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Gompelman M, Wezendonk GTJ, Wouters Y, Beurskens-Meijerink J, Fragkos KC, Rahman FZ, Coolen JPM, van Weerdenburg IJM, Wertheim HFL, Kievit W, Akkermans RP, Serlie MJ, Bleeker-Rovers CP, Wanten GJA. Randomized clinical trial: Long-term Staphylococcus aureus decolonization in patients on home parenteral nutrition. Clin Nutr 2023; 42:706-716. [PMID: 36965196 DOI: 10.1016/j.clnu.2023.03.010] [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: 11/01/2022] [Revised: 03/01/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND & AIMS Staphylococcus aureus decolonization has proven successful in prevention of S. aureus infections and is a key strategy to maintain venous access and avoid hospitalization in patients receiving home parenteral nutrition (HPN). We aimed to determine the most effective and safe long-term S. aureus decolonization regimen. METHODS A randomized, open-label, multicenter clinical trial was conducted. Adult intestinal failure patients with HPN support and carrying S. aureus were randomly assigned to a 'continuous suppression' (CS) strategy, a repeated chronic topical antibiotic treatment or a 'search and destroy' (SD) strategy, a short and systemic antibiotic treatment. Primary outcome was the proportion of patients in whom S. aureus was totally eradicated during a 1-year period. Secondary outcomes included risk factors for decolonization failure and S. aureus infections, antimicrobial resistance, adverse events, patient compliance and cost-effectivity. RESULTS 63 participants were included (CS 31; SD 32). The mean 1-year S. aureus decolonization rate was 61% (95% CI 44, 75) for the CS group and 39% (95% CI 25, 56) for the SD group with an OR of 2.38 (95% CI 0.92, 6.11, P = 0.07). More adverse effects occurred in the SD group (P = 0.01). Predictors for eradication failure were a S. aureus positive caregiver and presence of a (gastro)enterostomy. CONCLUSION We did not demonstrate an increased efficacy of a short and systemic S. aureus decolonization strategy over a continuous topical suppression treatment. The latter may be the best option for HPN patients as it achieved a higher long-term decolonization rate and was well-tolerated (NCT03173053).
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Affiliation(s)
- Michelle Gompelman
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Guus T J Wezendonk
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Yannick Wouters
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Judith Beurskens-Meijerink
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Konstantinos C Fragkos
- Intestinal Failure Service, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Farooq Z Rahman
- Intestinal Failure Service, Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Jordy P M Coolen
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid J M van Weerdenburg
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Heiman F L Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Wietske Kievit
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Reinier P Akkermans
- Radboud Institute for Health Sciences, Department for Health Evidence, Radboud University Medical Centre, Nijmegen, the Netherlands; Department of Primary and Community Care, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Mireille J Serlie
- Department of Endocrinology and Metabolism, Amsterdam University Medical Centers, Location Academic Medical Center, Amsterdam, the Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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2
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Bezerra DT, La Selva A, Cecatto RB, Deana AM, Prates RA, Bussadori SK, Mesquita-Ferrari RA, Motta LJ, Fernandes KPS, Martimbianco ALC, Frochot C, Pereira BJ, Rossi F, Mimica MJ, Horliana ACRT. Antimicrobial Photodynamic Therapy in the Nasal Decolonization of Maintenance Hemodialysis Patients: A Pilot Randomized Trial. Am J Kidney Dis 2022; 81:528-536.e1. [PMID: 36396084 DOI: 10.1053/j.ajkd.2022.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 09/11/2022] [Indexed: 11/16/2022]
Abstract
RATIONALE & OBJECTIVE Infections are an important cause of mortality among patients receiving maintenance hemodialysis. Staphylococcus aureus is a frequent etiological agent, and previous nasal colonization is a risk factor for infection. Repeated antimicrobial decolonization reduces infection in this population but can induce antibiotic resistance. We compared photodynamic therapy, a promising bactericidal treatment that does not induce resistance, to mupirocin treatment among nasal carriers of S aureus. STUDY DESIGN Randomized controlled pilot study. SETTING & PARTICIPANTS 34 patients receiving maintenance hemodialysis who had nasal carriage of S aureus. INTERVENTIONS Patients were randomly assigned to decolonization with a single application of photodynamic therapy (wavelength of 660nm, 400mW/cm2, 300 seconds, methylene blue 0.01%) or with a topical mupirocin regimen (twice a day for 5 days). OUTCOME Nasal swabs were collected at time 0 (when the carrier state was identified), directly after treatment completion, 1 month after treatment, and 3 months after treatment. Bacterial isolates were subjected to proteomic analysis to identify the species present, and antimicrobial susceptibility was characterized. RESULTS All 17 participants randomized to photodynamic therapy and 13 of 17 (77%) randomized to mupirocin were adherent to treatment. Directly after treatment was completed, 12 participants receiving photodynamic therapy (71%) and 13 participants treated with mupirocin (77%) had cultures that were negative for S aureus (risk ratio, 0.92 [95% CI, 0.61-1.38]; P=0.9). Of the patients who had negative cultures directly after completion of photodynamic therapy, 67% were recolonized within 3 months. There were no adverse events in the photodynamic therapy group. LIMITATIONS Testing was restricted to assessing nasal colonization; infectious complications were not assessed. CONCLUSIONS Photodynamic therapy is a feasible approach to treating nasal carriage of S aureus. Future larger studies should be conducted to determine whether photodynamic therapy is equivalent to the standard of care with mupirocin. FUNDING Government grant (National Council for Scientific and Technological Development process 3146682020-9). TRIAL REGISTRATION Registered at ClinicalTrials.gov with study number NCT04047914.
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Affiliation(s)
- Daniella Teixeira Bezerra
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Andreia La Selva
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Rebeca Boltes Cecatto
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Alessandro Melo Deana
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Renato Araujo Prates
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Sandra Kalil Bussadori
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil; Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Raquel Agnelli Mesquita-Ferrari
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil; Postgraduate Program in Rehabilitation Sciences, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Lara Jansiski Motta
- Postgraduate Program in Biophotonics Applied to Health Sciences, University Nove de Julho (UNINOVE), São Paulo, Brazil
| | | | | | - Céline Frochot
- Le Laboratoire Réactions et Génie des Procédés, University of Lorraine, CNRS, Nancy, France
| | - Benedito Jorge Pereira
- Renal Division, Internal Medicine, Clinical Hospital, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Flávia Rossi
- Clinical Microbiology Laboratory, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil
| | - Marcelo Jenne Mimica
- Discipline of Microbiology, Department of Pathological Sciences, Santa Casa de São Paulo School of Medicine, São Paulo, Brazil
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3
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Techasupaboon T, Vasikasin V, Varothai N, Raknaisil N, Nasomsong W. Staphylococcus aureus nasal carriage and bloodstream infection among conventional hemodialysis patients in Thailand: a prospective multicenter cohort study. BMC Res Notes 2022; 15:290. [PMID: 36068640 PMCID: PMC9450322 DOI: 10.1186/s13104-022-06185-y] [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: 06/06/2022] [Accepted: 08/27/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Staphylococcus aureus nasal carriage screening among hemodialysis patients is not standard practice in Thailand, because of data lacking regarding prevalence and correlation with subsequent infection. We aimed to investigate the prevalence of S. aureus nasal carriage and its association with bloodstream infection among hemodialysis patients. In this prospective multicenter cohort study, participants were screened for S. aureus nasal carriage over 2 consecutive weeks. Incidence of S. aureus bloodstream infection over the next 12 months was observed. Results The prevalence of S. aureus nasal carriage was 11.67%. Incidence of S. aureus bacteremia among participants with and without S. aureus nasal carriage were 7.1% and 3.8%, respectively. The odds ratio for nasal carriage and subsequent bacteremia was 1.96 (95% CI 0.04–21.79; p = 0.553). Survival analysis showed that time to bacteremia among participants in the two groups did not significantly differ (p = 0.531). Prevalence of S. aureus nasal carriage among hemodialysis patients in Thailand was low. Patients presenting with S. aureus nasal carriage did not have increased risk of S. aureus bacteremia after 12-month follow-up. Nasal S. aureus screening and decolonization should not be encouraged in this setting. Supplementary Information The online version contains supplementary material available at 10.1186/s13104-022-06185-y.
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Affiliation(s)
- Tanyanop Techasupaboon
- Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Vasin Vasikasin
- Department of Internal Medicine, Ananda Mahidol Hospital, Lopburi, Thailand.,Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Narittaya Varothai
- Division of Nephrology, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Navee Raknaisil
- Department of Internal Medicine, Ananda Mahidol Hospital, Lopburi, Thailand
| | - Worapong Nasomsong
- Division of Infectious Disease, Department of Internal Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, 10400, Thailand.
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Salgado BAB, Waters EM, Moran JC, Kadioglu A, Horsburgh MJ. Selection of Staphylococcus aureus in a murine nasopharyngeal colonization model. Front Cell Infect Microbiol 2022; 12:874138. [PMID: 35992161 PMCID: PMC9386156 DOI: 10.3389/fcimb.2022.874138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Staphylococcus aureus nasal colonization is a risk factor for infection. A large proportion of the population are identified as potential S. aureus carriers yet we only partially understand the repertoire of genetic factors that promote long-term nasal colonization. Here we present a murine model of nasopharyngeal colonization that requires a low S. aureus inoculum and is amenable to experimental evolution approaches. We used this model to experimentally evolve S. aureus using successive passages in the nasopharynx to identify those genetic loci under selection. After 3 cycles of colonization, mutations were identified in mannitol, sorbitol, arginine, nitrite and lactate metabolism genes promoting key pathways in nasal colonization. Stress responses were identified as being under selective pressure, with mutations in DNA repair genes including dnaJ and recF and key stress response genes clpL, rpoB and ahpF. Peptidoglycan synthesis pathway genes also revealed mutations indicating potential selection for alteration of the cell surface. The murine model used here is versatile to question colonization, persistence and evolution studies. We studied the human pathogen Staphylococcus aureus in our search to determine factors that contribute to its ability to live in the human nose and throat. The anterior nares and nasopharynx are considered primary habitats but we do not understand how the pathogen adapts as it moves from one person to the next. We first determined sustained survival of the pathogen over multiple days in the nasopharynx that might act as a good model for human persistence due to the low numbers of bacteria needed for it to establish. By using successive rounds of colonization of the nasopharynx across different mice we revealed that multiple genetic changes in the S. aureus occurred. These changes were found in genes associated with the cell surface and metabolism and might indicate adaptation to the niche. One gene showed an accumulation of multiple mutations supporting a key contribution in adaptation but the role of the protein it encodes is not yet known. The contribution of these genes and genetic changes are unclear but indicate an area for future research to better understand how this common human pathogen is so successful at human colonization and survival.
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5
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Costa CFFA, Merino-Ribas A, Ferreira C, Campos C, Silva N, Pereira L, Garcia A, Azevedo Á, Mesquita RBR, Rangel AOSS, Manaia CM, Sampaio-Maia B. Characterization of Oral Enterobacteriaceae Prevalence and Resistance Profile in Chronic Kidney Disease Patients Undergoing Peritoneal Dialysis. Front Microbiol 2022; 12:736685. [PMID: 34970231 PMCID: PMC8713742 DOI: 10.3389/fmicb.2021.736685] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022] Open
Abstract
Chronic Kidney Disease (CKD) is a growing public-health concern worldwide. Patients exhibit compromised immunity and are more prone to infection than other populations. Therefore, oral colonization by clinically relevant members of the Enterobacteriaceae family, major agents of both nosocomial and dialysis-associated infections with frequent prevalence of antibiotic resistances, may constitute a serious risk. Thus, this study aimed to assess the occurrence of clinically relevant enterobacteria and their antibiotic resistance profiles in the oral cavity of CKD patients undergoing peritoneal dialysis (CKD-PD) and compare it to healthy controls. Saliva samples from all the participants were cultured on MacConkey Agar and evaluated regarding the levels of urea, ammonia, and pH. Bacterial isolates were identified and characterized for antibiotic resistance phenotype and genotype. The results showed that CKD-PD patients exhibited significantly higher salivary pH, urea, and ammonia levels than controls, that was accompanied by higher prevalence and diversity of oral enterobacteria. Out of all the species isolated, only the prevalence of Raoultella ornithinolytica varied significantly between groups, colonizing the oral cavity of approximately 30% of CKD-PD patients while absent from controls. Antibiotic resistance phenotyping revealed mostly putative intrinsic resistance phenotypes (to amoxicillin, ticarcillin, and cephalothin), and resistance to sulfamethoxazole (~43% of isolates) and streptomycin (~17%). However, all isolates were resistant to at least one of the antibiotics tested and multidrug resistance isolates were only found in CKD-PD group (31,6%). Mobile genetic elements and resistance genes were detected in isolates of the species Raoultella ornithinolytica, Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, and Enterobacter asburiae, mostly originated from CKD-PD patients. PD-related infection history revealed that Enterobacteriaceae were responsible for ~8% of peritonitis and ~ 16% of exit-site infections episodes in CKD-PD patients, although no association was found to oral enterobacteria colonization at the time of sampling. The results suggest that the CKD-induced alterations of the oral milieu might promote a dysbiosis of the commensal oral microbiome, namely the proliferation of clinically relevant Enterobacteriaceae potentially harboring acquired antibiotic resistance genes. This study highlights the importance of the oral cavity as a reservoir for pathobionts and antibiotic resistances in CKD patients undergoing peritoneal dialysis.
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Affiliation(s)
- Carolina F F A Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal.,Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Ana Merino-Ribas
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Nephrology Department, Hospital Universitari Doctor Josep Trueta, Girona, Spain
| | - Catarina Ferreira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Carla Campos
- Instituto Português de Oncologia do Porto Francisco Gentil (IPO), Porto, Portugal
| | - Nádia Silva
- Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Luciano Pereira
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Nephrology Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - Andreia Garcia
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Álvaro Azevedo
- Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Raquel B R Mesquita
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - António O S S Rangel
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Célia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Benedita Sampaio-Maia
- Nephrology & Infectious Diseases R&D Group, INEB - Instituto de Engenharia Biomédica, i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,Faculdade de Medicina Dentária, Universidade do Porto, Porto, Portugal
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6
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Crowe K, White B, Khanna N, Cooke B, Kingsmore DB, Jackson A, Stevenson KS, Kasthuri R, Thomson PC. Epidemiology of bloodstream infections in a Scottish haemodialysis population with focus on vascular access method. J Hosp Infect 2021; 110:37-44. [PMID: 33484781 DOI: 10.1016/j.jhin.2021.01.008] [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: 08/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Infection is the second highest cause of mortality in end-stage renal disease, with a significant proportion relating to haemodialysis (HD) vascular access-related infection (VARI). AIM To report the rate and antimicrobial resistance (AMR) of all-source bloodstream infections (BSIs) by vascular access type in a Scottish HD cohort. METHODS Retrospective analysis was undertaken of data on adult patients attending seven HD units during 2017. Total HD days for each vascular access type were calculated. BSIs were analysed with rates expressed per 1000 HD days. AMR was verified using health board microbiology databases. FINDINGS Excluding contaminant organisms, there was an overall BSI rate of 0.57 per 1000 HD days. The highest all-source and vascular access-related infection (VARI) BSI rates per 1000 HD days were in the non-tunnelled central venous catheter (CVC) group (3.11 and 2.07 respectively), followed by tunnelled CVC (1.10 and 0.67), arteriovenous graft (0.51 and 0.31), and finally arteriovenous fistula (0.29 and 0.02). The non-VARI BSI rates were lowest in the arteriovenous graft group. Staphylococci comprised the majority of events, with Staphylococcus aureus implicated in 29%. Gram-negative BSIs were prevalent, particularly in CVC groups, and associated with higher mortality. Multidrug-resistant (MDR) S. aureus and carbapenem resistance were relatively low. MDR Gram-negatives were high compared with the Scottish population. CONCLUSION Arteriovenous fistula access is confirmed as having lowest all-source and VARI BSI rates, and arteriovenous graft access the lowest non-VARI BSI rates. Staphylococci remain the prevailing genus; however, the contributions of Gram-negative BSIs, the higher mortality, and proportion of MDR organisms in this group are notable.
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Affiliation(s)
- K Crowe
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - B White
- Queen Elizabeth University Hospital, Glasgow, UK
| | - N Khanna
- Queen Elizabeth University Hospital, Glasgow, UK
| | - B Cooke
- Forth Valley Royal Hospital, Larbert, UK
| | | | - A Jackson
- Queen Elizabeth University Hospital, Glasgow, UK
| | | | - R Kasthuri
- Queen Elizabeth University Hospital, Glasgow, UK
| | - P C Thomson
- Queen Elizabeth University Hospital, Glasgow, UK
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7
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Lin L, Ke ZY, Wang Y, Chen XL, Zhong D, Cheng S. Efficacy of preoperative screening and decolonization for staphylococcus aureus in total joint arthroplasty: A meta-analysis. Asian J Surg 2021; 44:807-818. [PMID: 33468375 DOI: 10.1016/j.asjsur.2020.12.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 01/11/2023] Open
Abstract
The purpose of this study is to conduct a meta-analysis to evaluate the efficacy of screening and decolonization protocol for Staphylococcus aureus (SA) in total joint arthroplasty (TJA). We systematically searched the electronic databases of PubMed, Embase and Cochrane databases for relevant literatures from January 2000 to September 2020. The outcomes were colonization rate, total-surgical site infection (SSI) rate, SA-SSI rate and methicillin-resistant Staphylococcus aureus (MRSA)-SSI rate. All calculations and statistical tests were performed using Stata 14.0 software. A total of 12 studies were eligible in this study. Compared with control group, the screening and decolonization group had lower risks in total-SSI (risk ratio (RR) = 0.52; 95% confidence interval (CI): 0.40-0.67), SA-SSI (RR = 0.48; 95% CI: 0.32-0.72) and MRSA-SSI (RR = 0.45; 95% CI: 0.21-0.96). The nasal SA colonization was found to be associated with higher accidences of SSI involving total-SSI (RR = 1.49; 95% CI: 1.02-2.18), SA-SSI (RR = 2.51; 95% CI: 0.97-6.50) and MRSA-SSI (RR = 7.84; 95% CI: 1.67-36.79). The colonization rate of SA was significantly reduced after decolonization. No difference was observed between universal decolonization and screening-based decolonization. In conclusion, colonization of SA is associated with increased risk of SSI in TJA. Screening and decolonization protocol are proven to be effective to reduce colonization of SA and present protective effects against SSI in TJA. Moreover, universal decolonization protocol is non-inferior to screening-based decolonization.
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Affiliation(s)
- Lu Lin
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhen-Yong Ke
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yang Wang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xiao-Lin Chen
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Dian Zhong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Si Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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8
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Gompelman M, Wertheim HFL, Bleeker-Rovers CP, Wanten GJA. Eradication of Staphylococcus aureus colonization by chronic use of mupirocin in patients on home parenteral nutrition. Nutrition 2020; 81:110985. [PMID: 33059128 DOI: 10.1016/j.nut.2020.110985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/08/2020] [Accepted: 08/19/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES Although in other groups Staphylococcus aureus eradication has proven to be an effective infection prevention measure, to our knowledge, no such studies have been performed in patients on home parenteral nutrition (HPN). The aim of this study was to investigate the efficacy of chronic nasal mupirocin use on S. aureus eradication and prevention of catheter related infections in patients on HPN. METHODS This was a cohort study with data collected from adult patients on HPN who were screened for S. aureus carriage. In case of carriage, the patient was instructed to apply mupirocin nasal ointment monthly. Outcomes were the percentage of successful S. aureus eradication and the effect on the incidence of catheter-related infections and development of mupirocin resistance. RESULTS S. aureus nasal carriage was found in 54% of the patients. Eradication was successful in 66% (70 of 106) of patients treated with mupirocin. Overall S. aureus catheter-related infection rates decreased by 50% (P = 0.02). The decrease was mostly due to a drop in central line-associated bloodstream infection (CLABSI) rates (0.26versus 0.1 per 1000 central venous catheter days; P = 0.04). The overall CLABSI rates decreased as well (incidence ratio rate, 0.43; 95% confidence interval. 0.24-0.76; P < 0.01). Low-level mupirocin resistance was observed in four patients. CONCLUSIONS Findings from the present study highlighted the potential usefulness of mupirocin ointment prophylaxis to establish S. aureus eradication in patients on HPN. However, awareness for the development of mupirocin resistance is prudent. Further research needs to be carried out to validate these findings.
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Affiliation(s)
- Michelle Gompelman
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - Heiman F L Wertheim
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Chantal P Bleeker-Rovers
- Department of Internal Medicine, Division of Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Geert J A Wanten
- Intestinal Failure Unit, Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, the Netherlands
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9
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Incidence and risk factors of sepsis in hemodialysis patients in the United States. J Vasc Surg 2020; 73:1016-1021.e3. [PMID: 32707386 DOI: 10.1016/j.jvs.2020.06.126] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/26/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Sepsis is one the most serious and life-threatening complication in patients with chronic hemodialysis (HD) access. Arteriovenous fistula (AVF) use is associated with a lower risk of infection. However, several prior studies identified significantly higher number of patients initiating HD using a catheter (HC) or arteriovenous graft (AVG). The aim of this study was to use a large national renal database to report the incidence and risk factors of sepsis in patients with end-stage renal disease (ESRD) initiating HD access using AVF, AVG, or HC in the United States. METHODS All patients with ESRD initiating HD access (AVF, AVG, HC) between January 1, 2006, and December 31, 2014, in United States Renal Data System were included. International Classification of Diseases, 9th edition-Clinical Modification diagnosis code (038x, 790.7) was used to identify patients who developed first onset of sepsis during follow-up. Standard univariate (Students t-test, χ2, and Kaplan-Meier) and multivariable (logistic/Cox regression) analyses were performed as appropriate. RESULTS A total of 870,571 patients were identified, of whom, 29.8% (n = 259,686) developed sepsis. HC (31.2%) and AVG (30.6%) were associated with a higher number of septic cases compared with AVF (22.9%; P < .001). The incident rate of sepsis was 12.66 episodes per 100 person-years. It was the highest among HC vs AVG vs AVF (13.86 vs 11.49 vs 8.03 per 100 person-years). Patients with sepsis were slightly older (mean age 65.09 ± 14.49 years vs 63.24 ± 15.17 years) and had higher number of comorbidities including obesity (40.7% vs 37.7%), congestive heart failure (36.6% vs 30.8%), peripheral arterial disease (15.6% vs 12.4%), and diabetes (59.6% vs 53.5%) (all P < .001). After adjusting for potential confounders, compared with AVF, patients with AVG (hazard ratio [HR], 1.35 [95% confidence interval [CI], 1.31-1.40) and HC (HR, 1.80 [95% CI, 1.77-1.84) were more likely to develop sepsis at 3 years (both P < .001). Compared with patients with no sepsis, sepsis was associated with a three-fold increase the odds of mortality (odds ratio, 3.16; 95% CI, 3.11-3.21; P < .001). Additionally, in patients who developed sepsis, AVF use was associated with significantly lower mortality compared with AVG and HC (73.7% vs 78.7% vs 78.0%; P < .001). After adjusting for significant covariates, compared with AVF, mortality at 1 year after sepsis was 21% higher in AVG (HR, 1.21; 95% CI, 1.15-1.28; P < .001) and nearly doubled in HC (HR, 1.94; 95% CI, 1.88-2.00; P < .001). CONCLUSIONS Sepsis risk in HD patients is clearly related to access type and is associated with dramatic increase in mortality. Initiating HD access with AVF to meet the National Kidney Foundation Kidney Disease Outcomes Quality recommendations should be implemented to reduce the incidence of sepsis and improve survival in patients with ESRD.
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10
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Troeman DPR, Van Hout D, Kluytmans JAJW. Antimicrobial approaches in the prevention of Staphylococcus aureus infections: a review. J Antimicrob Chemother 2020; 74:281-294. [PMID: 30376041 PMCID: PMC6337897 DOI: 10.1093/jac/dky421] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background The prophylactic application of antimicrobials that are active against Staphylococcus aureus can prevent infections. However, implementation in clinical practice is limited. We have reviewed antimicrobial approaches for the prevention of S. aureus infections. Methods We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE databases and trial registries using synonyms for S. aureus, infections and prevention as search terms. We included randomized controlled trials and systematic reviews only. Results Most studies were conducted with mupirocin. Mupirocin is effective in preventing S. aureus infections in patients receiving dialysis treatment and in surgical patients, particularly if the patients are carriers of S. aureus. The combination of mupirocin and chlorhexidine, but not chlorhexidine alone, is also effective against S. aureus infections. So far, vaccines have not proven successful in protecting against S. aureus infections. Regarding prophylactic povidone-iodine and systemic antibiotics, there is limited evidence supporting their effectiveness against S. aureus infections. Antimicrobial honey has not been proven to be more effective or non-inferior to mupirocin in protecting against S. aureus infections. Conclusions The current evidence supports the use of mupirocin as prophylaxis for preventing infections with S. aureus, particularly in carriers and in the surgical setting or in patients receiving dialysis treatment. Other antimicrobial agents have not been sufficiently proven to be effective so far, or have been proven ineffective. New trials with vaccines and anti-staphylococcal peptides are currently underway and may lead to new preventive strategies in the future.
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Affiliation(s)
- D P R Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands
| | - D Van Hout
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands
| | - J A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht University, Heidelberglaan 100, 3584 CG Utrecht, The Netherlands.,Department of Infection Control, Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands
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11
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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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12
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Connolly R, Denton MD, Humphreys H, McLoughlin RM. Would hemodialysis patients benefit from a Staphylococcus aureus vaccine? Kidney Int 2019; 95:518-525. [PMID: 30691691 DOI: 10.1016/j.kint.2018.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/17/2018] [Accepted: 10/05/2018] [Indexed: 11/19/2022]
Abstract
Staphylococcus aureus bloodstream infection can have potentially catastrophic consequences for patients on hemodialysis. Consequently, an effective vaccine to prevent S aureus infection would have a significant influence on morbidity and mortality in this group. To date, however, efforts to develop a vaccine have been unsuccessful. Previous antibody-inducing vaccine candidates did not prevent or attenuate S aureus infection in clinical trials. Recent advances have helped to elucidate the role of specific T-cell subsets, notably T-helper cell 1 and T-helper cell 17, in the immune response to S aureus. These cells are essential for coordinating an effective phagocytic response via cytokine production, indirectly leading to destruction of the organism. It is now widely accepted that next-generation S aureus vaccines must also induce effective T-cell-mediated immunity. However, there remains a gap in our knowledge: how will an S aureus vaccine drive these responses in those patients most at risk? Given that patients on hemodialysis are an immunocompromised population, in particular with specific T-cell defects, including defects in T-helper cell subsets, this is likely to affect their ability to respond to an S aureus vaccine. We urgently need a better understanding of T-cell-mediated immunity in this cohort if an efficacious vaccine is ever to be realized for these patients.
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Affiliation(s)
- Roisin Connolly
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland; Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Mark D Denton
- Beaumont Kidney Centre, Beaumont Hospital, Dublin, Ireland
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - Rachel M McLoughlin
- Host-Pathogen Interactions Group, School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Dublin, Ireland.
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13
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Golestaneh L, Mokrzycki MH. Prevention of hemodialysis catheter infections: Ointments, dressings, locks, and catheter hub devices. Hemodial Int 2018; 22:S75-S82. [PMID: 30411464 DOI: 10.1111/hdi.12703] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Tunneled central venous catheters used for the provision of hemodialysis are associated with excess morbidity and mortality. Catheter related exit site and blood stream infections are major risks of their use. Although catheter-avoidance is the best strategy to reduce infections and mortality in the hemodialysis population, the use of catheters remains unacceptably high. In this review, the existing clinical practice guidelines for the prevention of hemodialysis catheter associated infections are outlined, and a comprehensive evidenced-based summary of interventions is provided. This includes details about the use of topical antimicrobial ointments and dressings, intranasal ointment application, prophylactic use of antibiotic and non-antibiotic catheter lock solutions, and catheter hub devices for the prevention of catheter blood stream infections.
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Affiliation(s)
- Ladan Golestaneh
- Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Michele H Mokrzycki
- Division of Nephrology, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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14
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Risk factors for the development of active methicillin-resistant Staphylococcus aureus (MRSA) infection in patients colonized with MRSA at hospital admission. Am J Infect Control 2016; 44:1617-1621. [PMID: 27372225 DOI: 10.1016/j.ajic.2016.05.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 05/11/2016] [Accepted: 05/13/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients who present to Veterans Affairs hospitals are screened for methicillin-resistant Staphylococcus aureus (MRSA) colonization. Those who test positive are isolated during their hospital stay. However, it is unknown which of these patients are most likely to subsequently develop active MRSA infections. METHODS This retrospective case-control study characterized risk factors for active MRSA infection among patients colonized with MRSA at hospital admission. Potential demographic and clinical risk factors were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests, and variables with P ≤ .05 in bivariable analysis were entered into a multivariable logistic regression model. RESULTS There were 71 cases and 213 controls. Risk factors associated with MRSA infection included diabetes mellitus with or without end organ damage (26% vs 14%, P = .02), hemiplegia (9% vs 2%, P = .01), chronic kidney disease (33% vs 20%, P = .03), postcolonization inpatient admission within 90 days (44% vs 29%, P = .03), surgery (41% vs 9%, P < .01), and dialysis (10% vs 3%, P = .02). On multivariable analysis, surgery during follow-up, dialysis during follow-up, and hemiplegia remained significant. CONCLUSIONS Among patients with MRSA colonization, surgery or dialysis during follow-up and history of hemiplegia were associated with subsequent MRSA infection. Knowledge of these risk factors may allow for future targeted interventions to prevent MRSA infections among colonized patients.
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15
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Amini M. Evaluation the effectiveness of an educational intervention to decrease central line-associated bloodstream infections among hemodialysis patients. Am J Infect Control 2016; 44:1703-1704. [PMID: 27544789 DOI: 10.1016/j.ajic.2016.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/04/2016] [Accepted: 07/05/2016] [Indexed: 11/19/2022]
Abstract
The study aimed to compare the rates of central line-associated bloodstream infection (CLABSI) for all hemodialysis patients with a central catheter across the majority of Shariati hospital wards during a 6-month, 2-phase, before-and-after intervention. The median rate of CLABSI decreased from 18.1% at baseline to 6.5% after implementation of the intervention (64% reduction in CLABSI rate) (P = .002). The data analysis indicated that providing intensive training can positively influence the control of CLABSI in large teaching hospitals.
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Affiliation(s)
- Manouchehr Amini
- Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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16
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Botelho-Nevers E, Gagnaire J, Verhoeven PO, Cazorla C, Grattard F, Pozzetto B, Berthelot P, Lucht F. Decolonization of Staphylococcus aureus carriage. Med Mal Infect 2016; 47:305-310. [PMID: 27856080 DOI: 10.1016/j.medmal.2016.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 04/25/2016] [Accepted: 10/11/2016] [Indexed: 10/20/2022]
Abstract
Staphylococcus aureus nasal colonization is a well-known independent risk factor for infection caused by this bacterium. Screening and decolonization of carriers have been proven effective in reducing S. aureus infections in some populations. However, a gap remains between what has been proven effective and what is currently done. We aimed to summarize recommendations and current knowledge of S. aureus decolonization to answer the following questions: Why? For whom? How? When? And what are the perspectives?
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Affiliation(s)
- E Botelho-Nevers
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France.
| | - J Gagnaire
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - P O Verhoeven
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - C Cazorla
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France
| | - F Grattard
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - B Pozzetto
- Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - P Berthelot
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France; Laboratory of infectious agents and hygiene, university hospital of Saint-Étienne, 42055 Saint-Étienne cedex 02, France
| | - F Lucht
- Infectious diseases department, university hospital of Saint-Étienne, avenue Albert-Raimond, 42055 Saint-Étienne cedex 02, France; Groupe immunité des muqueuses et agents pathogènes (GIMAP EA 3064), university of Lyon, 42023 Saint-Étienne, France
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17
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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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Lemes MMDD, Bachion MM. Enfermeiros atuantes em hemodiálise indicam diagnósticos de enfermagem relevantes na prática clínica. ACTA PAUL ENFERM 2016. [DOI: 10.1590/1982-0194201600026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivos Avaliar o perfil de diagnósticos de enfermagem apontados por enfermeiros que atuam em hemodiálise como mais relevantes para a prática clínica na área. Métodos Estudo descritivo, transversal, realizado de agosto a setembro de 2014, em Goiânia, GO, Brasil, por meio de um questionário e escala tipo Likert (escore de 0-7) para julgamento de relevância do diagnóstico. Foi calculada a razão entre a somatória da pontuação obtida e a pontuação máxima possível. Considerou-se relevantes os diagnósticos com escore ≥0,75. Resultados Participaram 40 enfermeiros, 80% atuavam na área há mais de 24 meses, 42,5% eram especialistas em nefrologia. Eles indicaram 44 diagnósticos de enfermagem relevantes, os quais foram discutidos no contexto da enfermagem em hemodiálise. Conclusão Os diagnósticos identificados evidenciam as respostas humanas valorizadas pelos enfermeiros que atuam em hemodiálise.
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19
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Collier S, Kandil H, Yewnetu E, Cross J, Caplin B, Davenport A. Infection Rates Following Buttonhole Cannulation in Hemodialysis Patients. Ther Apher Dial 2016; 20:476-482. [PMID: 26991535 DOI: 10.1111/1744-9987.12409] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 12/12/2015] [Accepted: 12/17/2015] [Indexed: 12/23/2022]
Abstract
Arteriovenous fistula (AVF) is the preferred access for hemodialysis (HD). Buttonhole (BH) needling has increased following the introduction of "blunt" fistula needles. Although some reported advantages for BH needling, others have reported increased infection risk. As such we reviewed our center practice, and the effect of both nasal screening and eradication and re-education and training programs. We audited the outcomes of 881 HD patients dialyzed between November 2009 and May 2012, divided into three groups: 175 dialyzing exclusively by central venous catheter (CVC), 478 exclusively by area needling AVF (AVF) and 219 by BH. There were 31 Staphylococcus aureus bacteremias (SABs); 14 (45.2%) dialyzing with CVCs, 12 (38.7%) BH and five (16.1%) AVF. The 30 day mortality rate for SAB was 7.5% with a complication rate of 22.6%. The hazard ratio for first SAB was significantly greater for both CVC and BH access compared to AVF (5.3 (95% CI -1.9-18.6), P < 0.001 and 3.6 (1.3-96), P = 0.011, respectively). During the study SAB rates per 1000 CVC days were 0.21, compared to 0.15 for BH. After major re-education and asepsis technique campaigns the SAB rate for BH fell to 0.06, but quickly returned to 0.17. Extending BH needling to all our dialysis centers, SAB infection rates increased to those not dissimilar to CVC access. Despite re-education programs coupled with a strict asepsis policy and active SA eradication, followed by audit cycles, the increased infection risk with BH remained, such that we have limited BH to self-care patients.
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Affiliation(s)
| | - Hala Kandil
- Department of Microbiology, Royal Free Hospital
| | | | - Jennifer Cross
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
| | - Ben Caplin
- UCL Centre for Nephrology, Royal Free Hospital, London, UK
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20
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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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21
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Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis. J Hosp Infect 2015; 91:250-6. [DOI: 10.1016/j.jhin.2015.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022]
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22
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Nair R, Perencevich EN, Blevins AE, Goto M, Nelson RE, Schweizer ML. Clinical Effectiveness of Mupirocin for Preventing Staphylococcus aureus Infections in Nonsurgical Settings: A Meta-analysis. Clin Infect Dis 2015; 62:618-630. [PMID: 26503378 DOI: 10.1093/cid/civ901] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 10/16/2015] [Indexed: 11/15/2022] Open
Abstract
A systematic literature review and meta-analysis was performed to identify effectiveness of mupirocin decolonization in prevention of Staphylococcus aureus infections, among nonsurgical settings. Of the 15 662 unique studies identified up to August 2015, 13 randomized controlled trials, 22 quasi-experimental studies, and 1 retrospective cohort study met the inclusion criteria. Studies were excluded if mupirocin was not used for decolonization, there was no control group, or the study was conducted in an outbreak setting. The crude risk ratios were pooled (cpRR) using a random-effects model. We observed substantial heterogeneity among included studies (I(2) = 80%). Mupirocin was observed to reduce the risk for S. aureus infections by 59% (cpRR, 0.41; 95% confidence interval [CI], .36-.48) and 40% (cpRR, 0.60; 95% CI, .46-.79) in both dialysis and nondialysis settings, respectively. Mupirocin decolonization was protective against S. aureus infections among both dialysis and adult intensive care patients. Future studies are needed in other settings such as long-term care and pediatrics.
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Affiliation(s)
- Rajeshwari Nair
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Eli N Perencevich
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Amy E Blevins
- Hardin Library for Health Sciences, University of Iowa, Iowa City
| | - Michihiko Goto
- Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
| | - Richard E Nelson
- IDEAS Center, Veterans Affairs Salt Lake City Health Care System, Utah
| | - Marin L Schweizer
- Department of Epidemiology, University of Iowa College of Public Health.,Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Health Care System.,Department of Internal Medicine, University of Iowa Carver College of Medicine
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