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Chen F, Li Y, Wang W, Li J, Wang D, Sun X, Peng Y, Deng J. Comparative performance of contact plate metod and swab method for surface microbial contamination on medical fabrics. BMC Infect Dis 2024; 24:530. [PMID: 38802763 PMCID: PMC11129454 DOI: 10.1186/s12879-024-09416-8] [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: 10/08/2023] [Accepted: 05/20/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND The contact plate method is widely accepted and used in various fields where hygiene and contamination levels are crucial. Evidence regarding the applicability of the contact plate method for sampling fabric microbial contamination levels in real medical environments was limited. This study aimed to assess the applicability of the contact plate method for detecting microbial contamination on medical fabrics in a real healthcare environment, thereby providing a benchmark for fabric microbial sampling methods. METHODS In a level three obstetrics ward of a hospital, twenty-four privacy curtains adjacent to patient beds were selected for this study. The contact plate and swab method were used to collect microbial samples from the privacy curtains on the 1st, 7th, 14th, and 28th days after they were hung. The total colony count on each privacy curtain surface was calculated, and microbial identification was performed. RESULTS After excluding the effects of time, room type, and curtain location on the detected microbial load, the linear mixed-effects model analysis showed that contact plate method yielded lower colony counts compared to swab method (P < 0.001). However, the contact plate method isolated more microbial species than swab method (P < 0.001). 291 pathogenic strains were isolated using the contact plate method and 133 pathogenic strains were isolated via the swab method. There was no difference between the two sampling methods in the detection of gram-negative bacteria (P = 0.089). Furthermore, the microbial load on curtains in double-occupancy rooms was lower than those in triple-occupancy rooms (P = 0.021), and the microbial load on curtains near windows was lower than that near doors (P = 0.004). CONCLUSION Contact plate method is superior to swab method in strain isolation. Swab method is more suitable for evaluating the bacterial contamination of fabrics.
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Affiliation(s)
- Feng Chen
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Yaru Li
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Wanqiu Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Juan Li
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Dong Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Xiaxia Sun
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Yaping Peng
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
- Department of medical administration, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China
| | - Jianjun Deng
- Department of Nosocomial Infection Management, West China Second University Hospital, Sichuan University, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, No. 20, Section 3, Renmin South Road,Wuhou District, Chengdu, Sichuan Province, 610041, PR China.
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Shams S, Lima C, Xu Y, Ahmed S, Goodacre R, Muhamadali H. Optical photothermal infrared spectroscopy: A novel solution for rapid identification of antimicrobial resistance at the single-cell level via deuterium isotope labeling. Front Microbiol 2023; 14:1077106. [PMID: 36819022 PMCID: PMC9929359 DOI: 10.3389/fmicb.2023.1077106] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 01/12/2023] [Indexed: 02/04/2023] Open
Abstract
The rise and extensive spread of antimicrobial resistance (AMR) has become a growing concern, and a threat to the environment and human health globally. The majority of current AMR identification methods used in clinical setting are based on traditional microbiology culture-dependent techniques which are time-consuming or expensive to be implemented, thus appropriate antibiotic stewardship is provided retrospectively which means the first line of treatment is to hope that a broad-spectrum antibiotic works. Hence, culture-independent and single-cell technologies are needed to allow for rapid detection and identification of antimicrobial-resistant bacteria and to support a more targeted and effective antibiotic therapy preventing further development and spread of AMR. In this study, for the first time, a non-destructive phenotyping method of optical photothermal infrared (O-PTIR) spectroscopy, coupled with deuterium isotope probing (DIP) and multivariate statistical analysis was employed as a metabolic fingerprinting approach to detect AMR in Uropathogenic Escherichia coli (UPEC) at both single-cell and population levels. Principal component-discriminant function analysis (PC-DFA) of FT-IR and O-PTIR spectral data showed clear clustering patterns as a result of distinctive spectral shifts (C-D signature peaks) originating from deuterium incorporation into bacterial cells, allowing for rapid detection and classification of sensitive and resistant isolates at the single-cell level. Furthermore, the single-frequency images obtained using the C-D signature peak at 2,163 cm-1 clearly displayed the reduced ability of the trimethoprim-sensitive strain for incorporating deuterium when exposed to this antibiotic, compared to the untreated condition. Hence, the results of this study indicated that O-PTIR can be employed as an efficient tool for the rapid detection of AMR at the single-cell level.
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Affiliation(s)
- Sahand Shams
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Cassio Lima
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Yun Xu
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Shwan Ahmed
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
- Department of Environment and Quality Control, Kurdistan Institution for Strategic Studies and Scientific Research, Sulaymaniyah, Kurdistan Region, Iraq
| | - Royston Goodacre
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Howbeer Muhamadali
- Centre for Metabolomics Research, Department of Biochemistry and Systems Biology, Institute of Systems, Molecular, and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Munyeshyaka E, Cyuzuzo P, Yadufashije C, Karemera J. Contribution of Medical Wards Contamination to Wound Infection among Patients Attending Ruhengeri Referral Hospital. Int J Microbiol 2021; 2021:7838763. [PMID: 34671400 PMCID: PMC8523243 DOI: 10.1155/2021/7838763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/14/2021] [Accepted: 09/27/2021] [Indexed: 11/18/2022] Open
Abstract
Nosocomial infections or hospital-acquired infections are infections that potentially occur in the patients under medical care. These infections are often caused by multidrug-resistant pathogens acquired via improper antibiotic use, not following infection control and prevention procedures. The main objective of this study was to investigate the contribution of medical wards contamination to wound infection and antibiotics susceptibility patterns at Ruhengeri Referral Hospital, Musanze district, Rwanda. This was a cross-sectional study where a total of 61 samples including air sampling to evaluate the contamination by airborne bacteria, working surface, equipment, and patients' surgical wounds swabs were collected in intensive care unit (ICU), pediatrics, and surgery departments. Culture, Gram stain, and biochemical tests were performed for microbiological isolation and identification. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method. Statistical Package for Social Science (SPSS) version 22 was used for data analysis. Gram-negative bacteria were frequently from surgery, pediatric, and ICU with 68.8%, 63.9%, and 31.1%, respectively, while Gram-positive isolates were 37.7% in surgery, 32.9% in pediatric, and 18.0% in ICU. There was a statistically significant association with E. coli and swabbed materials and surgical wound sites (x 2 = 10.0253, P value = 0.018). All bacterial contaminants were sensitive to clindamycin and erythromycin. Pseudomonas aeruginosa, E. coli, and S. aureus were resistant to nitrofurantoin. Hospital environment could be a contributing factor to surgical wound site infections. Hospitals should apply preventive measures in the hospital environment surrounding wound surgery patients to prevent wound infections during hospital stay.
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Affiliation(s)
- Emmanuel Munyeshyaka
- Biomedical Laboratory Sciences Department, INES-Ruhengeri Institute of Applied Sciences, Ruhengeri, Musanze, Rwanda
| | - Parfait Cyuzuzo
- Biomedical Laboratory Sciences Department, INES-Ruhengeri Institute of Applied Sciences, Ruhengeri, Musanze, Rwanda
| | - Callixte Yadufashije
- Biomedical Laboratory Sciences Department, INES-Ruhengeri Institute of Applied Sciences, Ruhengeri, Musanze, Rwanda
| | - John Karemera
- Microbiology Unity, Rwanda Forensic Laboratory, Kigali, Rwanda
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Póvoa P, Coelho L. Which Biomarkers Can Be Used as Diagnostic Tools for Infection in Suspected Sepsis? Semin Respir Crit Care Med 2021; 42:662-671. [PMID: 34544183 DOI: 10.1055/s-0041-1735148] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The diagnosis of infection in patients with suspected sepsis is frequently difficult to achieve with a reasonable degree of certainty. Currently, the diagnosis of infection still relies on a combination of systemic manifestations, manifestations of organ dysfunction, and microbiological documentation. In addition, the microbiologic confirmation of infection is obtained only after 2 to 3 days of empiric antibiotic therapy. These criteria are far from perfect being at least in part responsible for the overuse and misuse of antibiotics, in the community and in hospital, and probably the main drive for antibiotic resistance. Biomarkers have been studied and used in several clinical settings as surrogate markers of infection to improve their diagnostic accuracy as well as in the assessment of response to antibiotics and in antibiotic stewardship programs. The aim of this review is to provide a clear overview of the current evidence of usefulness of biomarkers in several clinical scenarios, namely, to diagnose infection to prescribe antibiotics, to exclude infection to withhold antibiotics, and to identify the causative pathogen to target antimicrobial treatment. In recent years, new evidence with "old" biomarkers, like C-reactive protein and procalcitonin, as well as new biomarkers and molecular tests, as breathomics or bacterial DNA identification by polymerase chain reaction, increased markedly in different areas adding useful information for clinical decision making at the bedside when adequately used. The recent evidence shows that the information given by biomarkers can support the suspicion of infection and pathogen identification but also, and not less important, can exclude its diagnosis. Although the ideal biomarker has not yet been found, there are various promising biomarkers that represent true evolutions in the diagnosis of infection in patients with suspected sepsis.
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Affiliation(s)
- Pedro Póvoa
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal.,Center for Clinical Epidemiology and Research Unit of Clinical Epidemiology, OUH Odense University Hospital, Odense, Denmark
| | - Luis Coelho
- Polyvalent Intensive Care Unit, Sao Francisco Xavier Hospital, CHLO, Lisbon, Portugal.,Nova Medical School, Clinical Medicine, CHRC, New University of Lisbon, Lisbon, Portugal
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5
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Shanmugakani RK, Srinivasan B, Glesby MJ, Westblade LF, Cárdenas WB, Raj T, Erickson D, Mehta S. Current state of the art in rapid diagnostics for antimicrobial resistance. LAB ON A CHIP 2020; 20:2607-2625. [PMID: 32644060 PMCID: PMC7428068 DOI: 10.1039/d0lc00034e] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Antimicrobial resistance (AMR) is a fundamental global concern analogous to climate change threatening both public health and global development progress. Infections caused by antimicrobial-resistant pathogens pose serious threats to healthcare and human capital. If the increasing rate of AMR is left uncontrolled, it is estimated that it will lead to 10 million deaths annually by 2050. This global epidemic of AMR necessitates radical interdisciplinary solutions to better detect antimicrobial susceptibility and manage infections. Rapid diagnostics that can identify antimicrobial-resistant pathogens to assist clinicians and health workers in initiating appropriate treatment are critical for antimicrobial stewardship. In this review, we summarize different technologies applied for the development of rapid diagnostics for AMR and antimicrobial susceptibility testing (AST). We briefly describe the single-cell technologies that were developed to hasten the AST of infectious pathogens. Then, the different types of genotypic and phenotypic techniques and the commercially available rapid diagnostics for AMR are discussed in detail. We conclude by addressing the potential of current rapid diagnostic systems being developed as point-of-care (POC) diagnostic tools and the challenges to adapt them at the POC level. Overall, this review provides an insight into the current status of rapid and POC diagnostic systems for AMR.
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Affiliation(s)
- Rathina Kumar Shanmugakani
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Balaji Srinivasan
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
| | - Marshall J. Glesby
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Lars F. Westblade
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Washington B. Cárdenas
- Laboratorio para Investigaciones Biomédicas, Escuela Superior Politécnica del Litoral, Guayaquil, Guayas, Ecuador
| | - Tony Raj
- St. John’s Research Institute, Bangalore, Karnataka, India
| | - David Erickson
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, New York, USA
| | - Saurabh Mehta
- Institute for Nutritional Sciences, Global Health, and Technology, Cornell University, Ithaca, New York, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, New York, USA
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6
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Impact of Changes in Clinical Microbiology Laboratory Location and Ownership on the Practice of Infectious Diseases. J Clin Microbiol 2020; 58:JCM.01508-19. [PMID: 32075902 DOI: 10.1128/jcm.01508-19] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/07/2020] [Indexed: 12/17/2022] Open
Abstract
The number of onsite clinical microbiology laboratories in hospitals is decreasing, likely related to the business model for laboratory consolidation and labor shortages, and this impacts a variety of clinical practices, including that of banking isolates for clinical or epidemiologic purposes. To determine the impact of these trends, infectious disease (ID) physicians were surveyed regarding their perceptions of offsite services. Clinical microbiology practices for retention of clinical isolates for future use were also determined. Surveys were sent to members of the Infectious Diseases Society of America's (IDSA) Emerging Infections Network (EIN). The EIN is a sentinel network of ID physicians who care for adult and/or pediatric patients in North America and who are members of IDSA. The response rate was 763 (45%) of 1,680 potential respondents. Five hundred forty (81%) respondents reported interacting with the clinical microbiology laboratory. Eighty-six percent of respondents thought an onsite laboratory very important for timely diagnostic reporting and ongoing communication with the clinical microbiologist. Thirty-five percent practiced in institutions where the core microbiology laboratory has been moved offsite, and an additional 7% (n = 38) reported that movement of core laboratory functions offsite was being considered. The respondents reported that only 24% of laboratories banked all isolates, with the majority saving isolates for less than 30 days. Based on these results, the trend toward centralized core laboratories negatively impacts the practice of ID physicians, potentially delays effective implementation of prompt and targeted care for patients with serious infections, and similarly adversely impacts infection control epidemiologic investigations.
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7
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Midega J. Estimating the global burden of antimicrobial resistance: Reflections on current methods and data needs. Wellcome Open Res 2020. [DOI: 10.12688/wellcomeopenres.15680.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prioritisation of policy action, research and the evaluation of progress towards curbing the threat of Antimicrobial Resistance (AMR) is dependent on our knowledge of its burden. The burden of AMR, like that of other causes of death and morbidity, is an important metric that not only provides the opportunity for generating and using data on periodic measures for timely and reliable updates on the prevailing disease situation and its potential to get better or worse, but also guides the development and positioning of interventions, including estimating the costs and benefits of interventions. The urgency with which AMR must be combatted as a global public health threat requires the need to determine and apply the most suitable methods, models and metrics for estimating the global burden of AMR to better inform decisions on how to best manage AMR.
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Rawlinson S, Ciric L, Cloutman-Green E. Who decides what's relevant? Factors driving publication on clinically significant organisms. Infect Prev Pract 2020; 2:100053. [PMID: 34368702 PMCID: PMC8336040 DOI: 10.1016/j.infpip.2020.100053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 03/02/2020] [Indexed: 11/30/2022] Open
Affiliation(s)
- Stacey Rawlinson
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK
| | - Lena Ciric
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK
| | - Elaine Cloutman-Green
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK.,Great Ormond Street Hospital NHS Foundation Trust, Camelia Botnar Laboratories, Department of Microbiology, London, UK
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Rawlinson S, Ciric L, Cloutman-Green E. How to carry out microbiological sampling of healthcare environment surfaces? A review of current evidence. J Hosp Infect 2019; 103:363-374. [PMID: 31369807 DOI: 10.1016/j.jhin.2019.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 07/24/2019] [Indexed: 12/15/2022]
Abstract
There is increasing evidence that the hospital surface environment contributes to the spread of pathogens. However, evidence on how best to sample these surfaces is inconsistent and there is no guidance or legislation in place on how to do this. The aim of this review was to assess current literature on surface sampling methodologies, including the devices used, processing methods, and the environmental and biological factors that might influence results. Studies published prior to March 2019 were selected using relevant keywords from ScienceDirect, Web of Science, and PubMed. Abstracts were reviewed and all data-based studies in peer-reviewed journals in the English language were included. Microbiological air and water sampling in the hospital environment were not included. Although the numbers of cells or virions recovered from hospital surface environments were generally low, the majority of surfaces sampled were microbiologically contaminated. Of the organisms detected, multidrug-resistant organisms and clinically significant pathogens were frequently isolated and could, therefore, present a risk to vulnerable patients. Great variation was found between methods and the available data were incomplete and incomparable. Available literature on sampling methods demonstrated deficits with potential improvements for future research. Many of the studies included in the review were laboratory-based and not undertaken in the real hospital environment where sampling recoveries could be affected by the many variables present in a clinical environment. It was therefore difficult to draw overall conclusions; however, some recommendations for the design of routine protocols for surface sampling of healthcare environments can be made.
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Affiliation(s)
- S Rawlinson
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK
| | - L Ciric
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK
| | - E Cloutman-Green
- University College London, Chadwick Building, Department of Civil, Environmental and Geomatic Engineering, London, UK; Great Ormond Street Hospital NHS Foundation Trust, Camiliar Botnar Laboratories, Department of Microbiology, London, UK.
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Cui Y, Liu J, Zhang X. Effects of laboratory capabilities on combating antimicrobial resistance, 2013-2016: A static model panel data analysis. J Glob Antimicrob Resist 2019; 19:116-121. [PMID: 30904685 DOI: 10.1016/j.jgar.2019.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 03/06/2019] [Accepted: 03/10/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance (AMR) has become a serious global public health problem. The World Health Organization (WHO) and European Union (EU) have taken actions to combat this issue, in which laboratory capability construction is a crucial part. This study aimed to explore the relationship between laboratory capabilities and antimicrobial resistance from a macro perspective. METHODS The study used annual national level penal data from the EU Laboratory Capability Monitoring System and Antimicrobial Resistance Surveillance Europe 2013-2016. A conventional static panel data analysis was constructed to establish the relationship between the antimicrobial resistance rates and laboratory capabilities. RESULTS Laboratory capability on antimicrobial drug resistance characterisation and monitoring (LC8) showed a positive effect on Escherichia coli (E. coli) combined resistance rate (Y5), E. coli resistant rate of aminoglycosides (Y4), and Klebsiella pneumoniae resistant rate of carbapenems (Y8) (OR=0.929, 0.957, and 0.861; P=0.035, 0.007, and 0.026, respectively). However, following the diagnostic testing guidelines (LC2) caused higher resistance rates of Klebsiella pneumoniae to fluoroquinolones (Y6), third-generation cephalosporins (Y7), and aminoglycosides (Y9) (OR=1.076, 1.093, and1.065; P=0.011, 0.032, and 0.002, respectively). CONCLUSIONS Antimicrobial drug resistance characterisation and monitoring by laboratories has contributed to minimising antimicrobial resistance, while the mechanism of laboratory capabilities to pose an ineffective or negative impact on AMR remains to be further studied.
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Affiliation(s)
- Youwen Cui
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Junjie Liu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xinping Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
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11
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Bouza E, Muñoz P, Burillo A. Role of the Clinical Microbiology Laboratory in Antimicrobial Stewardship. Med Clin North Am 2018; 102:883-898. [PMID: 30126578 DOI: 10.1016/j.mcna.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
For adequate antimicrobial stewardship, microbiology needs to move from the laboratory to become physically and verbally amenable to the caregivers of an institution. Herein, we describe the contributions of our microbiology department to the antimicrobial stewardship program of a large teaching hospital as 10 main points ranging from the selection of patients deemed likely to benefit from a fast track approach, to their clinical samples, or the rapid reporting of results via a microbiology hotline, to rapid searches for pathogens and susceptibility testing. These points should serve as guidelines for similar programs designed to decrease the unnecessary use of antimicrobials.
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Affiliation(s)
- Emilio Bouza
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Doctor Esquerdo 46, Madrid 28007, Spain.
| | - Patricia Muñoz
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain; CIBER de Enfermedades Respiratorias (CIBERES CB06/06/0058), Doctor Esquerdo 46, Madrid 28007, Spain
| | - Almudena Burillo
- Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Plaza Ramón y Cajal s/n, Madrid 28040, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Doctor Esquerdo, 46, Madrid 28007, Spain; Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo 46, Madrid 28007, Spain
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12
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Simões AS, Maia MR, Gregório J, Couto I, Asfeldt AM, Simonsen GS, Póvoa P, Viveiros M, Lapão LV. Participatory implementation of an antibiotic stewardship programme supported by an innovative surveillance and clinical decision-support system. J Hosp Infect 2018; 100:257-264. [PMID: 30071264 DOI: 10.1016/j.jhin.2018.07.034] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 07/24/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Antibiotic resistance will cause about 10 million deaths per year by 2050. Fighting antimicrobial resistance is a health priority. Interventions aimed to reduce antimicrobial resistance, such as antibiotic stewardship programmes (ASPs), must be implemented. To be effective, those interventions, and the implementation process, should be matched with social-cultural context. The complexity of ASPs can no longer be developed without considering both organizational and information systems. AIM To support ASPs through the co-design and implementation, in collaboration with healthcare workers, of a surveillance and clinical decision-support system to monitor antibiotic resistance and improve antibiotic prescription. METHODS The surveillance and clinical decision-support system was designed and implemented in three Portuguese hospitals, using a participatory approach between researchers and healthcare workers following the Design Science Research Methodology. FINDINGS Based on healthcare workers' requirements, we developed HAITooL, a real-time surveillance and clinical decision-support system that integrates visualizations of patient, microbiology, and pharmacy data, facilitating clinical decision. HAITooL monitors antibiotic usage and rates of antibiotic-resistant bacteria, allowing early identification of outbreaks. It is a clinical decision-support tool that integrates evidence-based algorithms to support proper antibiotic prescription. HAITooL was considered valuable to support monitoring of antibiotic resistant infections and an important tool for ASP sustainability. CONCLUSION ASP implementation can be leveraged through a surveillance and clinical decision-support system such as HAITooL that allows antibiotic resistance monitoring and supports antibiotic prescription, once it has been adapted to the context and specific needs of healthcare workers and hospitals.
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Affiliation(s)
- A S Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - M R Maia
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J Gregório
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - I Couto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - A M Asfeldt
- University Hospital of North Norway and UiT - Arctic University of Norway, Tromsø, Norway
| | - G S Simonsen
- University Hospital of North Norway and UiT - Arctic University of Norway, Tromsø, Norway
| | - P Póvoa
- NOVA Medical School, CEDOC, Universidade Nova de Lisboa, Lisbon, Portugal; Polyvalent Intensive Care Unit, São Francisco Xavier Hospital, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - M Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - L V Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
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Vandenberg O, Kozlakidis Z, Schrenzel J, Struelens MJ, Breuer J. Control of Infectious Diseases in the Era of European Clinical Microbiology Laboratory Consolidation: New Challenges and Opportunities for the Patient and for Public Health Surveillance. Front Med (Lausanne) 2018; 5:15. [PMID: 29457001 PMCID: PMC5801420 DOI: 10.3389/fmed.2018.00015] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 01/18/2018] [Indexed: 01/03/2023] Open
Abstract
Many new innovative diagnostic approaches have been made available during the last 10 years with major impact on patient care and public health surveillance. In parallel, to enhance the cost-effectiveness of the clinical microbiology laboratories (CMLs), European laboratory professionals have streamlined their organization leading to amalgamation of activities and restructuring of their professional relationships with clinicians and public health specialists. Through this consolidation process, an operational model has emerged that combines large centralized clinical laboratories performing most tests on one high-throughput analytical platform connected to several distal laboratories dealing locally with urgent analyses at near point of care. The centralization of diagnostic services over a large geographical region has given rise to the concept of regional-scale "microbiology laboratories network." Although the volume-driven cost savings associated with such laboratory networks seem self-evident, the consequence(s) for the quality of patient care and infectious disease surveillance and control remain less obvious. In this article, we describe the range of opportunities that the changing landscape of CMLs in Europe can contribute toward improving the quality of patient care but also the early detection and enhanced surveillance of public health threats caused by infectious diseases. The success of this transformation of health services is reliant on the appropriate preparation in terms of staff, skills, and processes that would be inclusive of stakeholders. In addition, rigorous metrics are needed to set out more concrete laboratory service performance objectives and assess the expected benefits to society in terms of saving lives and preventing diseases.
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Affiliation(s)
- Olivier Vandenberg
- Innovation and Business Development Unit, LHUB-ULB, Pôle Hospitalier Universitaire de Bruxelles, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Centre for Environmental Health and Occupational Health, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Zisis Kozlakidis
- Division of Infection and Immunity, University College London, London, United Kingdom
- The Farr Institute of Health Informatics Research, University College London, London, United Kingdom
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Marc Jean Struelens
- Microbiology Coordination Section, Office of the Chief Scientist, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Judith Breuer
- Division of Infection and Immunity, University College London, London, United Kingdom
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14
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Simões AS, Alves DA, Gregório J, Couto I, Dias S, Póvoa P, Viveiros M, Gonçalves L, Lapão LV. Fighting antibiotic resistance in Portuguese hospitals: Understanding antibiotic prescription behaviours to better design antibiotic stewardship programmes. J Glob Antimicrob Resist 2018; 13:226-230. [PMID: 29409949 DOI: 10.1016/j.jgar.2018.01.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 12/27/2017] [Accepted: 01/19/2018] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES Since physicians play an important role in antibiotic usage, it is vital to understand their antibiotic-prescribing behaviour and knowledge on antimicrobial resistance in order to develop and implement effective antibiotic stewardship interventions. The aim of this study was to evaluate Portuguese physicians' knowledge and to understand prescription behaviours, difficulties and barriers in their antibiotic prescription process in order to promote better and well-adapted antibiotic stewardship policies. METHODS This study was conducted in 2016 using a self-administered questionnaire to physicians in two tertiary public hospitals from two different regions in Portugal. RESULTS Participating physicians [response rate 47.6% (30/63)] identified antibiotic resistance as a global problem; however, one-third did not recognise antibiotic resistance as a major problem on their own hospital. Factors that most influenced antibiotic prescription were 'microbiology laboratory results', 'patient clinical situation' and patient 'co-morbidities'. On the other hand, 'colleagues' opinion' and 'costs control' were considered as less determining factors. Regarding difficulties and bottlenecks in the antibiotic prescription process, participant physicians reported 'lack of (or delayed) microbiological results' and 'no access to antibiotic susceptibility patterns' as major barriers. 'Education and training' was considered the most effective intervention to improve antibiotic prescription. CONCLUSION These results suggest that the design and implementation of antibiotic stewardship interventions should provide better data management and sharing tools between physicians and the microbiology laboratory, especially through the creation of antimicrobial prescribing guidelines according to hospital epidemiology, and easy access to hospital antibiotic susceptibility patterns and epidemiological data.
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Affiliation(s)
- Alexandra S Simões
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal.
| | - Daniela A Alves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
| | - João Gregório
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
| | - Isabel Couto
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
| | - Sónia Dias
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
| | - Pedro Póvoa
- CEDOC, NOVA Medical School, UNL, Lisbon, Portugal; Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Miguel Viveiros
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
| | - Luzia Gonçalves
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal; Centro de Estatística e Aplicações da Universidade de Lisboa, Lisbon, Portugal
| | - Luís V Lapão
- Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical (IHMT), Universidade Nova de Lisboa (UNL), Rua da Junqueira no 100, 1349-008 Lisbon, Portugal
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Xu Q, Zheng Z, Wang B, Mao H, Yan F. Zinc Ion Coordinated Poly(Ionic Liquid) Antimicrobial Membranes for Wound Healing. ACS APPLIED MATERIALS & INTERFACES 2017; 9:14656-14664. [PMID: 28418650 DOI: 10.1021/acsami.7b01677] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Herein, a series of quaternary ammonium (Qa) or imidazolium (Im) cation-based poly(ionic liquid) (PIL) membranes and their corresponding zinc ion coordinated PIL membranes were synthesized. The effects of chemical structure, including organic cations, alkyl side chain of substitution, and zinc atoms on the antimicrobial activities against Escherichia coli, Staphylococcus aureus, and Candida albicans were investigated. The Zn-containing PIL membranes show higher antibacterial activities compared to those of pristine PIL membranes due to the synergistic attributes of both organic cations (Qa or Im) and zinc atoms. A wound healing test using methicillin-resistant S. aureus infected mouse as the model further demonstrated that zinc ion coordinated PIL membranes were antibacterially active, biologically safe, and may have potential application as an antimicrobial wound dressing in a clinical setting.
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Affiliation(s)
- Qiming Xu
- Department of Anesthesiology and Critical Care Medicine, Zhongshan Hospital, Fudan University , Shanghai 200032, China
| | - Zhiqiang Zheng
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, Department of Polymer Science and Engineering, College of Chemistry, Chemical Engineering and Materials Science, Soochow University , Suzhou 215123, China
| | - Bin Wang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine , Shanghai 200011, China
| | - Hailei Mao
- Department of Anesthesiology and Critical Care Medicine, Zhongshan Hospital, Fudan University , Shanghai 200032, China
| | - Feng Yan
- Jiangsu Key Laboratory of Advanced Functional Polymer Design and Application, Department of Polymer Science and Engineering, College of Chemistry, Chemical Engineering and Materials Science, Soochow University , Suzhou 215123, China
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Liu S, Zhang XX. Small colony variants are more susceptible to copper-mediated contact killing for Pseudomonas aeruginosa and Staphylococcus aureus. J Med Microbiol 2016; 65:1143-1151. [DOI: 10.1099/jmm.0.000348] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Sha Liu
- Institute of Natural and Mathematical Sciences, Massey University, Auckland 0745, New Zealand
| | - Xue-Xian Zhang
- Institute of Natural and Mathematical Sciences, Massey University, Auckland 0745, New Zealand
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