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Elfadil A, Ibrahem K, Abdullah H, Mokhtar JA, Al-Rabia MW, Mohammed HA. Synergistic Activity of 3-Hydrazinoquinoxaline-2-Thiol in Combination with Penicillin Against MRSA. Infect Drug Resist 2024; 17:355-364. [PMID: 38312520 PMCID: PMC10838510 DOI: 10.2147/idr.s448843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Background The growing resistance seen in various antibiotics, including those considered as last-resort options, underscores the pressing need for novel approaches and new substances to address MRSA infections. Combining antibiotics as a treatment approach can enhance effectiveness, expand the range of targeted bacteria, and minimize the likelihood of resistance emergence. This approach holds promise in addressing the escalating issue of antibiotic resistance. Purpose This study seeks to investigate the potential synergy between 3-hydrazinoquinoxaline-2-thiol and penicillin against a diverse array of MRSA isolates, thereby providing insights into their combined antimicrobial action. Methods Twenty-two clinical MRSA isolates subjected to broth microdilution to determine the Minimum Inhibitory Concentrations (MICs) of 3-hydrazinoquinoxaline-2-thiol and penicillin. Subsequently, a checkerboard assay was employed to evaluate the interaction between 3-hydrazinoquinoxaline-2-thiol and penicillin, focusing on the Fractional Inhibitory Concentration Index (FICI). Results The MICs of penicillin and 3-hydrazinoquinoxaline-2-thiol were determined for 22 clinical MRSA strains. Penicillin exhibited MICs within a range of 1024 to 128 µg/mL, while 3-hydrazinoquinoxaline-2-thiol displayed MICs varying from 64 to 8 µg/mL. Remarkably, the combination of 3-hydrazinoquinoxaline-2-thiol and penicillin yielded a synergistic effect, resulting in a significant reduction of MICs by up to 64-fold. Conclusion The potential of 3-hydrazinoquinoxaline-2-thiol in combination with penicillin as a viable solution against MRSA appears promising. However, to establish its practical utility, further extensive testing and experiments are essential.
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Affiliation(s)
- Abdelbagi Elfadil
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
| | - Karem Ibrahem
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
| | - Hani Abdullah
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
| | - Jawahir A Mokhtar
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
| | - Mohammed W Al-Rabia
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
| | - Hafsa Alawad Mohammed
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabic
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Rödenbeck M, Ayobami O, Eckmanns T, Pletz MW, Bleidorn J, Markwart R. Clinical epidemiology and case fatality due to antimicrobial resistance in Germany: a systematic review and meta-analysis, 1 January 2010 to 31 December 2021. Euro Surveill 2023; 28:2200672. [PMID: 37199987 PMCID: PMC10197495 DOI: 10.2807/1560-7917.es.2023.28.20.2200672] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 02/14/2023] [Indexed: 05/19/2023] Open
Abstract
BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide.AimWe aimed to summarise the German AMR situation for clinicians and microbiologists.MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016-2021) and the case fatality rates (2010-2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively.ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886-0.891; p < 0.0001), while vancomycin resistance in Enterococcus faecium (VRE) bloodstream infections increased (OR = 1.18; (95% CI: 1.16-1.21); p < 0.0001) with a pooled proportion of 34.9%. Case fatality rates for MRSA and VRE were higher than for their susceptible strains (OR = 2.29; 95% CI: 1.91-2.75 and 1.69; 95% CI: 1.22-2.33, respectively). Carbapenem resistance in Gram-negative pathogens (Klebsiella pneumoniae, Acinetobacter baumannii, Enterobacter spp. and Escherichia coli) was low to moderate (< 9%), but resistance against third-generation cephalosporins and fluoroquinolones was moderate to high (5-25%). Pseudomonas aeruginosa exhibited high resistance against carbapenems (17.0%; 95% CI: 11.9-22.8), third-generation cephalosporins (10.1%; 95% CI: 6.6-14.2) and fluoroquinolones (24.9%; 95% CI: 19.3-30.9). Statistical heterogeneity was high (I2 > 70%) across studies reporting resistance proportions.ConclusionContinuous efforts in AMR surveillance and infection prevention and control as well as antibiotic stewardship are needed to limit the spread of AMR in Germany.
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Affiliation(s)
- Maria Rödenbeck
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Olaniyi Ayobami
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Unit for Healthcare Associated Infections, Surveillance of Antimicrobial Resistance and Consumption, Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Jutta Bleidorn
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
| | - Robby Markwart
- InfectoGnostics Research Campus Jena, Jena, Germany
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich Schiller University Jena, Jena, Germany
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3
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Tilouche L, Ben Dhia R, Boughattas S, Ketata S, Bouallegue O, Chaouch C, Boujaafar N. Staphylococcus aureus Ventilator-Associated Pneumonia: A Study of Bacterio-Epidemiological Profile and Virulence Factors. Curr Microbiol 2021; 78:2556-2562. [PMID: 33969430 PMCID: PMC8107017 DOI: 10.1007/s00284-021-02512-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 04/25/2021] [Indexed: 11/30/2022]
Abstract
Ventilator-associated pneumonia (VAP) represents a major cause of nosocomial infections in the intensive care units in which Staphylococcus aureus is frequently involved. Better knowledge of this pathogen is required in order to enhance the patient’s treatment and care. In this article, we studied the bacteriological profile and virulence factors of S. aureus-related VAP on a 3-year period. We included a collection of S. aureus strains (n = 35) isolated from respiratory samples from patients diagnosed with VAP in the intensive care units. We studied the bacteriological aspects and we searched for the presence of virulence factors (SpA, FnbpA, Hla, and PVL genes) in the strains, and we also studied the clinical and biological aspects of the infections. The average age of our patients was of 36 years and they were predominantly males (sex ratio = 3.37). A severe head trauma or a history of coma was noted in 73.43% of the patients. The average duration of ventilation was 29 days. Among the studied strains, five were Methicillin-resistant S. aureus of which three expressed the mecA gene. Overall, the Hla gene was detected in 85.7% of the strains and it was more prevalent in Methicillin-susceptible than Methicillin-resistant strains (93.3% versus 40%; P = 0.014). FnbpA, Spa, and PVL genes were detected, respectively, in 80%, 45.7%, and 20% of the strains. Therefore, our studied strains were essentially associated with the production of Hla and FnbpA genes. It is, however, important to elucidate their expression in order to establish their role in the VAP pathogenesis.
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Affiliation(s)
- Lamia Tilouche
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Refka Ben Dhia
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia. .,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia.
| | - Sameh Boughattas
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Soumaya Ketata
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Olfa Bouallegue
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of medicine Ibn El-Jazzar of Sousse, University of Sousse, Sousse, Tunisia
| | - Cherifa Chaouch
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
| | - Noureddine Boujaafar
- Department of microbiology, Sahloul University Teaching Hospital, Route de la ceinture, H.Sousse, 4011, Monastir, Tunisia.,Faculty of Pharmacy of Monastir, University of Monastir, Monastir, Tunisia
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4
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Talagtag M, Patel TS, Scappaticci GB, Perissinotti AJ, Schepers AJ, Petty LA, Pettit KM, Burke PW, Bixby DL, Marini BL. Utility of methicillin-resistant Staphylococcus aureus (MRSA) nasal screening in patients with acute myeloid leukemia (AML). Transpl Infect Dis 2021; 23:e13612. [PMID: 33825279 DOI: 10.1111/tid.13612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/22/2021] [Accepted: 03/28/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Current literature has demonstrated the utility of the MRSA nasal screen as a de-escalation tool to decrease unnecessary anti-MRSA antibiotic therapy. However, data on the applicability of this test in patients with hematologic malignancy is lacking. METHODS This is a single-center, retrospective cohort study of patients with acute myeloid leukemia (AML) with or without a history of hematopoietic cell transplant (HCT), with pneumonia and MRSA nasal screening with respiratory cultures obtained. The primary outcome was to determine the negative predictive value (NPV) of the MRSA nasal screen for MRSA pneumonia. Secondary outcomes included sensitivity, specificity, positive predictive value (PPV) of the MRSA nasal screen and prevalence of MRSA pneumonia. RESULTS Of 98 patients with AML and pneumonia, the prevalence of MRSA pneumonia was 4.1% with confirmed positive MRSA respiratory cultures observed in 4 patient cases. In patients with confirmed MRSA pneumonia, 3 had positive MRSA nasal screens while 1 had a false negative result, possibly due to a long lag time (21 days) between MRSA nasal screen and pneumonia diagnosis. Overall, the MRSA nasal screen demonstrated 75% sensitivity and 100% specificity, with a PPV of 100% and a NPV of 98.9%. CONCLUSIONS Given the low prevalence, empiric use of anti-MRSA therapy in those AML and HCT patients with pneumonia may not be warranted in clinically stable patients. For patients in whom empiric anti-MRSA antibiotics are initiated, nasal screening for MRSA may be utilized to de-escalate anti-MRSA antibiotics in patients with AML with or without HCT.
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Affiliation(s)
- Millicynth Talagtag
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Twisha S Patel
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Gianni B Scappaticci
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Anthony J Perissinotti
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Allison J Schepers
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Lindsay A Petty
- Department of Internal Medicine, Division of Infectious Diseases, Ann Arbor, MI, USA
| | - Kristen M Pettit
- Department of Internal Medicine, Division of Hematology/Oncology, Adult BMT and Leukemia Programs, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Patrick W Burke
- Department of Internal Medicine, Division of Hematology/Oncology, Adult BMT and Leukemia Programs, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Dale L Bixby
- Department of Internal Medicine, Division of Hematology/Oncology, Adult BMT and Leukemia Programs, Michigan Medicine and University of Michigan Medical School, Ann Arbor, MI, USA
| | - Bernard L Marini
- Department of Pharmacy Services and Clinical Pharmacy, Michigan Medicine and the University of Michigan College of Pharmacy, Ann Arbor, MI, USA
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5
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Davis M, Elliott R, Hills R, Fry M. Single-Room Ward Design and Its Impact on Service and Patient Outcomes: An Evaluation Study. Orthop Nurs 2019; 38:317-325. [PMID: 31568120 DOI: 10.1097/nor.0000000000000593] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Evidence suggests that single-room inpatient wards are associated with better patient outcomes than open-room wards but little is known about the impact on adverse events, patient satisfaction, and clinician experiences. METHODS/PURPOSE We evaluated the impact of a new inpatient single-room orthopaedic ward on patient and clinician outcomes using a medical record audit; patient, nurse, and medical doctor surveys; and nonparticipant observations in a tertiary hospital in Sydney, Australia. RESULTS The audit (1,569 patients; 819 open-room ward and 750 new single-room ward) revealed unchanged adverse event rates and fewer emergency calls after the move to a single-room ward. Survey responses from nurses, medical doctors, and patients were positive. Observations suggested that clinicians devised solutions to potential threats to patient safety. CONCLUSION The single-room ward design did not negatively impact on patient and clinician outcomes and was preferred by them. Clinicians organized their work to ensure patient safety.
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Affiliation(s)
- Melissa Davis
- Melissa Davis, RN, BSc, GradCert, Royal North Shore Hospital, St. Leonards, New South Wales, Australia. Rosalind Elliott, RN, PhD, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; and Research and Practice Development Unit, Nursing and Midwifery Directorate, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia. Rosemary Hills, RN, Royal North Shore Hospital, St. Leonards, New South Wales, Australia. Margaret Fry, RN, PhD, Faculty of Health, University of Technology Sydney, Ultimo, New South Wales, Australia; and Research and Practice Development Unit, Nursing and Midwifery Directorate, Royal North Shore Hospital, Northern Sydney Local Health District, St. Leonards, New South Wales, Australia
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6
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Vandana Kalwaje E, Rello J. Management of ventilator-associated pneumonia: Need for a personalized approach. Expert Rev Anti Infect Ther 2018; 16:641-653. [DOI: 10.1080/14787210.2018.1500899] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Eshwara Vandana Kalwaje
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Jordi Rello
- Critical Care Department, Vall d’Hebron Barcelona Hospital Campus & Centro de Investigacion Biomedica en Red (CIBERES), Barcelona, Spain
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7
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Dahal M, Schwan WR. Management of methicillin-resistant Staphylococcus aureus mediated ventilator-associated pneumonia. CURRENT TRENDS IN MICROBIOLOGY 2018; 12:95-107. [PMID: 31341354 PMCID: PMC6656405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Prevention strategies and clinical management of methicillin- resistant Staphylococcus aureus (MRSA) infections in ventilated patients who develop ventilator-associated pneumonia (VAP) are important. Since MRSA are the most frequently isolated bacteria in patients with VAP, and a significant cause of morbidity and mortality in intubated patients, rapid diagnosis and early treatment could reduce mortality. This review will examine preventive steps (i.e. screening ventilated patients for MRSA, decolonization, and hand washing), assessing clinical presentations before the results of culture are obtained to direct empiric treatment, and the appropriate antibiotic therapy upon culture confirmation of MRSA that could help in the management of VAP.
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Affiliation(s)
| | - William R. Schwan
- Corresponding Author: William Schwan, Department of Microbiology, University of Wisconsin-La Crosse, 1725 State St., La Crosse, WI 54601, 608-785-6980,
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8
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Nasal Methicillin-Resistant Staphylococcus aureus (MRSA) PCR Testing Reduces the Duration of MRSA-Targeted Therapy in Patients with Suspected MRSA Pneumonia. Antimicrob Agents Chemother 2017; 61:AAC.02432-16. [PMID: 28137813 DOI: 10.1128/aac.02432-16] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 01/15/2017] [Indexed: 01/26/2023] Open
Abstract
The objective of this study was to evaluate the impact of pharmacist-ordered methicillin-resistant Staphylococcus aureus (MRSA) PCR testing on the duration of empirical MRSA-targeted antibiotic therapy in patients with suspected pneumonia. This is a retrospective analysis of patients who received vancomycin or linezolid for suspected pneumonia before and after the implementation of a pharmacist-driven protocol for nasal MRSA PCR testing. Patients were included if they were adults of >18 years of age and initiated on vancomycin or linezolid for suspected MRSA pneumonia. The primary endpoint was the duration of vancomycin or linezolid therapy. After screening 368 patients, 57 patients met inclusion criteria (27 pre-PCR and 30 post-PCR). Baseline characteristics were similar between the two groups, with the majority of patients classified as having health care-associated pneumonia (68.4%). The use of the nasal MRSA PCR test reduced the mean duration of MRSA-targeted therapy by 46.6 h (74.0 ± 48.9 h versus 27.4 ± 18.7 h; 95% confidence interval [CI], 27.3 to 65.8 h; P < 0.0001). Fewer patients in the post-PCR group required vancomycin serum levels and dose adjustment (48.1% versus 16.7%; P = 0.02). There were no significant differences between the pre- and post-PCR groups regarding days to clinical improvement (1.78 ± 2.52 versus 2.27 ± 3.34; P = 0.54), length of hospital stay (11.04 ± 9.5 versus 8.2 ± 7.8; P = 0.22), or hospital mortality (14.8% versus 6.7%; P = 0.41). The use of nasal MRSA PCR testing in patients with suspected MRSA pneumonia reduced the duration of empirical MRSA-targeted therapy by approximately 2 days without increasing adverse clinical outcomes.
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9
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Richter E, Harms M, Ventz K, Nölker R, Fraunholz MJ, Mostertz J, Hochgräfe F. Quantitative Proteomics Reveals the Dynamics of Protein Phosphorylation in Human Bronchial Epithelial Cells during Internalization, Phagosomal Escape, and Intracellular Replication of Staphylococcus aureus. J Proteome Res 2016; 15:4369-4386. [DOI: 10.1021/acs.jproteome.6b00421] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Erik Richter
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
| | - Manuela Harms
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
| | - Katharina Ventz
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
| | - Rolf Nölker
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
| | | | - Jörg Mostertz
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
| | - Falko Hochgräfe
- Competence
Center Functional Genomics, Junior Research Group Pathoproteomics, University of Greifswald, 17489 Greifswald, Germany
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10
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Equils O, da Costa C, Wible M, Lipsky BA. The effect of diabetes mellitus on outcomes of patients with nosocomial pneumonia caused by methicillin-resistant Staphylococcus aureus: data from a prospective double-blind clinical trial comparing treatment with linezolid versus vancomycin. BMC Infect Dis 2016; 16:476. [PMID: 27600290 PMCID: PMC5011934 DOI: 10.1186/s12879-016-1779-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 08/15/2016] [Indexed: 02/04/2023] Open
Abstract
Background The presence of diabetes mellitus increases the risk of several severe infections, but data on its effect on treatment outcomes in patients with nosocomial pneumonia (NP) caused by methicillin-resistant Staphylococcus aureus (MRSA) are limited. Methods We retrospectively analyzed data from a double-blind, randomized, multi-center, international clinical trial of culture-confirmed MRSA NP that compared treatment with linezolid to vancomycin. Specifically, we evaluated the clinical and microbiologic outcomes of patients with and without diabetes in the modified intent to treat population at end-of-treatment (EOT) and end-of-study (EOS, 7–30 days post-EOT). Results Among 448 enrolled patients 183 (40.8 %) had diabetes mellitus, 87 (47.5 %) of whom received linezolid and 96 (52.5 %) vancomycin. Baseline demographic and clinical characteristics were similar for the two treatment groups. Clinical success rates at EOS were 57.6 % with linezolid and 39.3 % with vancomycin, while microbiological success rates were 58.9 % with linezolid and 41.1 % with vancomycin. Among diabetic patients, rates of mortality and study drug-related adverse effects were similar between the treatment groups. Overall day 28 mortality rates were higher among diabetic patients compared to non-diabetic patients (23.5 vs 14.7 %, respectively: RD = 8.8 %, 95 % CI [1.4, 16.3]). Conclusions Among diabetic patients with MRSA NP, treatment with linezolid, compared to vancomycin, was associated with higher clinical and microbiologic success rates, and comparable adverse event rates. Trial registration NCT00084266. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1779-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | - Benjamin A Lipsky
- University of Oxford, Oxford, UK.,University of Washington, Seattle, WA, USA
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11
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Abstract
PURPOSE OF REVIEW To highlight the importance of escalating pathogen resistance in ventilator-associated pneumonia (VAP) along with diagnostic and treatment implications. RECENT FINDINGS In a period of rising bacterial resistance, VAP remains an important infection occurring in critically ill patients. Risk factors for multidrug-resistant pathogens depend on both local epidemiology and host factors. New diagnostic techniques and antimicrobials can help with rapid bacterial identification and timely and appropriate treatment while avoiding emergence of bacterial resistance. SUMMARY Clinicians should be aware of risk factors for multidrug-resistant pathogens causing VAP and also of particularities of diagnosis and treatment of this important clinical entity.
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12
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Schwab S, Schellinger P, Werner C, Unterberg A, Hacke W. Nosokomiale Pneumonie – Antibiotikatherapie und hygienische Interventionsstrategien. NEUROINTENSIV 2015. [PMCID: PMC7120723 DOI: 10.1007/978-3-662-46500-4_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Die Pneumonie ist auch in unserer Zeit eine schwere Infektionskrankheit. Sie ist eine der häufigsten infektiösen Todesursachen der westlichen Industrieländer und steht an 3. Stelle unter den Infektionskrankheiten. Jede 4. ärztlich diagnostizierte Pneumonie ist nosokomial erworben. Nosokomiale Pneumonien führen neben einer verlängerten Morbidität und erhöhten Letalität zu einer Verlängerung der Krankenhausverweildauer und zu erheblichen Kosten.
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Affiliation(s)
- Stefan Schwab
- Neurologische Klinik, Universitätklinikum Erlangen, Erlangen, Germany
| | - Peter Schellinger
- Neurologische Klinik und Geriatrie, Johannes Wesling Klinikum Minden, Minden, Germany
| | - Christian Werner
- Klinik für Anästhesiologie, Klinikum der Johannes-Gutenberg-Universität Mainz, Mainz, Germany
| | - Andreas Unterberg
- Neurochirurgische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Werner Hacke
- Neurologische Klinik, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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Heizmann WR, Löschmann PA, Eckmann C, von Eiff C, Bodmann KF, Petrik C. Clinical efficacy of tigecycline used as monotherapy or in combination regimens for complicated infections with documented involvement of multiresistant bacteria. Infection 2014; 43:37-43. [PMID: 25367409 PMCID: PMC4315528 DOI: 10.1007/s15010-014-0691-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/08/2014] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Tigecycline is an established treatment option for infections with multiresistant bacteria (MRB). It retains activity against many strains with limited susceptibility to other antibiotics. Efficacy and safety of tigecycline as monotherapy or in combination regimens were investigated in a prospective noninterventional study involving 1,025 severely ill patients in clinical routine at 137 German hospitals. MATERIALS AND METHODS Data on the full population have been published; our present analysis focuses on infections caused by MRB. The study population included patients with complicated infections, high disease severity (APACHE II > 15: 65 %) and high MRB prevalence. Most patients had comorbidities, including cardiovascular disease, renal insufficiency, and/or diabetes mellitus. Treatment success was defined as cure/improvement without requirement of further antibiotic therapy. RESULTS Pathogens isolated from 215 evaluable patients with documented MRB infections included 132 methicillin-resistant Staphylococcus aureus (MRSA), 42 vancomycin-resistant Enterococci (VRE) and 67 Gram-negative extended beta-lactamase (ESBL) producers. Of the MRB subpopulation, 140 patients received tigecycline monotherapy, 75 were treated with combination regimens. High overall clinical success rates were recorded for MRB infections treated with tigecycline alone (94 %) or in combinations (88 %); in detail intraabdominal infections (monotherapy: 90 %; combinations: 93 %), skin/soft tissue infections (93; 100 %), community-acquired pneumonia (100; 100 %), hospital-acquired pneumonia (94,7; 72,7 %), diabetic foot infections (89; 33 %), blood stream infections (100; 100 %) and multiple-site infections (92; 71 %). CONCLUSIONS Tigecycline achieved high clinical success rates in patients with documented infections involving MRB strains despite high disease severity. These results add to the evidence indicating that tigecycline is a valuable therapeutic option for complicated infections in severely ill patients with a high likelihood of multidrug-resistant pathogen involvement.
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Affiliation(s)
- W R Heizmann
- Orgamed Laborsysteme GmbH, Maria-Schmid-Str. 14b, 94086, Bad Griesbach, Germany,
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Balkhy HH, El-Saed A, Maghraby R, Al-Dorzi HM, Khan R, Rishu AH, Arabi YM. Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia. Ann Thorac Med 2014; 9:104-11. [PMID: 24791174 PMCID: PMC4005156 DOI: 10.4103/1817-1737.128858] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Accepted: 01/05/2014] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND: There is a wide geographic and temporal variability of bacterial resistance among microbial causes of ventilator-associated pneumonia (VAP). The contribution of multi-drug resistant (MDR) pathogens to the VAP etiology in Saudi Arabia was never studied. We sought to examine the extent of multiple-drug resistance among common microbial causes of VAP. MATERIALS AND METHODS: We conducted a retrospective susceptibility study in the adult intensive care unit (ICU) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility results of isolates from patients diagnosed with VAP between October 2004 and June 2009 were examined. The US National Healthcare Safety Network definition of MDR was adopted. RESULTS: A total of 248 isolates including 9 different pathogens were included. Acinetobacter spp. was highly (60-89%) resistant to all tested antimicrobials, including carbapenems (three- and four-class MDR prevalence were 86% and 69%, respectively). Pseudomonas aeruginosa was moderately (13-31%) resistant to all tested antimicrobials, including antipseudomonal penicillins (three- and four-class MDR prevalence were 13% and 10%, respectively). With an exception of ampicillin (fully resistant), Klebsiella spp. had low (0-13%) resistance to other tested antimicrobials with no detected MDR. Staphylococcus aureus was fully susceptible to vancomycin with 42% resistance to oxacillin. There were significant increasing trends of MDR Acinetobacter spp. however not P. aeruginosa during the study. Resistant pathogens were associated with worse profile of ICU patients but not patients’ outcomes. CONCLUSION: Acinetobacter in the current study was an increasingly resistant VAP-associated pathogen more than seen in many parts of the world. The current finding may impact local choice of initial empiric antibiotics.
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Affiliation(s)
- Hanan H Balkhy
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Aiman El-Saed
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia ; Gulf Cooperation Council States and WHO Collaborating Center for Infection Prevention and Control, Riyadh, Kingdom of Saudi Arabia ; King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Community Medicine, Faculty of Medicine, Mansoura University, Egypt
| | - Rana Maghraby
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hasan M Al-Dorzi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Raymond Khan
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Asgar H Rishu
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Yaseen M Arabi
- King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia ; Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Kingdom of Saudi Arabia
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Valour F, Chebib N, Gillet Y, Reix P, Laurent F, Chidiac C, Ferry T. [Staphylococcus aureus broncho-pulmonary infections]. REVUE DE PNEUMOLOGIE CLINIQUE 2013; 69:368-382. [PMID: 24183294 DOI: 10.1016/j.pneumo.2013.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 07/30/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Staphylococcus aureus accounts for 2-5% of the etiologies of community-acquired pneumonia. These infections occur mainly in elderly patients with comorbidity, after a respiratory viral infection. S. aureus could also be responsible for necrotizing pneumonia, which occurs in young subjects, also after flu. Necrotizing pneumonia are associated with the production of a particular staphylococcal toxin called Panton-Valentine leukocidin, responsible for pulmonary focal necrosis, occurrence haemoptysis, leucopenia, and death. In Europe, these strains are still predominantly sensitive to anti-staphylococcal penicillin, which must be used at high dosage intravenously in combination with an antibiotic that reduces toxin production such as clindamycin, and intravenous immunoglobulin in severe cases. The mortality rate is estimated at 50%. In addition, S. aureus is one of the pathogens involved in early respiratory infections in cystic fibrosis patients, in whom methicillin resistance plays an important prognostic role. However, the involvement of S. aureus in COPD exacerbations is rare. Finally, S. aureus represents 20 to 30% of cases of hospital-acquired pneumonia, including ventilator-associated pneumonia. In these cases, methicillin-resistance is common and requires the use of glycopeptides or linezolid. The place of new anti-staphylococcal antibiotics such as new generation cephalosporins or tigecyclin remains to be defined.
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Affiliation(s)
- F Valour
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France
| | - N Chebib
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France
| | - Y Gillet
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France; Service d'urgences pédiatriques, hospices civils de Lyon, hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - P Reix
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Service de pneumologie, allergologie, mucoviscidose, hospices civils de Lyon, hôpital Femme-Mère-Enfant, 69500 Bron, France
| | - F Laurent
- Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France; Laboratoire de bactériologie, hospices civils de Lyon, groupement hospitalier Nord, 69004 Lyon, France
| | - C Chidiac
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France
| | - T Ferry
- Service des maladies infectieuses et tropicales, hospices civils de Lyon, hôpital de la Croix-Rousse, groupement hospitalier Nord, 103, Grande-Rue-de-la-Croix-Rousse, 69004 Lyon, France; Université Claude-Bernard Lyon 1, 69008 Lyon, France; Inserm U1111, CNRS UMR5308, ENS de lyon, UCBL1, Centre international de recherche en infectiologie (CIRI), 69007 Lyon, France; Centre national de référence des staphylocoques, hospices civils de Lyon, 69008 Lyon, France.
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16
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Dalhoff K, Ewig S, Abele-Horn M, Andreas S, Bauer TT, von Baum H, Deja M, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern W, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:634-40. [PMID: 24133545 DOI: 10.3238/arztebl.2013.0634] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/13/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline. METHODS An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system. RESULTS 9097 abstracts and 808 articles were screened in full text, and 22 recommendations were issued. It is recommended that any antimicrobial treatment should be preceded by a microbiological diagnostic evaluation with cultures of blood and respiratory samples. The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3°C, and/or the presence of purulent respiratory secretions. The initially calculated antimicrobial treatment should be begun without delay; it should be oriented to the locally prevailing resistance pattern, and its intensity should be a function of the risk of infection with MDROs. The initial treatment should be combination therapy if there is a high risk of MDRO infection and/or if the patient is in septic shock. In the new guideline, emphasis is laid on a strict de-escalation concept. In particular, antimicrobial treatment usually should not be continued for longer than eight days. CONCLUSION The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided.
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Affiliation(s)
- Klaus Dalhoff
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Campus Lübeck
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Churkina LN, Bidnenko SI, Lopes dos Santos Santiago G, Vaneechoutte M, Avdeeva LV, Lutko OB, Oserjanskaja NM. Application of the antibiotic batumin for accurate and rapid identification of staphylococcal small colony variants. BMC Res Notes 2012; 5:374. [PMID: 22828414 PMCID: PMC3439339 DOI: 10.1186/1756-0500-5-374] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 06/30/2012] [Indexed: 12/23/2022] Open
Abstract
Background Staphylococcus aureus is a major human pathogen causing significant morbidity and mortality. The S. aureus colonies in osteomyelitis, in patients with cystic fibrosis and patients with endoprosthesis rejection frequently have an atypical morphology, i.e. staphylococcal small-colony variants, which form a naturally occurring subpopulation of clinically important staphylococci. Identification of these small colony variants is difficult, because of the loss of typical phenotypic characteristics of these variants. We wanted to improve and simplify the diagnosis of staphylococcal infection using a diagnostic preparation, consisting of 5 μg batumin paper disks. Batumin possesses a unique selective activity against all studied Staphylococcus spp., whereas all other species tested thus far are batumin resistant. We assessed the efficacy of the batumin diagnostic preparation to identify staphylococcal small colony variants, isolated from osteomyelitis patients. Findings With the batumin diagnostic preparation, all 30 tested staphylococcal small-colony variants had a growth inhibition zone around the disk of minimum 25 mm, accordant with the inhibition zones of the parent strains, isolated from the same patients. Conclusions The batumin diagnostic preparation correctly identified the small-colony variants of S. aureus, S. haemolyticus and S. epidermidis as belonging to the genus Staphylococcus, which differ profoundly from parental strains and are difficult to identify with standard methods. Identification of staphylococcal small-colony variants with the batumin diagnostic preparation is technically simple and can facilitate practical laboratory work.
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Affiliation(s)
- Larisa N Churkina
- Institute of Microbiology and Virology, National Academy of Sciences of Ukraine, Kyiv, Ukraine
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Meyer E, Schwab F, Schroeren-Boersch B, Gastmeier P. Increasing consumption of MRSA-active drugs without increasing MRSA in German ICUs. Intensive Care Med 2011; 37:1628-32. [PMID: 21858520 DOI: 10.1007/s00134-011-2335-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 07/23/2011] [Indexed: 11/30/2022]
Abstract
PURPOSE The aim of our study was to analyze changes in the consumption of MRSA-active antibiotics and in the burden of methicillin-resistant S. aureus (MRSA) over a period of 9 years in a network of German intensive care units (ICU). METHODS Data from 55 ICUs in Germany were analyzed from 2001 through 2009. The term "old MRSA-active antibiotics" included vancomycin, teicoplanin and fosfomycin, whereas the term "new MRSA-active antibiotics" included quinupristin/dalfopristin, linezolid and daptomycin. The burden of MRSA was defined as MRSA per 1,000 patient-days. RESULTS A total of 1,584,995 patient-days and 32,450 S. aureus isolates were analyzed. The burden of MRSA was 4.4, and the pooled mean MRSA resistance proportion was 21.8%. Both parameters did not change significantly over time. In contrast, MRSA-active antibiotics more than doubled from 44 defined daily doses per 1,000 patient-days in 2001 to 92 in 2009. This was due to the significant increase of new MRSA-active antibiotics (from 1 to 40), whereas old MRSA antibiotics stayed stable (43 in 2001 and 52 in 2009). CONCLUSION New MRSA-active antibiotics did not replace old ones, but were added on top. The use of new MRSA-active antibiotics-mainly linezolid-steadily increased over a period of 9 years, although the burden of MRSA stayed stable, as did the proportion of MRSA (%).
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Affiliation(s)
- Elisabeth Meyer
- Institute of Hygiene and Environmental Medicine, Charité University Medicine, Hindenburgdamm 27, 12203 Berlin, Germany.
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Patyi M, Varga É, Kristóf K. Curiosities of the methicillin-resistant Staphylococcus aureus survey - possibility of pseudo-outbreak and transmission to household contacts. Acta Microbiol Immunol Hung 2011; 58:135-44. [PMID: 21715283 DOI: 10.1556/amicr.58.2011.2.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is currently one of the most prevalent antibiotic-resistant pathogens in hospitals, but it is also emerging as a community-acquired pathogen. We analysed the clinical and microbiological data of the patients in a county teaching hospital regarding MRSA. During the examination period (1996-2010), four outbreaks and one pseudo-outbreak occurred. It also became evident that health care workers and their families are possibly at risk of becoming carriers of MRSA. The importance of the molecular epidemiological investigation (pulsed-field gel-electrophoresis (PFGE)) typing and hygienic measures in order to detect and control MRSA outbreaks must be emphasised. Following infection control guidelines seems to be cost-effective method of controlling the nosocomial transmission of MRSA.
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Affiliation(s)
- Márta Patyi
- 1 Bács-Kiskun County Teaching Hospital Department of Hospital Hygiene Kecskemét Hungary
| | - Éva Varga
- 1 Bács-Kiskun County Teaching Hospital Department of Hospital Hygiene Kecskemét Hungary
| | - Katalin Kristóf
- 2 Semmelweis University Clinical Microbiological Diagnostic Laboratory, Institute of Laboratory Medicine Budapest Hungary
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