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Medeiros LP, de Miranda KS, Gonçalves TM, Rodrigues DDM, Hiraki KRN, Valim MD, Taminato M, de Morais RB. Knowledge of and adherence to standard precautions in a hemodialysis unit: a cross-sectional study. SAO PAULO MED J 2022; 140:297-304. [PMID: 35239834 PMCID: PMC9610244 DOI: 10.1590/1516-3180.2021.0288.23072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 07/23/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Standard precautions (SPs) are recommended safety measures for healthcare professionals to follow, with a view to preventing healthcare-related infections (HCRIs) and for their own protection. Inadequate adherence to these measures can lead to occurrences of occupational accidents and HCRIs. OBJECTIVES To ascertain the knowledge of and adherence to SP measures among the nursing staff of a hemodialysis service and the relationship of these variables to occurrences of work accidents with biological material. DESIGN AND SETTING Descriptive cross-sectional and correlational study with a quantitative approach developed in a hemodialysis clinic in Minas Gerais. METHODS Data were collected through sociodemographic questionnaires and questionnaires on knowledge of and adherence to SPs. RESULTS 29 professionals participated in the study. It is noteworthy that all of them had already participated in training related to SPs. However, no relationship was identified between knowledge of (15.17 points) and adherence to (71.86 points) SPs. In addition, inferential analysis showed that there was a relationship between suffering a work accident with biological material and the sociodemographic data and knowledge of and adherence to standard precautions. CONCLUSION Knowledge of the SPs that had been established did not mean mastery of the subject. Despite positive results regarding adherence, factors requiring improvement were observed. It was possible to infer the characteristics that gave rise to greater risk of occurrences of accidents at work. Thus, this study showed the importance of assessing knowledge of and adherence to SP, in order to optimize and direct continuing education towards resolving occupational exposure.
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Affiliation(s)
- Laura Prado Medeiros
- Nurse Resident, Multiprofessional Residency Program, Universidade Federal de Uberlândia, Uberlândia (MG), Brazil.
| | | | | | | | - Karen Renata Nakamura Hiraki
- PhD. Associate Professor, Instituto de Ciências Biomédicas, Universidade Federal de Uberlândia, Uberlândia (MG), Brazil.
| | - Marilia Duarte Valim
- PhD. Adjunct Professor, Faculdade de Enfermagem, Universidade Federal de Mato Grosso, Cuiabá (MT), Brazil.
| | - Monica Taminato
- PhD. Adjunct Professor, Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo (SP), Brazil.
| | - Richarlisson Borges de Morais
- MSc. Doctoral Student and Assistant Professor, Escola Técnica de Saúde, Universidade Federal de Uberlândia, Uberlândia (MG), Brazil.
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2
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McFarlane AC, Kabbani D, Bakal JA, Smith SW. Clinical impact of vancomycin-resistant enterococci colonization in nonliver solid organ transplantation and its implications for infection control strategies: A single-center, 10-year retrospective study. Transpl Infect Dis 2021; 23:e13747. [PMID: 34674357 DOI: 10.1111/tid.13747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/30/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) colonization in nonliver solid organ transplantation (SOT) is poorly defined. Infection control management of these patients is influenced by the association of VRE with adverse outcomes in liver transplantation. This study examines the frequency and clinical impact of VRE colonization specifically on nonliver SOT patients and discusses implications for nosocomial VRE control. METHODS We retrospectively reviewed all nonliver SOT patients at a single transplant center from 2005 to 2015. We determined colonization rates in the peritransplant period and the rate of VRE infections. The association between VRE colonization with 90-day mortality and other clinical outcomes was examined. RESULTS There were 1786 nonliver SOTs from 2005 to 2015, with 81 (4.6%) colonized with VRE in the peritransplantation period. The colonization prevalence varied by organ type: 45 of 423 lung (10.6%), 12 of 352 heart (3.4%), one of 18 heart-lung (5.6%), 20 of 884 kidney (2.3%), three of 63 kidney-pancreas (4.8%), zero of 11 pancreas, zero of five small bowel, and zero of 11 multivisceral. Peritransplant VRE colonization was not associated with 90-day mortality odds ratio = 2.35 (95% CI = 0.53, 10.29) and adjusted odds ratio = 1.52 (95% CI = 0.34, 6.88). In the multivariable logistic regression, there was no association with mortality at 1 year or 5 years, hospital length of stay, rehospitalization, or days alive out of hospital. There were 14 inpatient VRE infections up to 1 year after transplantation. CONCLUSION Nonliver SOT patients have lower rates of VRE colonization than liver SOT, and colonization was not associated with increased adverse clinical outcomes. Although infection control strategies for VRE in hospital remain controversial, nonliver SOT should be considered among typical hospitalized patients when designing strategies for prevention.
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Affiliation(s)
- Alexandra C McFarlane
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Dima Kabbani
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Bakal
- Provincial Research Data Services, Alberta Health Services, Edmonton, Alberta, Canada.,Alberta SPOR SUPPORT Unit Data Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Stephanie W Smith
- Department of Medicine, Division of Infectious Diseases, University of Alberta, Edmonton, Alberta, Canada
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3
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Taminato M, Morais RBD, Fram DS, Pereira RRF, Esmanhoto CG, Pignatari AC, Barbosa DA. Risk factors for colonization and infection by resistant microorganisms in kidney transplant recipients. Rev Bras Enferm 2021; 74Suppl 6:e20210219. [PMID: 34406267 DOI: 10.1590/0034-7167-2021-0219] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 05/13/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES to assess the prevalence of colonization and infection by multidrug-resistant bacteria in patients undergoing kidney transplantation and identify the rate of infection, morbidity and mortality and associated risk factors. METHODS a prospective cohort of 200 randomly included kidney transplant recipients. Epidemiological surveillance of the studied microorganisms was carried out in the first 24 hours and 7 days after transplantation. RESULTS ninety (45%) patients were considered colonized. Female sex, hypertension and diabetes (p<0.005), dialysis time (p<0.004), length of stay after transplantation, delayed renal function, and length of stay were identified as risk factors. The microorganisms were isolated from surgical site, bloodstream and urinary tract infections. CONCLUSIONS colonization by resistant microorganisms in kidney transplant patients was frequent and risk factors associated with infection were identified. The results should guide the care team in order to minimize morbidity and mortality related to infectious causes in this population.
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Affiliation(s)
- Monica Taminato
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil
| | - Richarlisson Borges de Morais
- Universidade Federal de São Paulo. São Paulo, São Paulo, Brazil.,Universidade Federal de Uberlândia. Uberlândia, Minas Gerais, Brazil
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4
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Lim JH, Kim CJ, Oh JH, Cho AY, Chang MO, Kim YS, Lee KY, Sun IO. Transplantation of a kidney from a donor with vancomycin-resistant Enterococci. KOREAN JOURNAL OF TRANSPLANTATION 2020; 34:114-116. [PMID: 35769352 PMCID: PMC9188926 DOI: 10.4285/kjt.2020.34.2.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/11/2020] [Accepted: 05/18/2020] [Indexed: 11/04/2022] Open
Abstract
The colonization of vancomycin-resistant Enterococci before and after solid organ transplantation is associated with an increased risk of its infection. The prevalence of these bacterial colonies in renal transplant recipients are as high as that in intensive care unit patients. However, it is unclear whether donors with vancomycin-resistant Enterococci colonization can be considered in renal transplantation. Herein, we report a case wherein a kidney was transplanted from a deceased donor with vancomycin-resistant Enterococci colonies in urine and rectal swab. After transplant, the recipient had no vancomycin-resistant Enterococci infection and maintained relatively good renal function.
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Affiliation(s)
- Ji Hye Lim
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Chan Jung Kim
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Ju Hwan Oh
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - A Young Cho
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Mi Ok Chang
- Division of Infection, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Young Suk Kim
- Department of Laboratory Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - Kwang Young Lee
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
| | - In O Sun
- Division of Nephrology, Department of Internal Medicine, Presbyterian Medical Center, Jeonju, Korea
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5
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Abstract
The prevalence of antimicrobial resistance among many common bacterial pathogens is increasing. The emergence and global dissemination of these antibiotic-resistant bacteria (ARB) is fuelled by antibiotic selection pressure, inter-organism transmission of resistance determinants, suboptimal infection prevention practices and increasing ease and frequency of international travel, among other factors. Patients with chronic kidney disease, particularly those with end-stage renal disease who require dialysis and/or kidney transplantation, have some of the highest rates of colonization and infection with ARB worldwide. These ARB include methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus spp. and several multidrug-resistant Gram-negative organisms. Antimicrobial resistance limits treatment options and increases the risk of infection-related morbidity and mortality. Several new antibiotic agents with activity against some of the most common ARB have been developed, but resistance to these agents is already emerging and highlights the dire need for new treatment options as well as consistent implementation and improvement of basic infection prevention practices. Clinicians involved in the care of patients with renal disease must be familiar with the local epidemiology of ARB, remain vigilant for the emergence of novel resistance patterns and adhere strictly to practices proven to prevent transmission of ARB and other pathogens.
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Affiliation(s)
- Tina Z Wang
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | | | - David P Calfee
- NewYork Presbyterian-Weill Cornell Medical Center, New York, NY, USA.
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York, NY, USA.
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6
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Infectious disease risks in pediatric renal transplantation. Pediatr Nephrol 2019; 34:1155-1166. [PMID: 29626241 DOI: 10.1007/s00467-018-3951-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/19/2018] [Accepted: 03/19/2018] [Indexed: 02/06/2023]
Abstract
Renal transplantation is a vital treatment option in children with ESRD with more than 10,000 pediatric kidney transplants and survival rates of greater than 80% at 10 years post-transplant in the USA alone. Despite these advances, infection remains a significant cause of morbidity in pediatric recipients. Screening potential organ donors and recipients is imperative to identify and mitigate infectious risks in the transplant patient. Despite the unique risks of each patient, the timing of many infections post-transplant is predictable. In early post-transplant infections (within 30 days), bacterial and fungal pathogens predominate with donor-derived events and nosocomial infections. In the intermediate period (31-180 days after transplant), latent infections from donor organs, such as EBV and CMV, develop. Late infections occurring > 180 days after the transplant can be due to latent pathogens or community-acquired organisms. Approaching an infectious evaluation in a pediatric kidney recipient requires finesse to diagnose and treat this vulnerable population in a timely manner. The following article highlights the most relevant and common infections including clinical manifestations, risk factors, diagnostic techniques, and treatment options.
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7
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Nellore A, Huprikar S. Vancomycin-resistant Enterococcus in solid organ transplant recipients: Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant 2019; 33:e13549. [PMID: 30913322 DOI: 10.1111/ctr.13549] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/19/2022]
Abstract
These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation address vancomycin-resistant enterococci (VRE) infections in SOT candidates and recipients. VRE are an important cause of infection and have been named by the CDC as a serious public threat. Typically, a commensal of the gastrointestinal tract, VRE may become pathogenic after abdominal organ manipulation like transplantation. This guideline reviews the microbiology, antimicrobial resistance mechanisms, epidemiology, and clinical manifestations of VRE infection in the context of solid organ transplantation. Treatment regimens including combination therapies and novel investigational agents are also reviewed. Finally, an updated appraisal of infection control measures relevant to VRE infection and colonization is presented.
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Affiliation(s)
- Anoma Nellore
- Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Shirish Huprikar
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Multidrug-Resistant Bacterial Infections in Solid Organ Transplant Candidates and Recipients. Infect Dis Clin North Am 2018; 32:551-580. [DOI: 10.1016/j.idc.2018.04.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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9
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Banach DB, Peaper DR, Fortune BE, Emre S, Dembry LM. The clinical and molecular epidemiology of pre-transplant vancomycin-resistant enterococci colonization among liver transplant recipients. Clin Transplant 2016; 30:306-11. [DOI: 10.1111/ctr.12690] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 02/01/2023]
Affiliation(s)
- David B. Banach
- Section of Infectious Diseases; Yale School of Medicine; New Haven CT USA
| | - David R. Peaper
- Department of Laboratory Medicine; Yale School of Medicine; New Haven CT USA
| | | | - Sukru Emre
- Yale-New Haven Transplantation Center; New Haven CT USA
| | - Louise M. Dembry
- Section of Infectious Diseases; Yale School of Medicine; New Haven CT USA
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10
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Kaveh M, Bazargani A, Ramzi M, Sedigh Ebrahim-Saraie H, Heidari H. Colonization Rate and Risk Factors of Vancomycin-Resistant Enterococci among Patients Received Hematopoietic Stem Cell Transplantation in Shiraz, Southern Iran. Int J Organ Transplant Med 2016; 7:197-205. [PMID: 28078058 PMCID: PMC5219580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Infections caused by antimicrobial-resistant bacteria are associated with increased mortality and health care costs. Enterococci have been recognized as a clinically important pathogen in hospitalized patients. Vancomycin-resistant enterococci (VRE) infections cause significant morbidity and mortality among patients undergoing transplantation. OBJECTIVE To identify epidemiology of VRE colonization and related risk factors among patients with hematological malignancies after hematopoietic stem cell transplantation (HSCT). METHODS This cross-sectional study was performed on 42 patients who underwent bone-marrow transplantation between July 2013 and March 2014. A stool sample was taken from each patient 3-5 days after transplantation and cultured on appropriate media. Suspected colonies of enterococci were detected to species level by their culture characteristics, biochemical reactions and molecular features. VRE were confirmed via phenotypic and genotypic methods. RESULTS VRE were detected in 14 (33%) of studied samples. 10 (71%) of the detected VRE isolates were identified as high level vancomycin-resistant E. faecium with minimum inhibitory concentration (MIC) of ≥256 μg/mL of vancomycin; 3 isolates were E. galinarum and 1 was E. casseliflavus with an MIC of 8-16 μg/mL. VanA was dominant phenotype and all VRE isolates with high-level of vancomycin resistance had vanA gene. VRE isolation was mostly observed in patients with acute lymphoblastic leukemia (ALL) than other diseases. Moreover, antibiotic prophylaxis and hospitalization were independent risk factors for acquisition of VRE after transplantation. CONCLUSION We found high level of vancomycin-resistance in E. faecium isolates obtained from HSCT patients. The vancomycin-resistant isolates of E.faecium had vanA and/or simultaneously vanB genes.
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Affiliation(s)
- M. Kaveh
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - A. Bazargani
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran,Correspondence: Abdollah Bazargani, Department of Bacteriology & Virology, School of Medicine, Shiraz University of Medical Sciences, Zand St, Imam Hossein Sq, Shiraz, Iran ,Tel/Fax: +98-713-230-4356, E-mail:
| | - M. Ramzi
- Hematology Research Center, Department of Hematology-Oncology and Stem Cell Transplantation, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Sedigh Ebrahim-Saraie
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - H. Heidari
- Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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11
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Stripling J, Kumar R, Baddley JW, Nellore A, Dixon P, Howard D, Ptacek T, Lefkowitz EJ, Tallaj JA, Benjamin WH, Morrow CD, Rodriguez JM. Loss of Vancomycin-Resistant Enterococcus Fecal Dominance in an Organ Transplant Patient With Clostridium difficile Colitis After Fecal Microbiota Transplant. Open Forum Infect Dis 2015; 2:ofv078. [PMID: 26180828 PMCID: PMC4498259 DOI: 10.1093/ofid/ofv078] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 06/01/2015] [Indexed: 12/20/2022] Open
Abstract
We report the use of fecal microbiota transplantation in a single heart-kidney transplant recipient with recurrent Clostridium difficile, vancomycin-resistant Enterococcus (VRE) fecal dominance, and recurrent VRE infections. Fecal microbiota transplantation resulted in the reconstruction of a diverse microbiota with (1) reduced relative abundance of C difficile and VRE and (2) positive clinical outcome.
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Affiliation(s)
| | | | | | - Anoma Nellore
- Division of Infectious Diseases, Department of Medicine
| | - Paula Dixon
- Division of Infectious Diseases, Department of Medicine
| | | | | | | | | | | | - Casey D Morrow
- Department of Cell, Developmental and Integrative Biology , University of Alabama at Birmingham
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12
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Maldonado AQ, Tichy EM, Rogers CC, Campara M, Ensor C, Doligalski CT, Gabardi S, Descourouez JL, Doyle IC, Trofe-Clark J. Assessing pharmacologic and nonpharmacologic risks in candidates for kidney transplantation. Am J Health Syst Pharm 2015; 72:781-93. [DOI: 10.2146/ajhp140476] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Affiliation(s)
| | - Eric M. Tichy
- Department of Pharmacy, Yale–New Haven Hospital, New Haven, CT
| | - Christin C. Rogers
- Department of Pharmacy, Beth Israel Deaconess Medical Center, Boston, MA
| | - Maya Campara
- Department of Pharmacy, University of Illinois at Chicago
| | | | | | - Steven Gabardi
- Departments of Transplant Surgery and Pharmacy and Renal Division, Brigham and Women’s Hospital, Boston, MA
| | | | - Ian C. Doyle
- School of Pharmacy, Pacific University, Hillsboro, OR
| | - Jennifer Trofe-Clark
- Department of Pharmacy Services, Hospital of the University of Pennsylvania, Philadelphia, and Adjunct Associate Professor, Renal Electrolyte and Hypertension Division, Perelman School of Medicine, University of Pennsylvania
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13
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Ziakas PD, Pliakos EE, Zervou FN, Knoll BM, Rice LB, Mylonakis E. MRSA and VRE colonization in solid organ transplantation: a meta-analysis of published studies. Am J Transplant 2014; 14:1887-94. [PMID: 25040438 DOI: 10.1111/ajt.12784] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 03/27/2014] [Accepted: 04/13/2014] [Indexed: 01/25/2023]
Abstract
The burden of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) colonization among the increasing number of solid organ transplant patients has not been systematically explored. We searched PubMed and EMBASE for pertinent articles, performed a meta-analysis of prevalence across eligible studies and estimated the risk of ensuing MRSA or VRE infections relative to colonization status. We stratified effects in the pretransplant and posttransplant period. Twenty-three studies were considered eligible. Seventeen out of 23 (74%) referred to liver transplants. Before transplantation, the pooled prevalence estimate for MRSA and VRE was 8.5% (95% confidence interval [CI] 3.2–15.8) and 11.9% (95% CI 6.8–18.2), respectively. MRSA estimate was influenced by small studies and was lower (4.0%; 95% CI 0.4–10.2) across large studies (>200 patients). After transplantation, the prevalence estimates were 9.4% (95% CI 3.0–18.5) for MRSA and 16.2% (95% CI 10.7–22.6) for VRE. Pretransplant as well as posttransplant MRSA colonization significantly increased the risk for MRSA infections (pooled risk ratio [RR] 5.51; 95% CI 2.36–12.90 and RR 10.56; 95% CI 5.58–19.95, respectively). Pretransplant and posttransplant VRE colonization were also associated with significant risk of VRE infection (RR 6.65; 95% CI 2.54–17.41 and RR 7.93; 95% CI 2.36–26.67, respectively). Solid organ transplantation is a high-risk setting for MRSA and VRE colonization, and carrier state is associated with infection. Upgraded focus in prevention and eradication strategies is warranted.
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Zacharioudakis IM, Zervou FN, Ziakas PD, Rice LB, Mylonakis E. Vancomycin-resistant enterococci colonization among dialysis patients: a meta-analysis of prevalence, risk factors, and significance. Am J Kidney Dis 2014; 65:88-97. [PMID: 25042816 DOI: 10.1053/j.ajkd.2014.05.016] [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: 02/18/2014] [Accepted: 05/30/2014] [Indexed: 02/04/2023]
Abstract
BACKGROUND Vancomycin-resistant enterococci (VRE) have become important nosocomial pathogens causing outbreaks worldwide. Patients undergoing dialysis represent a vulnerable population due to their comorbid conditions, frequent use of antibacterial agents, and frequent contact with health care settings. STUDY DESIGN Systematic review and meta-analysis of cross-sectional studies of screening for VRE colonization. SETTING & POPULATION Patients receiving long-term dialysis treatment. SELECTION CRITERIA FOR STUDIES We performed a systematic literature search of PubMed and EMBASE databases to identify studies performing screening for VRE colonization among dialysis patients. PREDICTOR Region, recent use of vancomycin or other antibiotics, previous hospitalization. OUTCOMES (1) VRE colonization and (2) rate of VRE infection among colonized and noncolonized individuals. Relative effects were expressed as ORs and 95% CIs. RESULTS We identified 23 studies that fulfilled the inclusion criteria and provided data for 4,842 dialysis patients from 100 dialysis centers. The pooled prevalence of VRE colonization was 6.2% (95% CI, 2.8%-10.8%), with significant variability between centers. The corresponding number for North American centers was 5.2% (95% CI, 2.8%-8.2%). Recent use of any antibiotic (OR, 3.62; 95% CI, 1.22-10.75), particularly vancomycin (OR, 5.15; 95% CI, 1.56-17.02), but also use of antibiotics other than vancomycin (OR, 2.92; 95% CI, 0.99-8.55) and recent hospitalization (OR, 4.55; 95% CI, 1.93-10.74) significantly increased the possibility of a VRE-positive surveillance culture. Colonized patients had a significantly higher risk of VRE infection (OR, 21.62; 95% CI, 5.33-87.69) than their noncolonized counterparts. LIMITATIONS In 19 of 23 studies, a low percentage of dialysis patients (<80%) consented to participate in the screening procedure. 4 of 8 studies in which patients were followed up for more than 1 month reported VRE infections and only 5 of 23 studies provided extractable data for antibiotic consumption prior to screening. CONCLUSIONS VRE colonization is prevalent in dialysis centers. Previous antibiotic use, in particular vancomycin, and recent hospitalization are important predicting factors of colonization, whereas the risk of VRE infection is significantly higher for colonized patients.
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Affiliation(s)
- Ioannis M Zacharioudakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Fainareti N Zervou
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Panayiotis D Ziakas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Louis B Rice
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI.
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15
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Bucheli E, Kralidis G, Boggian K, Cusini A, Garzoni C, Manuel O, Meylan PRA, Mueller NJ, Khanna N, van Delden C, Berger C, Koller MT, Weisser M. Impact of enterococcal colonization and infection in solid organ transplantation recipients from the Swiss transplant cohort study. Transpl Infect Dis 2013; 16:26-36. [PMID: 24330137 DOI: 10.1111/tid.12168] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/14/2013] [Accepted: 05/14/2013] [Indexed: 12/14/2022]
Abstract
BACKGROUND The burden of enterococcal infections has increased over the last decades with vancomycin-resistant enterococci (VRE) being a major health problem. Solid organ transplantation is considered as a risk factor. However, little is known about the relevance of enterococci in solid organ transplantation recipients in areas with a low VRE prevalence. METHODS We examined the epidemiology of enterococcal events in patients followed in the Swiss Transplant Cohort Study between May 2008 and September 2011 and analyzed risk factors for infection, aminopenicillin resistance, treatment, and outcome. RESULTS Of the 1234 patients, 255 (20.7%) suffered from 392 enterococcal events (185 [47.2%] infections, 205 [52.3%] colonizations, and 2 events with missing clinical information). Only 2 isolates were VRE. The highest infection rates were found early after liver transplantation (0.24/person-year) consisting in 58.6% of Enterococcus faecium. The highest colonization rates were documented in lung transplant recipients (0.33/person-year), with 46.5% E. faecium. Age, prophylaxis with a betalactam antibiotic, and liver transplantation were significantly associated with infection. Previous antibiotic treatment, intensive care unit stay, and lung transplantation were associated with aminopenicillin resistance. Only 4/205 (2%) colonization events led to an infection. Adequate treatment did not affect microbiological clearance rates. Overall mortality was 8%; no deaths were attributable to enterococcal events. CONCLUSIONS Enterococcal colonizations and infections are frequent in transplant recipients. Progression from colonization to infection is rare. Therefore, antibiotic treatment should be used restrictively in colonization. No increased mortality because of enterococcal infection was noted.
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Affiliation(s)
- E Bucheli
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
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16
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Patel G, Rana MM, Huprikar S. Multidrug-resistant bacteria in organ transplantation: an emerging threat with limited therapeutic options. Curr Infect Dis Rep 2013; 15:504-13. [PMID: 24101302 DOI: 10.1007/s11908-013-0371-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Multidrug-resistant organisms (MDROs) are an emerging threat in solid organ transplantation (SOT). The changing epidemiology of these MDROs is reviewed along with the growing evidence regarding risk factors and outcomes associated with both colonization and infection in SOT. The management of these infections is complicated by the lack of antimicrobial agents available to treat these infections, and only a handful of new agents, especially for the treatment of MDR GNR infections, are being evaluated in clinical trials. Due to the increased prevalence of MDROs and limited treatment options, as well as organ shortages, transplant candidacy and use of organs from donors with evidence of MDRO colonization and/or infection remain controversial. Increasing collaboration between transplant programs, individual practitioners, infection control programs, and researchers in antimicrobial development will be needed to face this challenge.
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Affiliation(s)
- Gopi Patel
- Division of Infectious Diseases, Department of Medicine, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1090, New York, NY, 10029, USA,
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Patel G, Snydman DR. Vancomycin-resistant Enterococcus infections in solid organ transplantation. Am J Transplant 2013; 13 Suppl 4:59-67. [PMID: 23464999 DOI: 10.1111/ajt.12099] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- G Patel
- Division of Infectious Diseases, Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
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18
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Tuon FF, Penteado-Filho SR, Camilotti J, van der Heijden IM, Costa SF. Outbreak of vancomycin-resistant Enterococcus in a renal transplant unit. Braz J Infect Dis 2011. [DOI: 10.1016/s1413-8670(11)70216-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Oliveira AC, Bettcher L. [Epidemiological aspects of the occurrence of vancomycin-resistant enterococci]. Rev Esc Enferm USP 2010; 44:725-31. [PMID: 20964050 DOI: 10.1590/s0080-62342010000300025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This descriptive study was conducted in a public hospital from May 2005 to October 2007, with the purpose to determine the epidemiological aspects that involve vancomycin-resistant enterococci (VRE) and describe the evolution of patients. The data was obtained from registers on patient records and then processed in SPSS. Frequency distribution and measures of central tendency were used. A total 122 patients participated of the study, the majority were males with an average age of 43 years (SD = 18.8), and 16.3% developed VRE infection. Vancomycin has been the most used antibiotic (62.3%), 97.5% used invasive procedures, 45.0% were dependent on intensive care nursing, 77.9% had at least one open wound and 50.8% progressed to death. The data suggests that recommendations for bacterial resistance control should be encouraged to reduce mortality, morbidity, hospital costs and thus provide better quality care to patients.
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Estudio del primer brote por Enterococcus faecium vanA en Canarias. Enferm Infecc Microbiol Clin 2010; 28:430-4. [DOI: 10.1016/j.eimc.2009.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Revised: 11/10/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022]
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21
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Fram D, Castrucci FM, Taminato M, Godoy-Martinez P, Freitas MCS, Belasco A, Sesso R, Pacheco-Silva A, Pignatari AC, Barbosa D. Cross-transmission of vancomycin-resistant Enterococcus in patients undergoing dialysis and kidney transplant. Braz J Med Biol Res 2009; 43:115-9. [PMID: 19967262 DOI: 10.1590/s0100-879x2009007500023] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2009] [Accepted: 11/16/2009] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to investigate the occurrence of vancomycin-resistant Enterococcus (VRE) cross-transmission between two patient groups (long-term dialysis and kidney transplant patients). Molecular typing, by automated ribotyping with the RiboPrinter Microbial Characterization System (Qualicon, USA), was used to analyze VRE isolates from 31 fecal samples of 320 dialysis patients and 38 fecal samples of 280 kidney transplant patients. Clonal spread of E. faecalis and E. casseliflavus was observed intragroup, but not between the two groups of patients. In turn, transmission of E. gallinarum and E. faecium between the groups was suggested by the finding of vancomycin-resistant isolates belonging to the same ribogroup in both dialysis and transplant patients. The fact that these patients were colonized by VRE from the same ribogroup in the same health care facility provides evidence for cross-transmission and supports the adoption of stringent infection control measures to prevent dissemination of these bacteria.
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Affiliation(s)
- D Fram
- Departamento de Enfermagem, Universidade Federal de São Paulo, São Paulo, SP, Brasil
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22
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Muñoz P. Multiply resistant gram-positive bacteria: vancomycin-resistant enterococcus in solid organ transplant recipients. Am J Transplant 2009; 9 Suppl 4:S50-6. [PMID: 20070695 DOI: 10.1111/j.1600-6143.2009.02893.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- P Muñoz
- Clinical Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
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Młynarczyk G, Grzybowska W, Młynarczyk A, Tyski S, Kawecki D, Łuczak M, Durlik M, Pączek L, Chmura A, Rowiński W. Occurrence of Glycopeptide-Resistant Enterococci in Transplant Medicine Internal Wards in 2001–2005. Transplant Proc 2007; 39:2886-9. [DOI: 10.1016/j.transproceed.2007.08.072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Strategies for the prevention of infectious complications after renal transplantation. Curr Opin Organ Transplant 2007. [DOI: 10.1097/mot.0b013e3282435e3f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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