response against such infections could be the use of bacteriophages (phages). Phage therapy was found to be highly effective against biofilm and multidrug-resistant bacteria and has other advantages like ease of isolation and possibilities for genetic manipulations. The potential of phage therapy in dentistry, in particular against E. faecalis biofilms in root canals, is almost unexplored. Here we review the efforts to develop phage therapy against biofilms. We also focus on the phages isolated against E. faecalis and discuss the possibility of using phages against E. faecalis biofilm in root canals.
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Affiliation(s)
- Leron Khalifa
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Mor Shlezinger
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shaul Beyth
- Orthopedic Surgery Complex, Hadassah University Hospital, Jerusalem, Israel
| | - Yael Houri-Haddad
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Shunit Coppenhagen-Glazer
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Nurit Beyth
- Department of Prosthodontics, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel
| | - Ronen Hazan
- Institute of Dental Science, The Hebrew University Hadassah School of Dental Medicine, Jerusalem, Israel;
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Abstract
Because the development of resistance is steadily increasing, especially among Gram-negative pathogens and new developments in antibiotics are lacking, a rational antibiotic therapy is necessary now more than ever. A continuing uncritical and non-guideline-conform use of antibiotics leads to selection of multidrug-resistant pathogens, which can colonize patients and as instigators of infections make treatment more difficult. A prerequisite for targeted antibiotic therapy is a critical testing of the suspected infection diagnosis based on a guideline-conform microbiological preanalytical procedure. To promote a guideline-conform antibiotic therapy in hospitals with respect to choice of substance, dosage and duration, in December 2013 so-called antibiotic stewardship (ABS) measures were summarized in a so-called S3-guideline from the Association of the Scientific Medical Societies in Germany (AWMF) under the auspices of the German Society for Infectious Diseases (DGI). With a strategy of targeted antibiotic therapy and infection prevention it is possible to achieve optimum treatment results and to minimize the development of resistance.
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19
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Ekuma AE, Oduyebo OO, Efunshile AM, Konig B. SURVEILLANCE FOR VANCOMYCIN RESISTANT ENTEROCOCCI IN A TERTIARY INSTITUTION IN SOUTH WESTERN NIGERIA. Afr J Infect Dis 2016; 10:121-126. [PMID: 28480447 PMCID: PMC5411987 DOI: 10.21010/ajid.v10i2.8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enterococci are responsible for up to 12% of cases of healthcare associated infections worldwide and cause life threatening infections among critically ill patients. They show intrinsic and acquired resistance to a wide range of antimicrobial agents. Glycopeptide resistance is due to vanA, vanB, vanC, vanD, vanE, vanG and vanL genes. OBJECTIVES To determine the carriage rate of VRE among patients on prolonged hospitalization in Lagos University Teaching Hospital, assess the antimicrobial resistance pattern of VRE, identify factors associated with VRE colonization and describe the genetic determinants of enterococcal resistance to Vancomycin. METHODS VRE were isolated from rectal swabs collected from patients hospitalized for seven days or more in Lagos University Teaching Hospital and identified by Matrix Assisted Laser Desorption Ionization (MALDI) and Polymerase Chain Reaction (PCR). Antimicrobial susceptibility testing was performed by E-test. PCR assay for Vancomycin resistance genes was also performed. Data on demographic and risk factors collected by questionnaire was tested for significance using Chi square. RESULTS Thirteen of 319 patients surveyed were colonized with VRE; one with vanA E. faecium, two with vanB E. faecium, ten with E. gallinarum and one with E. casseliflavus. Univariate analysis for risk factors associated with VRE colonization was only significant for the ward of admission. Only one VRE isolate showed full resistance to Vancomycin and Teicoplanin. Three were resistant to Ampicillin and nine to Ciprofloxacin but all were susceptible to Linezolid. High-level resistance to Gentamicin was found in four VRE isolates. CONCLUSION There is a low prevalence of VRE in Lagos University Teaching Hospital which may be spreading among patients in affected wards.
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Affiliation(s)
- Agantem Emmanuel Ekuma
- Dept. of Medical Microbiology, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Oyin O Oduyebo
- Department of Microbiology, College of Medicine; University of Lagos, Nigeria
| | - Akinwale Michael Efunshile
- Dept. of Medical Microbiology, Ebonyi State University, Abakaliki, Nigeria.,Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Germany
| | - Brigitte Konig
- Institute of Medical Microbiology and Infectious Disease Epidemiology, University of Leipzig, Germany
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Persistence of a ST6 clone of Enterococcus faecalis genotype vanB2 in two Hospitals in Aragon (Spain). Enferm Infecc Microbiol Clin 2016; 35:578-581. [PMID: 27059750 DOI: 10.1016/j.eimc.2016.02.020] [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: 11/10/2015] [Revised: 02/18/2016] [Accepted: 02/20/2016] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In order to study the evolution of the outbreak that occurred between 2009 and 2010 in 3 hospitals in Zaragoza, all vancomycin-resistant clinical Enterococcus faecalis isolates identified between 2011 and 2013 at these hospitals were characterised. METHODS Molecular characterisation of the isolates and analysis of their clonal relationships was performed using pulsed field electrophoresis, along with a retrospective review of the patient records. RESULTS A total of 79 vancomycin-resistant E.faecalis isolates with genotype vanB2 of 73 patients were recovered in 2 of the 3 hospitals, most of them from urine specimens. About 46% of the cases were nosocomial. Distribution of the isolates among hospital services demonstrated high variability, making it difficult to predict a common source of infection. All the strains were multiresistant (vancomycin, erythromycin, tetracycline, ciprofloxacin, streptomycin, gentamicin, kanamycin) and belonged to lineage ST6. Seventy-four isolates (93.7%) were identical or closely related to the dominant one in the origin of the outbreak. CONCLUSION The outbreak remains constant over three years after being initially described, indicating the need to implement an active control in order to limit the emergence and spread of vancomycin-resistant clones.
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21
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Wang M, Doak TG, Ye Y. Subtractive assembly for comparative metagenomics, and its application to type 2 diabetes metagenomes. Genome Biol 2015; 16:243. [PMID: 26527161 PMCID: PMC4630832 DOI: 10.1186/s13059-015-0804-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 10/09/2015] [Indexed: 12/18/2022] Open
Abstract
Comparative metagenomics remains challenging due to the size and complexity of metagenomic datasets. Here we introduce subtractive assembly, a de novo assembly approach for comparative metagenomics that directly assembles only the differential reads that distinguish between two groups of metagenomes. Using simulated datasets, we show it improves both the efficiency of the assembly and the assembly quality of the differential genomes and genes. Further, its application to type 2 diabetes (T2D) metagenomic datasets reveals clear signatures of the T2D gut microbiome, revealing new phylogenetic and functional features of the gut microbial communities associated with T2D.
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Affiliation(s)
- Mingjie Wang
- School of Informatics and Computing, Indiana University, Bloomington, IN, 47405, USA.
| | - Thomas G Doak
- Department of Biology, Indiana University, Bloomington, IN, 47405, USA. .,National Center for Genome Analysis Support, Indiana University, Bloomington, IN, 47401, USA.
| | - Yuzhen Ye
- School of Informatics and Computing, Indiana University, Bloomington, IN, 47405, USA.
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Amikacin prophylaxis and risk factors for surgical site infection after kidney transplantation. Transplantation 2015; 99:521-7. [PMID: 25254907 DOI: 10.1097/tp.0000000000000381] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Antibiotic prophylaxis plays a major role in preventing surgical site infections (SSIs). This study aimed to evaluate antibiotic prophylaxis in kidney transplantation and identify risk factors for SSIs. METHODS We evaluated all kidney transplantation recipients from January 2009 and December 2012. We excluded patients who died within the first 72 hr after transplantation, were undergoing simultaneous transplantation of another organ, or were below 12 years of age. The main outcome measure was SSI during the first 60 days after transplantation. RESULTS A total of 819 kidney transplants recipients were evaluated, 65% of whom received a deceased-donor kidney. The antibiotics used as prophylaxis included cephalosporin, in 576 (70%) cases, and amikacin, in 233 (28%). We identified SSIs in 106 cases (13%), the causative agent being identified in 72 (68%). Among the isolated bacteria, infections caused by extended-spectrum β-lactamase-producing Enterobacteriaceae predominated. Multivariate analysis revealed that the risk factors for post-kidney transplantation SSIs were deceased donor, thin ureters at kidney transplantation, antithymocyte globulin induction therapy, blood transfusion at the transplantation procedure, high body mass index, and diabetes mellitus. The only factor associated with a reduction in the incidence of SSIs was amikacin use as antibiotic prophylaxis. Factors associated with reduced graft survival were: intraoperative blood transfusions, reoperation, human leukocyte antigen mismatch, use of nonstandard immunosuppression therapy, deceased donor, post-kidney transplantation SSIs, and delayed graft function. CONCLUSION Amikacin prophylaxis is a useful strategy for preventing SSIs.
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Pogue J, Kaye K, Cohen D, Marchaim D. Appropriate antimicrobial therapy in the era of multidrug-resistant human pathogens. Clin Microbiol Infect 2015; 21:302-12. [DOI: 10.1016/j.cmi.2014.12.025] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/22/2014] [Accepted: 12/27/2014] [Indexed: 01/02/2023]
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Russo A, Campanile F, Falcone M, Tascini C, Bassetti M, Goldoni P, Trancassini M, Della Siega P, Menichetti F, Stefani S, Venditti M. Linezolid-resistant staphylococcal bacteraemia: A multicentre case-case-control study in Italy. Int J Antimicrob Agents 2014; 45:255-61. [PMID: 25600893 DOI: 10.1016/j.ijantimicag.2014.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/10/2014] [Accepted: 12/19/2014] [Indexed: 11/24/2022]
Abstract
The aim of this multicentre study was to analyse the characteristics of patients with bloodstream infections due to staphylococcal strains resistant to linezolid. This was a retrospective case-case-control study of patients hospitalised in three large teaching hospitals in Italy. A linezolid-resistant (LIN-R) Staphylococcus spp. group and a linezolid-susceptible (LIN-S) Staphylococcus spp. group were compared with control patients to determine the clinical features and factors associated with isolation of LIN-R strains. All LIN-R Staphylococcus spp. strains underwent molecular typing. Compared with the LIN-S group, central venous catheters were the main source of infection in the LIN-R group. The LIN-R and LIN-S groups showed a similar incidence of severe sepsis or septic shock, and both showed a higher incidence of these compared with the control group. Overall, patients in the LIN-R group had a higher 30-day mortality rate. Multivariate analysis found previous linezolid therapy, linezolid therapy >14 days, antibiotic therapy in the previous 30 days, antibiotic therapy >14 days, previous use of at least two antibiotics and hospitalisation in the previous 90 days as independent risk factors associated with isolation of a LIN-R strain. The G2576T mutation in domain V of 23S rRNA was the principal mechanism of resistance; only one strain of Staphylococcus epidermidis carried the cfr methylase gene (A2503), together with L4 insertion (71GGR72) and L3 substitution (H146Q). LIN-R strains are associated with severe impairment of clinical conditions and unfavourable patient outcomes. Reinforcement of infection control measures may have an important role in preventing these infections.
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Affiliation(s)
- Alessandro Russo
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, 'Sapienza' University of Rome, Viale dell'Università 37, 00161 Rome, Italy
| | | | - Marco Falcone
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, 'Sapienza' University of Rome, Viale dell'Università 37, 00161 Rome, Italy
| | - Carlo Tascini
- UO Malattie Infettive, Azienda Ospedaliera Universitaria Pisana, Pisa, Italy
| | - Matteo Bassetti
- Infectious Diseases Clinic, Santa Maria Misericordia, University Hospital, Udine, Italy
| | - Paola Goldoni
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, 'Sapienza' University of Rome, Viale dell'Università 37, 00161 Rome, Italy
| | - Maria Trancassini
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, 'Sapienza' University of Rome, Viale dell'Università 37, 00161 Rome, Italy
| | - Paola Della Siega
- Infectious Diseases Clinic, Santa Maria Misericordia, University Hospital, Udine, Italy
| | | | | | - Mario Venditti
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, 'Sapienza' University of Rome, Viale dell'Università 37, 00161 Rome, Italy.
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25
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Humphreys H. Controlling the spread of vancomycin-resistant enterococci. Is active screening worthwhile? J Hosp Infect 2014; 88:191-8. [PMID: 25310998 DOI: 10.1016/j.jhin.2014.09.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 09/10/2014] [Indexed: 11/28/2022]
Abstract
Vancomycin-resistant enterococci (VRE) are significant causes of healthcare-acquired infections. Active screening, i.e. the use of rectal swabs or faeces to detect carriage in at-risk patients, has been described as contributing to prevention by identifying previously unrecognized cases. The aim of this review was to determine the impact of screening for VRE on prevention and control, its cost-effectiveness and recent approaches to laboratory detection. A review of published studies in English from 2000 was undertaken. Whereas various guidelines were accessed and reviewed, the emphasis was on original reports and studies. It was determined that the patient groups who may need screening are those admitted to critical care units, haematology/oncology and transplant wards, patients on chronic dialysis and patients admitted to acute hospitals from long-stay units. Active screening is associated with reduced VRE colonization and infection and cost savings in some studies, even if these fall short of randomized trials. Selective media increase sensitivity and reduce the time to detection but the role of molecular methods remains to be determined. In conclusion, active screening contributes to VRE prevention probably by heightening awareness of control measures, including isolation. However, further studies are required to: better define high-risk groups that warrant screening; quantify the clinical and economic benefit; and determine the optimal laboratory methods in a range of different patient populations.
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Affiliation(s)
- H Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland.
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Wojenski DJ, Barreto JN, Wolf RC, Tosh PK. Cefpodoxime for antimicrobial prophylaxis in neutropenia: a retrospective case series. Clin Ther 2014; 36:976-81. [PMID: 24832560 DOI: 10.1016/j.clinthera.2014.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/18/2014] [Accepted: 04/08/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Antimicrobial prophylaxis in select neutropenic patients has reduced fever, infection rates, hospital length of stay, and hospitalization rates. Guidelines from the Infectious Diseases Society of America recommend the consideration of prophylaxis with a fluoroquinolone in patients at high risk for infection after chemotherapy. The use of fluoroquinolones has been associated with many adverse events, and there is limited evidence on alternative antimicrobial prophylaxis in patients intolerant of fluoroquinolones. OBJECTIVES Our study describes a single-center experience of cefpodoxime as an alternative to fluoroquinolones for antibacterial prophylaxis during neutropenia after chemotherapy and represents a retrospective evaluation of an oral cephalosporin in adult patients for this purpose. METHODS This retrospective case series analyzed data from the electronic medical records of 41 patients having hematologic malignancies and given cefpodoxime for neutropenic prophylaxis. RESULTS The rate of febrile neutropenia was 85%, with 60% culture-positive infections. Gram-positive organisms were identified in 52% of positive cultures, and gram-negative organisms represented 40% of positive cultures. Antimicrobial resistance to guideline-recommended empiric treatment regimens was not seen in breakthrough infections. CONCLUSIONS Cefpodoxime can be utilized for prophylaxis, without adversely affecting resistance to broad-spectrum agents, and maintains a high level of appropriateness of guideline-recommended empiric regimens. This study of cefpodoxime prophylaxis in adult patients intolerant to fluoroquinolones adds to the literature of potential alternative agents for prophylaxis in neutropenic patients.
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Affiliation(s)
| | | | - Robert C Wolf
- Department of Pharmacy, Mayo Clinic, Rochester, Minnesota
| | - Pritish K Tosh
- Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
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Omotola AM, Li Y, Martin ET, Alshabani K, Yadav D, Sarkar M, Thapa SD, Kumar V, Mahabashya A, Ahmad S, Bhargava A, Marchaim D, Pogue JM, Rybak MJ, Kaye KS, Hayakawa K. Risk factors for and epidemiology of community-onset vancomycin-resistant Enterococcus faecalis in southeast Michigan. Am J Infect Control 2013; 41:1244-8. [PMID: 24011554 DOI: 10.1016/j.ajic.2013.05.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 05/11/2013] [Accepted: 05/13/2013] [Indexed: 11/18/2022]
Abstract
BACKGROUND Given the known link between vancomycin-resistant Enterococcus faecalis (VREF) and vancomycin-resistant Staphylococcus aureus (VRSA), the recent increase in prevalence of VREF in southeast Michigan has raised concerns about the presence of a large "community" reservoir of VREF. Efforts to control its spread face some important challenges. METHODS Patients with clinical isolates of community-onset (CO) VREF (cases) were compared with matched uninfected controls (study 1) and patients with hospital-onset (HO) VREF (study 2). Here, CO was defined as a hospital stay of ≤2 days before VRE isolation. RESULTS Independent predictors for the isolation of CO-VREF compared with uninfected controls were nonhome residence; chronic skin ulcers; previous invasive procedures/surgery; exposure to cephalosporin, penicillin, and/or vancomycin; immunosuppressive status; and the presence of indwelling devices. Independent predictors for isolation of CO-VREF compared with HO-VREF included no stay in an intensive care unit in the previous 3 months and recent hospitalization. VREF isolation from wounds and aminoglycoside exposure were inversely associated with isolation of CO-VREF. CONCLUSIONS Health care-related exposures and antimicrobial exposures are risk factors for the isolation of CO-VREF. Regional infection control practices are imperative in controlling CO-VREF, in addition to the emergence and spread of VRSA.
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Antimicrobial susceptibility pattern and epidemiology of female urinary tract infections in South Korea, 2010-2011. Antimicrob Agents Chemother 2013; 57:5384-93. [PMID: 23959315 DOI: 10.1128/aac.00065-13] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This study aimed to (i) investigate the antimicrobial susceptibilities of bacteria that cause urinary tract infections (UTIs) in outpatient and inpatient settings and (ii) evaluate the risk factors for emerging antimicrobial drug resistance in UTIs in South Korea. In total, 3,023 samples without duplication were collected from females between 25 and 65 years of age who had been diagnosed with a urinary tract infection. Multicenter patient data were collected using a Web-based electronic system and then evaluated. The isolation rates of Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecium in the outpatient setting were 78.1, 4.7, and 1.3%, respectively; in the inpatient setting, the isolation rates of these microorganisms were 37.8, 9.9, and 14.8%, respectively. The susceptibilities of E. coli to amikacin, amoxicillin-clavulanic acid, cefotaxime, cefoxitin, ciprofloxacin, piperacillin-tazobactam, and imipenem in the outpatient setting were 99.4, 79.8, 89.4, 92.8, 69.8, 96.9, and 100.0%, respectively; in the inpatient setting, the susceptibilities to these antibiotics were 97.8, 73.9, 73.7, 82.1, 53.6, 93.2, and 100.0%, respectively. The most unique and common risk factor for emerging antimicrobial-resistant E. coli, K. pneumoniae, and E. faecium was previous exposure to antimicrobials. On the basis of these data, the use of fluoroquinolones should be reserved until culture data are available for the treatment of UTIs in South Korea. The present study will serve as a useful reference for Far Eastern Asia.
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