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Edwin Erayil S, Palzer E, Kline S. An evaluation of risk factors for Staphylococcus aureus colonization in a pre-surgical population. Access Microbiol 2022; 4:000316. [PMID: 35252754 PMCID: PMC8895606 DOI: 10.1099/acmi.0.000316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 12/10/2021] [Indexed: 11/24/2022] Open
Abstract
Staphylococcus aureus (SA) colonization has significant implications in healthcare-associated infections. Here we describe a prospective study conducted in pre-surgical outpatients, done with the aim of identifying demographic and clinical risk factors for SA colonization. We found younger age to be a potential predictor of SA colonization.
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Affiliation(s)
- Serin Edwin Erayil
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
- *Correspondence: Serin Edwin Erayil,
| | - Elise Palzer
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN 55455, USA
| | - Susan Kline
- Department of Medicine, Division of Infectious Diseases and International Medicine, University of Minnesota Medical School, Minneapolis, MN 55455, USA
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Vanegas JM, Salazar-Ospina L, Roncancio GA, Builes J, Jiménez JN. Post-antibiotic era in hemodialysis? Two case reports of simultaneous colonization and bacteremia by multidrug-resistant bacteria. J Bras Nefrol 2020; 43:597-602. [PMID: 32926066 PMCID: PMC8940116 DOI: 10.1590/2175-8239-jbn-2020-0070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 07/26/2020] [Indexed: 11/22/2022] Open
Abstract
The emergence of resistance mechanisms not only limits the therapeutic options
for common bacterial infections but also worsens the prognosis in patients who
have conditions that increase the risk of bacterial infections. Thus, the
effectiveness of important medical advances that seek to improve the quality of
life of patients with chronic diseases is threatened. We report the simultaneous
colonization and bacteremia by multidrug-resistant bacteria in two hemodialysis
patients. The first patient was colonized by carbapenem- and colistin-resistant
Klebsiella pneumoniae, carbapenem-resistant
Pseudomonas aeruginosa, and methicillin-resistant
Staphylococcus aureus (MRSA). The patient had a bacteremia
by MRSA, and molecular typing methods confirmed the colonizing isolate was the
same strain that caused infection. The second case is of a patient colonized by
extended-spectrum beta-lactamases (ESBL)-producing Escherichia
coli and carbapenem-resistant Pseudomonas
aeruginosa. During the follow-up period, the patient presented
three episodes of bacteremia, one of these caused by ESBL-producing E.
coli. Molecular methods confirmed colonization by the same clone of
ESBL-producing E. coli at two time points, but with a different
genetic pattern to the strain isolated from the blood culture. Colonization by
multidrug-resistant bacteria allows not only the spread of these microorganisms,
but also increases the subsequent risk of infections with limited treatments
options. In addition to infection control measures, it is important to establish
policies for the prudent use of antibiotics in dialysis units.
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Affiliation(s)
- Johanna M Vanegas
- Universidad de Antioquia, Escuela de Microbiología, Grupo de Investigación en Microbiología Básica y Aplicada, Medellín, Colombia
| | - Lorena Salazar-Ospina
- Universidad de Antioquia, Escuela de Microbiología, Grupo de Investigación en Microbiología Básica y Aplicada, Medellín, Colombia
| | - Gustavo A Roncancio
- Universidad de Antioquia, Escuela de Microbiología, Grupo de Investigación en Microbiología Básica y Aplicada, Medellín, Colombia.,Clínica CardioVID, Departamento de Enfermedades Infecciosas, Medellín, Colombia
| | - Julián Builes
- Hospital San Vicente Fundación, Departamento de Nefrología, Medellín, Colombia
| | - Judy Natalia Jiménez
- Universidad de Antioquia, Escuela de Microbiología, Grupo de Investigación en Microbiología Básica y Aplicada, Medellín, Colombia
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Ghavghani FR, Rahbarnia L, Naghili B, Dehnad A, Bazmani A, Varshochi M, Ghaffari Agdam MH. Nasal and extra nasal MRSA colonization in hemodialysis patients of north-west of Iran. BMC Res Notes 2019; 12:260. [PMID: 31077228 PMCID: PMC6509970 DOI: 10.1186/s13104-019-4298-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Methicillin resistant Staphylococcus (S.) aureus colonization is one of the main causes of serious infections in hemodialysis patients. This cross-sectional study was performed to examine prevalence of MRSA colonization and evaluation of risk factors in hemodialysis patients. A total of 560 swab samples from nasal, the skin around catheter and throat were collected from 231 hemodialysis patients in Tabriz. The standard biochemical tests were used for identification of S. aureus isolates. Antimicrobial susceptibility profile was determined against 11 antibiotics by the disk diffusion method. Phenotypic test of S. aureus was performed using novobiocin 30 μg/disc, and methicillin sensitivity test was performed by cefoxitin 30 μg/disc. RESULTS Overall, 50.65% (118/231) hemodialysis patients were positive for S. aureus which 34.93% (80/231) of patients were MRSA carriage. The MRSA colonization in patients with a catheter (44.06%) was more than individuals utilizing a fistula (24.57%, p = 0.030). Among sampling sites, the highest MRSA was related to nasal samples (30.70%, p < 0.00001). Extra nasal colonization of S. aureus was observed in 12.71% patients. The highest rates of resistance were observed against ampicillin (93.98%) and the highest sensitivity was against linezolid antibiotic (5.42%). These findings highlight the necessity of prophylaxis against S. aureus in individuals under dialysis.
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Affiliation(s)
- Fatemeh Ravanbakhsh Ghavghani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Leila Rahbarnia
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran. .,Higher Education Institute of Rab-Rashid, Tabriz, Iran, Tabriz, Iran.
| | - Behrooz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Alireza Dehnad
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran.,Higher Education Institute of Rab-Rashid, Tabriz, Iran, Tabriz, Iran.,Biotechnology Department, East Azerbaijan Research and Education Canter Agricultural and Natural Resources, AREEO, Tabriz, Iran
| | - Ahad Bazmani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Mojtaba Varshochi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
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Gompelman M, Wouters Y, Kievit W, Hopman J, Wertheim HF, Bleeker-Rovers CP, Wanten GJA. Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition: study protocol for a randomized multicenter trial. Trials 2018; 19:346. [PMID: 29954418 PMCID: PMC6025807 DOI: 10.1186/s13063-018-2732-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/08/2018] [Indexed: 01/23/2023] Open
Abstract
Background Patients with long-term intestinal failure are usually treated by means of home parenteral nutrition (HPN) where they administer their nutritional formulation intravenously via a central venous access device (mostly a catheter). This implies that such patients are exposed to a lifelong risk of developing Staphylococcus aureus bacteremia (SAB). SAB poses a threat to both catheter and patient survival and may lead to frequent hospitalization and a permanent loss of vascular access. In other clinical settings, S. aureus carriage eradication has been proven effective in the prevention of S. aureus infections. Unfortunately, there is a complete lack of evidence in HPN support on the most effective and safe S. aureus decolonization strategy in S. aureus carriers. We hypothesized that long-term S. aureus decolonization in HPN patients can only be effective if it is aimed at the whole body (nasal and extra-nasal) and is given chronically or repeatedly on indication. Besides this, we believe that S. aureus carriage among caregivers, who are in close contact with the patient, are of great importance in the S. aureus transmission routes. Methods/design The CARRIER trial is a randomized, open-label, multicenter clinical trial in Dutch and Danish hospitals that treat patients on HPN. A total of 138 adult HPN patients carrying S. aureus will be randomly assigned to a search and destroy (SD) strategy, a quick and short, systemic antibiotic treatment, or a continuous suppression (CS) strategy, a repeated chronic topical antibiotic treatment. The primary outcome measure is the proportion of patients in whom S. aureus is totally eradicated during a 1-year period. Secondary outcomes are time to successful eradication, long-term antimicrobial resistance, adverse events, patient compliance, incidence of (S. aureus) infections, catheter removals, mortality rates, S. aureus transmission routes, quality of life, and health care costs. Discussion The CARRIER trial is designed to identify the most safe and effective long-term S. aureus carriage decolonization strategy in HPN patients. This will eventually lead to a better understanding of long-term S. aureus decolonization treatments in general. The results of this study will have a great impact on our daily clinical practice, which eventually may result in less S. aureus-related infections. Trial registration ClinicalTrials.gov; NCT03173053. Registered on 1 June 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-2732-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Michelle Gompelman
- Department of Gastroenterology & Hepatology I Infectious Diseases, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Yannick Wouters
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands
| | - Wietske Kievit
- Department for Health Evidence, Radboud University, Nijmegen, The Netherlands
| | - Joost Hopman
- Department Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | - Heiman F Wertheim
- Department Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
| | | | - Geert J A Wanten
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, The Netherlands
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Devraj A, Siva Tez Pinnamaneni V, Biswal M, Ramachandran R, Jha V. Extranasal Staphylococcus aureus colonization predisposes to bloodstream infections in patients on hemodialysis with noncuffed internal jugular vein catheters. Hemodial Int 2016; 21:35-40. [PMID: 27358213 DOI: 10.1111/hdi.12450] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Staphylococcal infection of endogenous origin is an important cause of morbidity and mortality in patients who receive hemodialysis (HD). The risk of such infections in nasal carriers of the organism is well defined. Extranasal carriage of the organism at extranasal sites may pose similar risks. METHODS A total of 70 patients about to undergo internal jugular vein catheterization for HD were enrolled in this prospective observational study. Swab cultures were obtained from anterior nares, posterior pharynx, axillae, toe web spaces, and vascular access sites at baseline and 1 week later. A patient was defined as a persistent carrier when the same organism was grown in both samples. Staphylococcus aureus bloodstream infections were assessed by blood and catheter tip cultures over a 90-day period. FINDINGS The mean age of the patients was 43.71 ± 16.2 years. Persistent S. aureus carriage at anterior nares, throat, axilla, toe web spaces, vascular access site, and all sites was documented in 27.9%, 11.4%, 40%, 32.9%, 4.3%, and 64.2% of patients, respectively. Fifteen patients developed S. aureus infections. Catheter related S. aureus infections (CRI) were more likely in persistent carriers than nonpersistent carriers with odds ratios (95% CI) of 10.2 (2.8-37.1), 8.6 (1.7-42.2), 17.3 (3.4-86.0), 3.0 (0.9-9.8), and 1.9 (0.2-22.4) for anterior nares, throat, axilla, toe web spaces, and vascular access site carriers, respectively. The probability of developing CRI in persistent S. aureus carriers was 55% compared to none in noncarriers at 90 days (P = 0.04). DISCUSSION Extranasal S. aureus carriage is as significant a risk factor as nasal carriage for staphylococcal infections in patients on HD through catheters. The study is limited by lack of molecular phenotyping.
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Affiliation(s)
- Anand Devraj
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Raja Ramachandran
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.,George Institute for Global Health, New Delhi, India
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[Survey among French dialysis practitioners about the screening and decolonization of nasal Staphylococcus aureus carriage in dialysis patients]. Nephrol Ther 2015; 12:206-9. [PMID: 26725174 DOI: 10.1016/j.nephro.2015.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 10/20/2015] [Accepted: 11/12/2015] [Indexed: 11/21/2022]
Abstract
Staphylococcus aureus nasal carriage is frequent in dialysis patients and is associated with an increased risk of staphylococcal infections in this population. Data from the literature showed that decolonization of S. aureus nasal carriers in hemodialysis and peritoneal dialysis reduce S. aureus catheter-related infections. During the last national congress of nephrology, a survey was conducted among volunteer dialysis physicians to evaluate their practice about screening and decolonization of S. aureus nasal carriage among their patients. Only 30 participants (45.5% [30/66]) declared to screen S. aureus nasal carriage in patients of hemodialysis and 59.6% (31/52) in peritoneal dialysis. Participants declared to decolonize their patients before insertion of a vascular catheter in 55.8% of cases. This small study would need to be completed by a national survey.
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Sherman RA. Briefly Noted. Semin Dial 2015. [DOI: 10.1111/sdi.12391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Narasimha Krishna V, Allon M. What is the significance of Staphylococcus aureus colonization in hemodialysis patients? Nephron Clin Pract 2015; 129:75-8. [PMID: 25677104 DOI: 10.1159/000375325] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 12/18/2014] [Indexed: 11/19/2022] Open
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