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Sator T, Binder H, Payr S, Pichler L, Frenzel S, Hajdu S, Presterl E, Tiefenboeck TM. Surgical site infection after trochanteric and subtrochanteric fractures: a single centre retrospective analysis. Sci Rep 2024; 14:579. [PMID: 38182868 PMCID: PMC10770179 DOI: 10.1038/s41598-024-51180-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/07/2024] Open
Abstract
Surgical site infection (SSI) following osteosynthesis of trochanteric or subtrochanteric fractures is a rare but serious complication with incidence rate ranging from 1 to 3%. SSIs are associated with higher mortality and increased length of hospital stay resulting in higher healthcare costs and loss of life quality. In this retrospective analysis all patients with SSI following osteosynthesis of trochanteric or subtrochanteric fractures at the Department of Trauma Surgery were identified. We included all surgical procedures performed from 1992 to 2018, using data from electronic health records and SSI-Trauma-Registry. The aim was to describe epidemiological data, as well as to identify parameters correlating with the occurrence of SSI and mortality. Of 2753 patients, 53 (1.9%) developed SSI. Longer operative time was demonstrated among patients with SSI (P = 0.008). Mortality during the first postoperative year was significantly higher in the SSI group (32.1% vs. 19.1%; P = 0.018), with detection of methicillin-sensitive (MSSA) and methicillin-resistant Staphylococcus aureus (MRSA; HR 4.13, CI 95% 1.24-13.80; P = 0.021) or Enterococcus spp. (HR 5.58, CI 95% 1.67-18.65; P = 0.005) being independent risk factors. Male sex (HR 2.25, 95% CI 1.86-2.73; P < 0.001) and higher mean age (HR 1.05, 95% CI 1.04-1.06; P < 0.001) were found to be predictors for 1-year mortality in non-infected patients. SSI rate was low with 1.9% and longer duration of surgery was associated with infection. Patients with SSI had a higher 1-year mortality, with detection of MSSA, MRSA and enterococci significantly increasing the risk of dying. Male sex and higher age were risk factors for one-year mortality in patients without SSI.
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Affiliation(s)
- Thomas Sator
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Harald Binder
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Payr
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Lorenz Pichler
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stephan Frenzel
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Stefan Hajdu
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Thomas Manfred Tiefenboeck
- Department of Orthopedics and Trauma-Surgery, Division of Trauma-Surgery, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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Humphreys H, Vos M, Presterl E, Hell M. Greater attention to flexible hospital designs and ventilated clinical facilities are a pre-requisite for coping with the next airborne pandemic. Clin Microbiol Infect 2023; 29:1229-1231. [PMID: 37182640 DOI: 10.1016/j.cmi.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 04/21/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Affiliation(s)
- Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, Ireland; ESCMID Study Group for Nosocomial Infections (ESGNI), Switzerland.
| | - Margreet Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, the Netherlands; ESCMID Study Group for Nosocomial Infections (ESGNI), Switzerland
| | - Elisabeth Presterl
- Department of Hospital Epidemiology and Infection Control, Vienna General Hospital, Medical University of Vienna, Vienna, Austria; ESCMID Study Group for Nosocomial Infections (ESGNI), Switzerland
| | - Markus Hell
- Department of Clinical Microbiology and Hygiene, Medilab, Academic Teaching Laboratories of the Paracelsus Medical University, Salzburg, Austria; ESCMID Study Group for Nosocomial Infections (ESGNI), Switzerland
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3
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Plachouras D, Kacelnik O, Rodríguez-Baño J, Birgand G, Borg MA, Kristensen B, Kubele J, Lyytikäinen O, Presterl E, Reilly J, Voss A, Zingg W, Suetens C, Monnet DL. Revisiting the personal protective equipment components of transmission-based precautions for the prevention of COVID-19 and other respiratory virus infections in healthcare. Euro Surveill 2023; 28:2200718. [PMID: 37561052 PMCID: PMC10416576 DOI: 10.2807/1560-7917.es.2023.28.32.2200718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/10/2023] [Indexed: 08/11/2023] Open
Abstract
The COVID-19 pandemic highlighted some potential limitations of transmission-based precautions. The distinction between transmission through large droplets vs aerosols, which have been fundamental concepts guiding infection control measures, has been questioned, leading to considerable variation in expert recommendations on transmission-based precautions for COVID-19. Furthermore, the application of elements of contact precautions, such as the use of gloves and gowns, is based on low-quality and inconclusive evidence and may have unintended consequences, such as increased incidence of healthcare-associated infections and spread of multidrug-resistant organisms. These observations indicate a need for high-quality studies to address the knowledge gaps and a need to revisit the theoretical background regarding various modes of transmission and the definitions of terms related to transmission. Further, we should examine the implications these definitions have on the following components of transmission-based precautions: (i) respiratory protection, (ii) use of gloves and gowns for the prevention of respiratory virus infections, (iii) aerosol-generating procedures and (iv) universal masking in healthcare settings as a control measure especially during seasonal epidemics. Such a review would ensure that transmission-based precautions are consistent and rationally based on available evidence, which would facilitate decision-making, guidance development and training, as well as their application in practice.
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Affiliation(s)
| | | | - Jesús Rodríguez-Baño
- CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
- Infectious Diseases and Microbiology division, Hospital Universitario Virgen Macarena and Department of Medicine, University of Seville/CSIC, Biomedicine Institute of Seville, Seville, Spain
| | - Gabriel Birgand
- Health Protection Research Unit, Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Regional Centre for Infection Prevention and Control, Region of Pays de la Loire, Nantes, France
| | - Michael A Borg
- Infection Control Department, Mater Dei Hospital, Msida, Malta
| | | | - Jan Kubele
- Clinical Microbiology and ATB centre, Na Homolce Hospital, Prague, Czechia
| | | | - Elisabeth Presterl
- Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow, United Kingdom
| | - Andreas Voss
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Groningen, Groningen, the Netherlands
| | - Walter Zingg
- Charité Universitätsmedizin, Berlin, Germany
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Carl Suetens
- European Centre for Disease Prevention and Control, Stockholm, Sweden
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4
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Füszl A, Ebner J, Van den Nest M, Bouvier-Azula L, Diab-El Schahawi M, Presterl E. COVID-19 patient and personal safety - lessons learnt for pandemic preparedness and the way to the next normal. Antimicrob Resist Infect Control 2023; 12:27. [PMID: 37005696 PMCID: PMC10066952 DOI: 10.1186/s13756-023-01231-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/21/2023] [Indexed: 04/04/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has profoundly challenged societies and healthcare systems in particular. To prevent the spread of SARS-CoV-2, infection prevention and control (IPC) strategies had to be developed on the local, national and international level. The aim of this study is to provide details of the COVID-19 experience at the Vienna General Hospital (VGH) in the context of the national and international COVID-19 response for learning and improvement. METHODS This is a retrospective report, outlining the evolution of IPC measures and challenges encountered at the health facility (VGH), the national (Austria) and global level between February 2020 and October 2022. RESULTS The IPC strategy at the VGH has been continuously adapted to changes in the epidemiological setting, new legal directives and Austrian by-laws. The current strategy, nationally and internationally, focuses on endemicity rather than maximum transmission risk reduction. For the VGH, this has recently resulted in an increase in COVID-19 clusters. To protect our particularly vulnerable patients, many COVID-19 precautions have been maintained. Barriers to adequate IPC implementation at the VGH and other hospitals include a lack of sufficient isolation options and non-adherence with universal face mask regulations. Globally, misinformation on COVID-19 hampered an effective response. CONCLUSIONS This retrospective analysis of the COVID-19 response at the VGH and international reports underline the need for pandemic preparedness, readiness and response by improving future hospital design and infrastructure, conducting regular trainings for protective attire and increasing health literacy as now recently published in a concise document by WHO.
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Affiliation(s)
- Astrid Füszl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Julia Ebner
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Miriam Van den Nest
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Lukas Bouvier-Azula
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Magda Diab-El Schahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria.
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
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van Dijk MD, Voor In 't Holt AF, Alp E, Hell M, Petrosillo N, Presterl E, Tsakris A, Severin JA, Vos MC. Correction: Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study. Antimicrob Resist Infect Control 2023; 12:23. [PMID: 36978143 PMCID: PMC10053034 DOI: 10.1186/s13756-023-01221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Markus Hell
- Department of Clinical Microbiology and Infection Control, MEDILAB-Academic Teaching Laboratories, Paracelsus Medical University, Salzburg, Austria
- Teaching Hospital, Kardinal Schwarzenberg Klinikum, Paracelsus Medical University, Schwarzach, Austria
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
- Department of Infection Control, University Hospital Campus Bio-Medico, Rome, Italy
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Babu Rajendran N, Arieti F, Mena-Benítez CA, Galia L, Tebon M, Alvarez J, Gladstone BP, Collineau L, De Angelis G, Duro R, Gaze W, Göpel S, Kanj SS, Käsbohrer A, Limmathurotsakul D, Lopez de Abechuco E, Mazzolini E, Mutters NT, Pezzani MD, Presterl E, Renk H, Rodríguez-Baño J, Săndulescu O, Scali F, Skov R, Velavan TP, Vuong C, Tacconelli E, Avery L, Bonten M, Cassini A, Chauvin C, Compri M, Damborg P, De Greeff S, Del Toro MD, Filter M, Franklin A, Gonzalez-Zorn B, Grave K, Hocquet D, Hoelzle LE, Kalanxhi E, Laxminarayan R, Leibovici L, Malhotra-Kumar S, Mendelson M, Paul M, Muñoz Madero C, Murri R, Piddock LJ, Ruesen C, Sanguinetti M, Schilling T, Schrijver R, Schwaber MJ, Scudeller L, Torumkuney D, Van Boeckel T, Vanderhaeghen W, Voss A, Wozniak T. EPI-Net One Health reporting guideline for antimicrobial consumption and resistance surveillance data: a Delphi approach. Lancet Reg Health Eur 2023; 26:100563. [PMID: 36895445 PMCID: PMC9989632 DOI: 10.1016/j.lanepe.2022.100563] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/22/2022] [Accepted: 11/24/2022] [Indexed: 12/24/2022]
Abstract
Strategic and standardised approaches to analysis and reporting of surveillance data are essential to inform antimicrobial resistance (AMR) mitigation measures, including antibiotic policies. Targeted guidance on linking full-scale AMR and antimicrobial consumption (AMC)/antimicrobial residues (AR) surveillance data from the human, animal, and environmental sectors is currently needed. This paper describes the initiative whereby a multidisciplinary panel of experts (56 from 20 countries-52 high income, 4 upper middle or lower income), representing all three sectors, elaborated proposals for structuring and reporting full-scale AMR and AMC/AR surveillance data across the three sectors. An evidence-supported, modified Delphi approach was adopted to reach consensus among the experts for dissemination frequency, language, and overall structure of reporting; core elements and metrics for AMC/AR data; core elements and metrics for AMR data. The recommendations can support multisectoral national and regional plans on antimicrobials policy to reduce resistance rates applying a One Health approach.
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Affiliation(s)
- Nithya Babu Rajendran
- Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Fabiana Arieti
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Liliana Galia
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maela Tebon
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Julio Alvarez
- VISAVET Health Surveillance Center and Department of Animal Health, Faculty of Veterinary Medicine, Complutense University, Madrid, Spain
| | - Beryl Primrose Gladstone
- Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.,German Centre for Infection Research (DZIF) Clinical Research Unit for Healthcare Associated and Antibiotic Resistant Bacterial Infections, Tübingen, Germany
| | - Lucie Collineau
- French Agency for Food, Environmental and Occupational Health and Safety, ANSES, Maisons-Alfort, France
| | - Giulia De Angelis
- Dipartimento di Scienze Biotecnologiche di base, Cliniche Intensivologiche e Perioperatorie, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Raquel Duro
- Unit for the Prevention and Control of Infection and Antimicrobial Resistance, Centro Hospitalar do Tâmega e Sousa, Penafiel, Porto, Portugal
| | - William Gaze
- The European Centre for Environment and Human Health, University of Exeter Medical School, University of Exeter, Penryn, Cornwall, UK
| | - Siri Göpel
- Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany.,German Centre for Infection Research (DZIF) Clinical Research Unit for Healthcare Associated and Antibiotic Resistant Bacterial Infections, Tübingen, Germany
| | - Souha S Kanj
- Department of Internal Medicine, Division of Infectious Diseases, Infection Control Program, Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Annemarie Käsbohrer
- German Federal Institute for Risk Assessment (BfR), Department 4 - Biological Safety, Berlin, Germany
| | - Direk Limmathurotsakul
- Mahidol Oxford Tropical Medicine Research Unit and Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, UK
| | | | - Elena Mazzolini
- Department of Epidemiology, Istituto Zooprofilattico Sperimentale delle Venezie, Udine-Padova, Padua, Italy
| | - Nico T Mutters
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany.,European Committee on Infection Control, Basel, Switzerland
| | - Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabeth Presterl
- European Committee on Infection Control, Basel, Switzerland.,Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria.,ESCMID Study Group for Nosocomial Infections, Basel, Switzerland
| | - Hanna Renk
- Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen, Germany
| | - Jesús Rodríguez-Baño
- Infectious Diseases and Microbiology Division, Hospital Universitario Virgen Macarena/Department of Medicine, School of Medicine, University of Seville/Biomedicine Institute of Seville (IBiS)/CSIC, Seville, Spain.,CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain
| | - Oana Săndulescu
- Department of Infectious Diseases I, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.,National Institute for Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania
| | - Federico Scali
- Istituto Zooprofilattico Sperimentale della Lombardia e Dell'Emilia Romagna, Brescia, Italy
| | - Robert Skov
- Epidemiological Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Tübingen, Germany.,Vietnamese - German Center for Medical Research, Hanoi, Vietnam
| | - Cuong Vuong
- AiCuris Anti-infective Cures GmbH, Wuppertal, Germany.,Jansen Pharmaceuticals, Beerse, Belgium
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,European Committee on Infection Control, Basel, Switzerland
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7
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Righi E, Mutters NT, Guirao X, Del Toro MD, Eckmann C, Friedrich AW, Giannella M, Kluytmans J, Presterl E, Christaki E, Cross ELA, Visentin A, Sganga G, Tsioutis C, Tacconelli E. ESCMID/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery. Clin Microbiol Infect 2022; 29:463-479. [PMID: 36566836 DOI: 10.1016/j.cmi.2022.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 12/10/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
SCOPE The aim of the guidelines is to provide recommendations on perioperative antibiotic prophylaxis (PAP) in adult inpatients who are carriers of multidrug-resistant Gram-negative bacteria (MDR-GNB) before surgery. METHODS These evidence-based guidelines were developed after a systematic review of published studies on PAP targeting the following MDR-GNB: extended-spectrum cephalosporin-resistant Enterobacterales, carbapenem-resistant Enterobacterales (CRE), aminoglycoside-resistant Enterobacterales, fluoroquinolone-resistant Enterobacterales, cotrimoxazole-resistant Stenotrophomonas maltophilia, carbapenem-resistant Acinetobacter baumannii (CRAB), extremely drug-resistant Pseudomonas aeruginosa, colistin-resistant Gram-negative bacteria, and pan-drug-resistant Gram-negative bacteria. The critical outcomes were the occurrence of surgical site infections (SSIs) caused by any bacteria and/or by the colonizing MDR-GNB, and SSI-attributable mortality. Important outcomes included the occurrence of any type of postsurgical infectious complication, all-cause mortality, and adverse events of PAP, including development of resistance to targeted (culture-based) PAP after surgery and incidence of Clostridioides difficile infections. The last search of all databases was performed until April 30, 2022. The level of evidence and strength of each recommendation were defined according to the Grading of Recommendations Assessment, Development and Evaluation approach. Consensus of a multidisciplinary expert panel was reached for the final list of recommendations. Antimicrobial stewardship considerations were included in the recommendation development. RECOMMENDATIONS The guideline panel reviewed the evidence, per bacteria, of the risk of SSIs in patients colonized with MDR-GNB before surgery and critically appraised the existing studies. Significant knowledge gaps were identified, and most questions were addressed by observational studies. Moderate to high risk of bias was identified in the retrieved studies, and the majority of the recommendations were supported by low level of evidence. The panel conditionally recommends rectal screening and targeted PAP for fluoroquinolone-resistant Enterobacterales before transrectal ultrasound-guided prostate biopsy and for extended-spectrum cephalosporin-resistant Enterobacterales in patients undergoing colorectal surgery and solid organ transplantation. Screening for CRE and CRAB is suggested before transplant surgery after assessment of the local epidemiology. Careful consideration of the laboratory workload and involvement of antimicrobial stewardship teams before implementing the screening procedures or performing changes in PAP are warranted. High-quality prospective studies to assess the impact of PAP among CRE and CRAB carriers performing high-risk surgeries are advocated. Future well-designed clinical trials should assess the effectiveness of targeted PAP, including the monitoring of MDR-GNB colonization through postoperative cultures using European Committee on Antimicrobial Susceptibility Testing clinical breakpoints.
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Affiliation(s)
- Elda Righi
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nico T Mutters
- University Hospital Bonn, Institute for Hygiene and Public Health, Bonn, Germany
| | - Xavier Guirao
- Surgical Endocrine Unit, Department of General Surgery, Surgical Site Prevention Unit, Parc Tauli, Hospital Universitari Sabadell, Spain
| | - Maria Dolores Del Toro
- Division of Infectious Diseases and Microbiology, University Hospital Virgen Macarena, Seville, Spain; Department of Medicine, University of Sevilla. Biomedicine Institute of Sevilla, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas, Spain
| | - Christian Eckmann
- Klinikum Hannoversch-Muenden, Academic Hospital of Goettingen University, Germany
| | - Alex W Friedrich
- University of Groningen, University Medical Center Groningen, Department of Medical Microbiology and Infection Prevention, Groningen, the Netherlands; Institute for European Prevention Networks in Infection Control, University Hospital Münster, Münster, Germany
| | - Maddalena Giannella
- Infectious Diseases Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy; Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Jan Kluytmans
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Eirini Christaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Elizabeth L A Cross
- Department of Global Health and Infection, Brighton and Sussex Medical School, Brighton, United Kingdom
| | - Alessandro Visentin
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Gabriele Sganga
- Emergency Surgery and Trauma, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Division of Infectious Diseases, Department of Internal Medicine I, University of Tübingen, Tübingen, Germany.
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8
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van Dijk MD, Voor In 't Holt AF, Alp E, Hell M, Petrosillo N, Presterl E, Tsakris A, Severin JA, Vos MC. Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study. Antimicrob Resist Infect Control 2022; 11:152. [PMID: 36474304 PMCID: PMC9727845 DOI: 10.1186/s13756-022-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are differences in infection prevention and control (IPC) policies to prevent transmission of highly resistant microorganisms (HRMO). The aim of this study is to give an overview of the IPC policy of six European hospitals and their HRMO prevalence, to compare the IPC policies of these hospitals with international guidelines, and to investigate the hospitals' adherence to their own IPC policy. METHODS The participating hospitals were located in Salzburg (Austria), Vienna (Austria), Kayseri (Turkey), Piraeus (Greece), Rome (Italy) and Rotterdam (The Netherlands). Data were collected via an online survey. Questions were aimed at prevalence rates in the years 2014, 2015, 2016 of carbapenemase-producing Klebsiella pneumoniae (CPK), carbapenemase-producing Pseudomonas aeruginosa (CPPA), vancomycin-resistant Enterococcus faecium (VRE) and hospitals' IPC policies of 2017. Implemented IPC measures (i.e. with a self-reported adherence of > 90%) were counted (26 points maximal). RESULTS The self-reported prevalence of CPK per year was low in the Austrian and Dutch hospitals and high in the Turkish and Greek hospitals. CPPA was highly prevalent in the Turkish hospital only, while the prevalence of VRE in four hospitals, except the Austrian hospitals which reported lower prevalence numbers, was more evenly distributed. The Dutch hospital had implemented the most IPC measures (n = 21), the Turkish and Greek hospitals the least (n = 14 and 7, respectively). CONCLUSION Hospitals with the highest self-reported prevalence of CPK and CPPA reported the least implemented IPC measures. Also, hospitals with a higher prevalence often reported a lower adherence to own IPC policy.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Markus Hell
- Department of Clinical Microbiology and Infection Control, MEDILAB-Academic Teaching Laboratories, Paracelsus Medical University, Salzburg, Austria
- Teaching Hospital, Kardinal Schwarzenberg Klinikum, Paracelsus Medical University, Schwarzach, Austria
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
- Department of Infection Control, University Hospital Campus Bio-Medico, Rome, Italy
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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9
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Füszl A, Bouvier-Azula L, Van den Nest M, Ebner J, Strassl R, Gabler C, Diab-Elschahawi M, Presterl E. Provision of safe patient care during the COVID-19 pandemic despite shared patient rooms in a tertiary hospital. Antimicrob Resist Infect Control 2022; 11:61. [PMID: 35449118 PMCID: PMC9021561 DOI: 10.1186/s13756-022-01091-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 03/01/2022] [Indexed: 11/18/2022] Open
Abstract
Background The COVID-19 pandemic has resulted in the disruption of healthcare systems. Vienna General Hospital (VGH), a tertiary hospital located in Austria, ran at almost full capacity despite high levels of community SARS-CoV-2 transmission and limited isolation room capacity. To ensure safe patient care, a bundle of infection prevention and control (IPC) measures including universal pre-admission screening and serial SARS-CoV-2 testing during hospitalization was implemented. We evaluated whether testing as part of our IPC approach was effective in preventing hospital outbreaks during different stages of the pandemic. Methods In this retrospective single center study, we analyzed the SARS-CoV-2 PCR test results of cases admitted to VGH between a low (15/05/2020–01/08/2020) and a high incidence period (15/09/2020–18/05/2021). Outcomes were the diagnostic yield of (a) admission screening, (b) the yield of serial testing during hospitalization and (c) the occurrence of healthcare-associated COVID-19 (HA-COVID-19) and SARS-CoV-2 related hospital outbreaks. Results The admission test positivity rate was 0.2% during the low and 2.3% during the high incidence phase. Regarding test conversions, 0.04% (low incidence phase) and 0.5% (high incidence phase) of initially negative cases converted to a positive test result within 7 days after admission The HA-COVID-19 incidence rate per 100,000 patient days was 1.0 (low incidence phase) and 10.7 (high incidence phase). One COVID-19 outbreak affecting eight patients in total could be potentially ascribed to the non-compliance with our IPC protocol. Conclusion Testing in conjunction with other IPC measures enabled the safe provision of patient care at a hospital with predominantly shared patient rooms despite high case numbers in the community. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01091-1.
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10
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Carrara E, Ong DSY, Hussein K, Keske S, Johansson AF, Presterl E, Tsioutis C, Tschudin-Sutter S, Tacconelli E. ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the healthcare setting. Clin Microbiol Infect 2022; 28:672-680. [PMID: 35124258 PMCID: PMC8812094 DOI: 10.1016/j.cmi.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/20/2022]
Abstract
Scope This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. Methods A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach. Recommendations Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.
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Affiliation(s)
- Elena Carrara
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland.
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Khetam Hussein
- European Committee on Infection Control (EUCIC), Basel, Switzerland; The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Siran Keske
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Anders F Johansson
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Clinical Microbiology and the Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Elisabeth Presterl
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Constantinos Tsioutis
- European Committee on Infection Control (EUCIC), Basel, Switzerland; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland
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11
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Zatorska B, Moser D, Diab-Elschahawi M, Ebner J, Lusignani LS, Presterl E. The effectiveness of surface disinfectants and a micellic H 2O 2 based water disinfectant on Candida auris. J Mycol Med 2021; 31:101178. [PMID: 34388399 DOI: 10.1016/j.mycmed.2021.101178] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 06/14/2021] [Accepted: 07/30/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND As infection control faces new challenges from emerging, multidrug resistant strains of the yeast Candida auris, this study was conducted in order to examine the efficacy of hospital surface disinfectants and a new water disinfectant against C. auris biofilm forms. METHODS We tested four reference strains of C. auris (NCPF8971, NCPF8977, NCPF8984, DSM21092) and one C. albicans strain (ATCC10231) against disinfectants based on ethanol (ETH), quaternary ammonium (QAC), a combination of glutaraldehyde, quaternary ammonium and surfactant (ALD) and potassium peroxymonosulfate (PP) as well as 3.4% H2O2 and 4.25% H2O2 alone. In addition, a micellic-based formulation containing 17% v/v hydrogene peroxide disinfectant (mH2O2) was tested. The efficacy of the disinfectants was measured in a 96-well plate using tetrazolium salt reduction (XTT) and the log10 reduction assay. RESULTS ETH and QAC displayed in clinically recommended concentrations more than 5log10 reduction and more than 80% XTT activity reduction for all of the Candida biofilms and planktonic cells. Only biofilms of C. auris NCPF8984 were additionally sensitive to all remaining disinfectants. All tested C. auris biofilms were sensitive to PP disinfectant and showed more than 5log10 reduction. However, the XTT assay showed a reduction of less than 80% for the PP disinfectant, indicating the presence of active but non-culturable cells. The 25% mH2O2 (corresponding to 4.25% H2O2) killed Candida biofilms after 1 minute.
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Affiliation(s)
- Beata Zatorska
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Doris Moser
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Julia Ebner
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luigi Segagni Lusignani
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
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12
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van Rooden SM, Aspevall O, Carrara E, Gubbels S, Johansson A, Lucet JC, Mookerjee S, Palacios-Baena ZR, Presterl E, Tacconelli E, Abbas M, Behnke M, Gastmeier P, van Mourik MSM. Governance aspects of large-scale implementation of automated surveillance of healthcare-associated infections. Clin Microbiol Infect 2021; 27 Suppl 1:S20-S28. [PMID: 34217464 DOI: 10.1016/j.cmi.2021.02.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Surveillance of healthcare-associated infections (HAI) is increasingly automated by applying algorithms to routine-care data stored in electronic health records. Hitherto, initiatives have mainly been confined to single healthcare facilities and research settings, leading to heterogeneity in design. The PRAISE network - Providing a Roadmap for Automated Infection Surveillance in Europe - designed a roadmap to provide guidance on how to move automated surveillance (AS) from the research setting to large-scale implementation. Supplementary to this roadmap, we here discuss the governance aspects of automated HAI surveillance within networks, aiming to support both the coordinating centres and participating healthcare facilities as they set up governance structures and to enhance involvement of legal specialists. METHODS This article is based on PRAISE network discussions during two workshops. A taskforce was installed that further elaborated governance aspects for AS networks by reviewing documents and websites, consulting experts and organizing teleconferences. Finally, the article has been reviewed by an independent panel of international experts. RESULTS Strict governance is indispensable in surveillance networks, especially when manual decisions are replaced by algorithms and electronically stored routine-care data are reused for the purpose of surveillance. For endorsement of AS networks, governance aspects specifically related to AS networks need to be addressed. Key considerations include enabling participation and inclusion, trust in the collection, use and quality of data (including data protection), accountability and transparency. CONCLUSIONS This article on governance aspects can be used by coordinating centres and healthcare facilities participating in an AS network as a starting point to set up governance structures. Involvement of main stakeholders and legal specialists early in the development of an AS network is important for endorsement, inclusivity and compliance with the laws and regulations that apply.
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Affiliation(s)
- Stephanie M van Rooden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Centre for Infectious Disease Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands.
| | - Olov Aspevall
- Unit for Surveillance and Coordination, Public Health Agency of Sweden, Solna, Sweden
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Sophie Gubbels
- Data Integration and Analysis Secretariat, Statens Serum Institut, Copenhagen, Denmark
| | | | - Jean-Christophe Lucet
- Infection Control Unit, Hôpital Bichat-Claude Bernard Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Siddharth Mookerjee
- Department of Infection Prevention and Control, Imperial College Healthcare NHS Trust, London, UK
| | - Zaira R Palacios-Baena
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (IBIS), Seville, Spain
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy; Infectious Diseases, Research Clinical Unit, DZIF Center, University Hospital Tübingen, Tübingen, Germany
| | - Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Michael Behnke
- National Reference Center for Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- National Reference Center for Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Maaike S M van Mourik
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, Utrecht, the Netherlands
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13
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van Mourik MSM, van Rooden SM, Abbas M, Aspevall O, Astagneau P, Bonten MJM, Carrara E, Gomila-Grange A, de Greeff SC, Gubbels S, Harrison W, Humphreys H, Johansson A, Koek MBG, Kristensen B, Lepape A, Lucet JC, Mookerjee S, Naucler P, Palacios-Baena ZR, Presterl E, Pujol M, Reilly J, Roberts C, Tacconelli E, Teixeira D, Tängdén T, Valik JK, Behnke M, Gastmeier P. PRAISE: providing a roadmap for automated infection surveillance in Europe. Clin Microbiol Infect 2021; 27 Suppl 1:S3-S19. [PMID: 34217466 DOI: 10.1016/j.cmi.2021.02.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Healthcare-associated infections (HAI) are among the most common adverse events of medical care. Surveillance of HAI is a key component of successful infection prevention programmes. Conventional surveillance - manual chart review - is resource intensive and limited by concerns regarding interrater reliability. This has led to the development and use of automated surveillance (AS). Many AS systems are the product of in-house development efforts and heterogeneous in their design and methods. With this roadmap, the PRAISE network aims to provide guidance on how to move AS from the research setting to large-scale implementation, and how to ensure the delivery of surveillance data that are uniform and useful for improvement of quality of care. METHODS The PRAISE network brings together 30 experts from ten European countries. This roadmap is based on the outcome of two workshops, teleconference meetings and review by an independent panel of international experts. RESULTS This roadmap focuses on the surveillance of HAI within networks of healthcare facilities for the purpose of comparison, prevention and quality improvement initiatives. The roadmap does the following: discusses the selection of surveillance targets, different organizational and methodologic approaches and their advantages, disadvantages and risks; defines key performance requirements of AS systems and suggestions for their design; provides guidance on successful implementation and maintenance; and discusses areas of future research and training requirements for the infection prevention and related disciplines. The roadmap is supported by accompanying documents regarding the governance and information technology aspects of implementing AS. CONCLUSIONS Large-scale implementation of AS requires guidance and coordination within and across surveillance networks. Transitions to large-scale AS entail redevelopment of surveillance methods and their interpretation, intensive dialogue with stakeholders and the investment of considerable resources. This roadmap can be used to guide future steps towards implementation, including designing solutions for AS and practical guidance checklists.
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Affiliation(s)
- Maaike S M van Mourik
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, the Netherlands.
| | - Stephanie M van Rooden
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Mohamed Abbas
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Olov Aspevall
- Unit for Surveillance and Coordination, Public Health Agency of Sweden, Solna, Sweden
| | - Pascal Astagneau
- Centre for Prevention of Healthcare-Associated Infections, Assistance Publique - Hôpitaux de Paris & Faculty of Medicine, Sorbonne University, Paris, France
| | - Marc J M Bonten
- Department of Medical Microbiology and Infection Control, University Medical Center Utrecht, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Aina Gomila-Grange
- Infectious Diseases Unit, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Barcelona, Infectious Diseases Unit, Consorci Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Sabine C de Greeff
- Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Sophie Gubbels
- Data Integration and Analysis Secretariat, Statens Serum Institut, Copenhagen, Denmark
| | - Wendy Harrison
- Healthcare Associated Infections, Antimicrobial Resistance and Prescribing Programme (HARP), Public Health Wales, UK
| | - Hilary Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland, Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | | | - Mayke B G Koek
- Centre for Infectious Disease Epidemiology and Surveillance National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Brian Kristensen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Alain Lepape
- Clinical Research Unit, Department of Intensive Care, Centre Hospitalier Universitaire Lyon Sud 69495, Pierre-Bénite, France
| | - Jean-Christophe Lucet
- Infection Control Unit, Hôpital Bichat-Claude Bernard Assistance Publique - Hôpitaux de Paris, Paris, France
| | - Siddharth Mookerjee
- Infection Prevention and Control Department, Imperial College Healthcare NHS Trust, UK
| | - Pontus Naucler
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Zaira R Palacios-Baena
- Unit of Infectious Diseases, Clinical Microbiology and Preventive Medicine, Hospital Universitario Virgen Macarena, Institute of Biomedicine of Seville (I. BIS), Sevilla, Spain
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Austria
| | - Miquel Pujol
- Infectious Diseases Unit, Bellvitge Biomedical Research Institute (IDIBELL), Bellvitge University Hospital, Barcelona, Infectious Diseases Unit, Consorci Corporació Sanitària Parc Taulí, Barcelona, Spain
| | - Jacqui Reilly
- Safeguarding Health Through Infection Prevention Research Group, Institute for Applied Health Research, Glasgow Caledonian University, Scotland, UK
| | - Christopher Roberts
- Healthcare Associated Infections, Antimicrobial Resistance and Prescribing Programme (HARP), Public Health Wales, UK
| | - Evelina Tacconelli
- Infectious Diseases, Research Clinical Unit, DZIF Center, University Hospital Tübingen, Germany; Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Daniel Teixeira
- Infection Control Programme, Geneva University Hospitals, Geneva, Switzerland
| | - Thomas Tängdén
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - John Karlsson Valik
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Michael Behnke
- National Reference Center for Surveillance of nosocomial Infections, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Petra Gastmeier
- National Reference Center for Surveillance of nosocomial Infections, Charité - Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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14
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Pezzani MD, Carrara E, Sibani M, Presterl E, Gastmeier P, Renk H, Kanj SS, Velavan TP, Song LH, Leibovici L, Torumkuney D, Kostyanev T, Mendelson M, Tacconelli E. White Paper: Bridging the gap between human and animal surveillance data, antibiotic policy and stewardship in the hospital sector-practical guidance from the JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks. J Antimicrob Chemother 2021; 75:ii20-ii32. [PMID: 33280046 PMCID: PMC7719407 DOI: 10.1093/jac/dkaa426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Antimicrobial surveillance and antimicrobial stewardship (AMS) are essential pillars in the fight against antimicrobial resistance (AMR), but practical guidance on how surveillance data should be linked to AMS activities is lacking. This issue is particularly complex in the hospital setting due to structural heterogeneity of hospital facilities and services. The JPIAMR ARCH and COMBACTE-MAGNET EPI-Net networks have joined efforts to formulate a set of target actions for linking surveillance data with AMS activities. METHODS A scoping review of the literature was carried out addressing research questions on three areas: (i) AMS leadership and accountability; (ii) antimicrobial usage and AMS; (iii) AMR and AMS. Consensus on the target actions was reached through a RAND-modified Delphi process involving over 40 experts in different fields from 18 countries. RESULTS Evidence was retrieved from 51 documents. Initially 38 targets were proposed, differentiated as essential or desirable according to clinical relevance, feasibility and applicability to settings and resources. In the first consultation round, preliminary agreement was reached for 32 targets. Following a second consultation, 27 targets were approved, 11 were deleted and 4 were suggested for rephrasing, leading to a final approved list of 34 target actions in the form of a practical checklist. CONCLUSIONS This White Paper provides a pragmatic and flexible tool to guide the development of calibrated hospital-surveillance-based AMS interventions. The strength of this tool is that it is a comprehensive perspective that takes into account the hospital patient case-mix and the related epidemiology, which ultimately drives antimicrobial usage, and the feasibility in low-resource settings.
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Affiliation(s)
- Maria Diletta Pezzani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elena Carrara
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Marcella Sibani
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabeth Presterl
- European Committee on Infection Control, Basel, Switzerland.,ESCMID Study group for nosocomial infections, Basel, Switzerland.,Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Petra Gastmeier
- German Centre for Infection Research Association (DZIF), Braunschweig, Germany.,Institute for Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, Germany, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Hanna Renk
- University Children's Hospital Tübingen, Department of Paediatric Cardiology, Pulmology and Intensive Care Medicine, Tübingen, Germany
| | - Souha S Kanj
- Division of Infectious Diseases, Department of Internal Medicine, and Infection Control and Prevention Program, and Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut, Lebanon
| | - Thirumalaisamy P Velavan
- Institute of Tropical Medicine, Universitätsklinikum Tübingen, Germany.,Vietnamese German Center for Medical Research, Hanoi, Vietnam.,Faculty of Medicine, Duy Tan University, Da Nang, Vietnam
| | - Le Huu Song
- Vietnamese German Center for Medical Research, Hanoi, Vietnam.,108 Military Central Hospital, Hanoi, Vietnam
| | - Leonard Leibovici
- Medicine E, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Didem Torumkuney
- International Federation of Pharmaceuticals and Manufacturers & Associations (IFPMA), Geneva, Switzerland
| | - Tomislav Kostyanev
- Department of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Marc Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Evelina Tacconelli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,Division of Infectious Diseases, Department of Internal Medicine, and Infection Control and Prevention Program, and Antimicrobial Stewardship Program, American University of Beirut Medical Center, Beirut, Lebanon.,Infectious Diseases, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
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15
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Diab-El Schahawi M, Zingg W, Vos M, Humphreys H, Lopez-Cerero L, Fueszl A, Zahar JR, Presterl E. Ultraviolet disinfection robots to improve hospital cleaning: Real promise or just a gimmick? Antimicrob Resist Infect Control 2021; 10:33. [PMID: 33579343 PMCID: PMC7879404 DOI: 10.1186/s13756-020-00878-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/22/2020] [Indexed: 11/17/2022] Open
Abstract
The global COVID-19 pandemic due to the novel coronavirus SARS-CoV-2 has challenged the availability of traditional surface disinfectants. It has also stimulated the production of ultraviolet-disinfection robots by companies and institutions. These robots are increasingly advocated as a simple solution for the immediate disinfection of rooms and spaces of all surfaces in one process and as such they seem attractive to hospital management, also because of automation and apparent cost savings by reducing cleaning staff. Yet, there true potential in the hospital setting needs to be carefully evaluated. Presently, disinfection robots do not replace routine (manual) cleaning but may complement it. Further design adjustments of hospitals and devices are needed to overcome the issue of shadowing and free the movement of robots in the hospital environment. They might in the future provide validated, reproducible and documented disinfection processes. Further technical developments and clinical trials in a variety of hospitals are warranted to overcome the current limitations and to find ways to integrate this novel technology in to the hospitals of to-day and the future.
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Affiliation(s)
- Magda Diab-El Schahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Walter Zingg
- Infection Control Programme, University Hospital of Zurich, Zurich, Switzerland
| | - Margreet Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hilary Humphreys
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland.,Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | | | - Astrid Fueszl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Jean Ralph Zahar
- Unité de contrôle et de prévention du risque infectieux, service de microbiologie, groupe hospitalier universitaire, Hôpital Avicenne, Paris Seine Saint-Denis, France.,UFR-SMBH, Université Paris XIII, Paris Sorbonne, France
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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16
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Kriechbaumer LK, Happak W, Distelmaier K, Thalhammer G, Kaiser G, Kugler S, Tan Y, Leonhard M, Zatorska B, Presterl E, Nürnberger S. Disinfection of contaminated metal implants with an Er:YAG laser. J Orthop Res 2020; 38:2464-2473. [PMID: 32167192 PMCID: PMC7687249 DOI: 10.1002/jor.24662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 02/04/2023]
Abstract
Infections related to orthopedic procedures are considered particularly severe when implantation materials are used, because effective treatments for biofilm removal are lacking. In this study, the relatively new approach for infection control by using an erbium:yttrium-aluminum-garnet (Er:YAG) laser was tested. This laser vaporizes all water containing cells in a very effective, precise, and predictable manner and results in only minimal thermal damage. For preliminary testing, 42 steel plates and 42 pins were seeded with mixed cultures. First, the minimally necessary laser energy for biofilm removal was determined. Subsequently, the effectiveness of biofilm removal with the Er:YAG laser and the cleansing of the metal implants with octenidine-soaked gauze was compared. Then, we compared the effectiveness of biofilm removal on 207 steel pins from 41 patients directly after explantation. Sonication and scanning electron microscopy were used for analysis. Laser fluences exceeding 2.8 J/cm2 caused a complete extinction of all living cells by a single-laser impulse. Cleansing with octenidine-soaked gauze and irradiation with the Er:YAG laser are both thoroughly effective when applied to seeded pins. In contrast, when explanted pins with fully developed biofilms were analyzed, we found a significant advantage of the laser procedure. The Er:YAG laser offers a secure, complete, and nontoxic eradication of all kinds of pathogens from metal implants without damaging the implant and without the possible development of resistance. The precise noncontact removal of adjacent tissue is a decisive advantage over conventional disinfectants. Therefore, laser irradiation could become a valuable method in every debridement, antibiotics, and implant retention procedure.
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Affiliation(s)
- Lukas K. Kriechbaumer
- University Clinic of Orthopaedics and TraumatologyParacelsus Medical UniversitySalzburgAustria,Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Wolfgang Happak
- Division of Plastic and Reconstructive Surgery, Department of SurgeryMedical University of ViennaViennaAustria
| | - Klaus Distelmaier
- Division of Cardiology, Department of Internal Medicine IIMedical University of ViennaViennaAustria
| | - Gerhild Thalhammer
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Georg Kaiser
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
| | - Sylvia Kugler
- Department of Dermatology, Division of Immunology Allergy and Infectious DiseasesMedical University of ViennaViennaAustria
| | - Yulong Tan
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Matthias Leonhard
- Department of Otorhinolaryngology and Head and Neck SurgeryMedical University of ViennaViennaAustria
| | - Beata Zatorska
- Department of Infection Control and Hospital EpidemiologyMedical University of ViennaViennaAustria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital EpidemiologyMedical University of ViennaViennaAustria
| | - Sylvia Nürnberger
- Division of Trauma‐Surgery, Department of Orthopedics and Trauma‐SurgeryMedical University of ViennaViennaAustria
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Assadian O, Zatorska B, Presterl E, Diab-El Schahawi M. A novel micellar formulation based on natural plant extracts enhances the efficacy of hydrogen peroxide against biofilms of Staphylococcus spp. and Pseudomonas aeruginosa. Biofouling 2020; 36:576-586. [PMID: 32586132 DOI: 10.1080/08927014.2020.1782388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 06/11/2023]
Abstract
The antibacterial efficacy of hydrogen peroxide encapsulated in micelles (mH2O2) against biofilms was compared with that of hydrogen peroxide alone and of three commercially available aqueous biocides. The activity of mH2O2 on 24-h biofilms of reference strains of Staphylococcus spp. and Pseudomonas aeruginosa was tested in a static microtiter plate model. The biofilms were incubated with mH2O2 (17% v/v H2O2, 2% lactic acid, 0.3% phytoextract, H2O) and its individual ingredients and compared with three aqueous biocides at different concentrations and times of exposure. After 5-min exposure, 10% mH2O2 (corresponding to 1.7% v/v H2O2) achieved > 8 log10 reductions against all the test strains, while 1.7% H2O2 achieved a maximum of 1.5 log10 reduction. After 5-min exposure, none of the commercially available biocides tested showed themselves to be capable of completely eliminating the test strains embedded in biofilms. Hydrogen peroxide encapsulated in micelles demonstrated enhanced activity against planktonic cells and biofilms of Staphylococcus spp. and P. aeruginosa.
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Affiliation(s)
- Ojan Assadian
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Beata Zatorska
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
| | - Magda Diab-El Schahawi
- Department of Infection Control and Hospital Epidemiology, Medical University Vienna, Vienna, Austria
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18
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Foessleitner P, Gasser J, Kiss H, Flunt A, Presterl E, Petricevic L, Farr A. Vaginal colonization of extended-spectrum beta-lactamase-producing bacteria during pregnancy: An observational study. Eur J Obstet Gynecol Reprod Biol 2020; 246:86-89. [DOI: 10.1016/j.ejogrb.2020.01.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 01/16/2020] [Accepted: 01/20/2020] [Indexed: 02/04/2023]
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Segagni Lusignani L, Presterl E, Zatorska B, Van den Nest M, Diab-Elschahawi M. Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011-2016) case-control study. Antimicrob Resist Infect Control 2020; 9:18. [PMID: 31988746 PMCID: PMC6969403 DOI: 10.1186/s13756-019-0668-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 12/20/2019] [Indexed: 01/01/2023] Open
Abstract
Background Carbapenemase-producing enterobacteriaceae (CPE) are a major threat for severely ill patients. However, only limited data on the epidemiology and on evidence-based infection prevention and control measures are available. The aim of this study was to investigate the epidemiology of patients with CPE, characterizing the CPE isolates by their resistance mechanisms and genetic similarity, to explore risk factors for their acquisition, and to evaluate the effectiveness of the current CPE infection control measures. Methods A retrospective case-control study was performed using data from 2011 to 2016 in a 1800-bed academic hospital in Central Europe, where risk-based screening at patients´ admission is performed. Carbapenem resistance mechanisms of all carbapenem resistant enterobacteriaceae from patients admitted during this period were investigated. Clinical data of the CPE-positive patients were analysed and compared to a matched control group (case-control ratio of 1:3). We performed univariate and multivariate statistical analysis to identify risk factors for CPE acquisition. Results Of 621,623 admitted patients in the study period, 75 patients with carriage of carbapenem resistant enterobacteriaceae were included (0.12/1000 admittances). Carbapenemase-encoding genes were detected in 77.3% (58/75) of patients with carbapenem-resistant enterobacteriaceae. The enzyme blaOXA-48 was found in 34.5% (20/58), blaKPC in 29.3% (17/58), blaNDM enzymes in 20.7% (12/58) and blaVIM in 8.6% (5/58) of the isolates. The overall mortality among CPE patients was 25.9% (15/58) and attributable mortality of CPE was 53.3% (8/15). Multivariate analysis revealed four risk factors to be independent predictors of CPE carriage: the length of hospital admission > 20 days (AOR: 4.9, 95% CI: 1.4–15.5; P < 0.001), hospital admission within the previous year (AOR: 22.3, 95% CI: 3.9–88.4; P < 0.001), exposure to a healthcare facility in a country with high or unknown carbapenem-resistant enterobacteriaceae prevalence 3 months before admission (AOR: 11.8, 95% CI: 2.2–63.2; P < 0.01) and the use of antibiotics longer than 10 days (AOR: 5.2, 95% CI: 1.4–35.9; P < 0.05). The current risk-based screening strategy at hospital admission could not identify 37 (63.8%) of the 58 CPE-positive patients. Epidemiological investigation and genotyping revealed that no outbreaks due to CPE occurred during this period. Conclusion Overall, the CPE carriage rate in patients was very low, the attributable mortality, however, is alarming (53%). BlaOXA-48 and blaKPC were the main cause of carbapenem resistance in enterobacteriaceae. Although the strict application of standard infection control measures was effective for prevention of outbreaks in this setting, an enlarged risk based targeted screening strategy has to be implemented.
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Affiliation(s)
- Luigi Segagni Lusignani
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Beata Zatorska
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Miriam Van den Nest
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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20
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Ravaioli S, Campoccia D, Speziale P, Pietrocola G, Zatorska B, Maso A, Presterl E, Montanaro L, Arciola CR. Various biofilm matrices of the emerging pathogen Staphylococcus lugdunensis: exopolysaccharides, proteins, eDNA and their correlation with biofilm mass. Biofouling 2020; 36:86-100. [PMID: 31985269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Staphylococcus lugdunensis is an emerging high-virulent pathogen causative of hospital-acquired infections. Biofilm formation is a complex pathogenic process that leads to well-established bacterial communities. There is a paucity of data on the composition of the biofilm matrix among S. lugdunensis strains. Here, twenty-two S. lugdunensis clinical isolates, mainly from orthopaedic infections but also from other clinical sources, were sub-grouped by ribotyping and dendrogram analysis. Biofilms were analysed by fluorimetric methods based on FITC-Wheat Germ Agglutinin, SYPRO Ruby and TOTO-1 dyes to detect exopolysaccharides, proteins and extracellular DNA (eDNA), respectively. Biofilm morphology was investigated under confocal laser scanning microscopy (CLSM). Isolates displayed intriguing diversities in biofilm mass and matrix composition. The content of exopolysaccharides was found to be to be strongly associated with the biofilm mass (R2 = 0.882), while the content of proteins turned out to be weakly (R2 = 0.465) and that of eDNA very weakly associated (R2 = 0.202) to the biofilm mass.
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Affiliation(s)
- Stefano Ravaioli
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Davide Campoccia
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Pietro Speziale
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
- Department of Industrial and Information Engineering, University of Pavia, Italy
| | - Giampiero Pietrocola
- Department of Molecular Medicine, Unit of Biochemistry, University of Pavia, Pavia, Italy
| | - Beata Zatorska
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Alessandra Maso
- Quality Control in GMP, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Lucio Montanaro
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
| | - Carla Renata Arciola
- Laboratorio di Patologia delle Infezioni Associate all'Impianto, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Bologna, Italy
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21
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Taghizadeh L, Karimi A, Presterl E, Heitzinger C. Bayesian inversion for a biofilm model including quorum sensing. Comput Biol Med 2019; 117:103582. [PMID: 31885354 DOI: 10.1016/j.compbiomed.2019.103582] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/06/2019] [Accepted: 12/10/2019] [Indexed: 10/25/2022]
Abstract
We propose a mathematical model based on a system of partial differential equations (PDEs) for biofilms. This model describes the time evolution of growth and degradation of biofilms which depend on environmental factors. The proposed model also includes quorum sensing (QS) and describes the cooperation among bacteria when they need to resist against external factors such as antibiotics. The applications include biofilms on teeth and medical implants, in drinking water, cooling water towers, food processing, oil recovery, paper manufacturing, and on ship hulls. We state existence and uniqueness of solutions of the proposed model and implement the mathematical model to discuss numerical simulations of biofilm growth and cooperation. We also determine the unknown parameters of the presented biofilm model by solving the corresponding inverse problem. To this end, we propose Bayesian inversion techniques and the delayed-rejection adaptive-Metropolis (DRAM) algorithm for the simultaneous extraction of multiple parameters from the measurements. These quantities cannot be determined directly from the experiments or from the computational model. Furthermore, we evaluate the presented model by comparing the simulations using the estimated parameter values with the measurement data. The results illustrate a very good agreement between the simulations and the measurements.
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Affiliation(s)
- Leila Taghizadeh
- Institute for Analysis and Scientific Computing, Vienna University of Technology (TU Wien), Wiedner Hauptstraße 8-10, 1040 Vienna, Austria.
| | - Ahmad Karimi
- Institute for Analysis and Scientific Computing, Vienna University of Technology (TU Wien), Wiedner Hauptstraße 8-10, 1040 Vienna, Austria.
| | - Elisabeth Presterl
- Department for Hospital Hygiene and Infection Control, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria.
| | - Clemens Heitzinger
- Institute for Analysis and Scientific Computing, Vienna University of Technology (TU Wien), Wiedner Hauptstraße 8-10, 1040 Vienna, Austria; School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, USA.
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22
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Meijs AP, Prantner I, Kärki T, Ferreira JA, Kinross P, Presterl E, Märtin P, Lyytikäinen O, Hansen S, Szőnyi A, Ricchizzi E, Valinteliėnė R, Zerafa S, de Greeff SC, Berg TC, Fernandes PA, Štefkovičová M, Asensio A, Lamagni T, Sartaj M, Reilly J, Harrison W, Suetens C, Koek MBG. Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate? J Hosp Infect 2019; 103:404-411. [PMID: 31265856 DOI: 10.1016/j.jhin.2019.06.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.
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Affiliation(s)
- A P Meijs
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
| | - I Prantner
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - T Kärki
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - J A Ferreira
- Department of Statistics, Informatics and Modelling, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - P Kinross
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - E Presterl
- Medical University Vienna, Vienna, Austria
| | - P Märtin
- West Tallinn Central Hospital, Health Board, Tallinn, Estonia
| | - O Lyytikäinen
- National Institute for Health and Welfare, Helsinki, Finland
| | - S Hansen
- Institute of Hygiene and Environmental Health Charité, University Medicine Berlin, Berlin, Germany
| | - A Szőnyi
- National Center for Epidemiology, Department of Hospital Epidemiology and Hygiene, Budapest, Hungary; National Public Health Center, Budapest, Hungary
| | - E Ricchizzi
- Agenzia sanitaria e sociale regionale - Regione Emilia Romagna, Bologna, Italy
| | | | - S Zerafa
- Mater Dei Hospital, Msida, Malta
| | - S C de Greeff
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - T C Berg
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - M Štefkovičová
- Alexander Dubcek University in Trenčín and Regional Public Health Authority in Trenčín, Slovakia
| | - A Asensio
- Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | - T Lamagni
- Public Health England, London, England, UK
| | - M Sartaj
- HSC Public Health Agency, Belfast, Northern Ireland, UK
| | - J Reilly
- Health Protection Scotland National Services Scotland and Glasgow Caledonian University, Glasgow, Scotland, UK
| | | | - C Suetens
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - M B G Koek
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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23
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Tacconelli E, Buhl M, Humphreys H, Malek V, Presterl E, Rodriguez-Baño J, Vos MC, Zingg W, Mutters NT. Analysis of the challenges in implementing guidelines to prevent the spread of multidrug-resistant gram-negatives in Europe. BMJ Open 2019; 9:e027683. [PMID: 31110101 PMCID: PMC6530321 DOI: 10.1136/bmjopen-2018-027683] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE The main objective of the study was to investigate major differences among European countries in implementing infection prevention and control (IPC) measures and reasons for reduced compliance. DESIGN An online survey including experts in IPC and a gap analysis were conducted to identify major limitations in implementing IPC guidelines. SETTING Europe. MAIN OUTCOME MEASURES Four areas were targeted: (1) healthcare structure, (2) finances, (3) culture and (4) education and awareness. Perceived compliance to IPC measures was classified as low (<50%), medium (50% to 80%) and high (>80%). Countries were classified in three regions: North-Western Europe (NWE), Eastern Europe (EE) and Southern Europe (SE). RESULTS In total, 482 respondents from 34 out of 44 (77.3%) European countries participated. Respondents reported availability of national guidelines to control multidrug-resistant Gram-negatives (MDR-GN) in 20 countries (58.0%). According to participants, compliance with IPC measures ranged from 17.8% (screening at discharge) to 96.0% (contact precautions). Overall, three areas were identified as critical for the compliance rate: (1) number of infection control staff, (2) IPC dedicated educational programmes and (3) number of clinical staff. Analysis of reasons for low compliance showed high heterogeneity among countries: participants from NWE and SE deemed the lack of educational programmes as the most important, while those from EE considered structural reasons, such as insufficient single bed rooms or lacking materials for isolation, as main contributors to the low compliance. CONCLUSIONS Although national guidelines to reduce the spread of MDR-GN are reported in the majority of the European countries, low compliance with IPC measures was commonly reported. Reasons for the low compliance are multifactorial and vary from region to region. Cross-country actions to reduce the spread of MDR-GN have to consider structural and cultural differences in countries. Locally calibrated interventions may be fruitful in the future.
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Affiliation(s)
- Evelina Tacconelli
- Infectious Diseases, University Hospital Tübingen, Tübingen, Germany
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
- European Committee on Infection Control, Basel, Switzerland
| | - Michael Buhl
- Infectious Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Hilary Humphreys
- Royal College of Surgeons in Ireland, Dublin, Ireland
- ESCMID Study group for nosocomial infections, Basel, Switzerland
- Beaumont Hospital, Dublin, Ireland
| | - Veronika Malek
- Centre of Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Elisabeth Presterl
- European Committee on Infection Control, Basel, Switzerland
- ESCMID Study group for nosocomial infections, Basel, Switzerland
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Jesús Rodriguez-Baño
- European Committee on Infection Control, Basel, Switzerland
- Hospital Universitario Virgen Macarena, Seville, Spain
| | - Margreet C Vos
- ESCMID Study group for nosocomial infections, Basel, Switzerland
- Department of Medical Microbiology and Infectious diseases, Erasmus MC Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Walter Zingg
- Infection Control Programme, University of Geneva Hospitals, Geneva, Switzerland
| | - Nico T Mutters
- European Committee on Infection Control, Basel, Switzerland
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center - University of Freiburg, Freiburg, Germany
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24
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Ott SR, Meier N, Kolditz M, Bauer TT, Rohde G, Presterl E, Schürmann D, Lepper PM, Ringshausen FC, Flick H, Leib SL, Pletz MW. Pulmonary nocardiosis in Western Europe—Clinical evaluation of 43 patients and population-based estimates of hospitalization rates. Int J Infect Dis 2019; 81:140-148. [DOI: 10.1016/j.ijid.2018.12.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/12/2018] [Accepted: 12/21/2018] [Indexed: 11/26/2022] Open
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25
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Klasinc R, Lupyr K, Zeller I, Paula H, Makristathis A, Tuchmann F, Wrba T, Assadian O, Presterl E. Clinical characteristics of a large cohort of patients with positive culture of Fusobacterium necrophorum. GMS Infect Dis 2019; 6:Doc03. [PMID: 30671334 PMCID: PMC6301733 DOI: 10.3205/id000038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Fusobacterium necrophorum is a rare pathogen, mostly affecting young adults, causing infections of the head and neck, typically described as the Lemierre's syndrome. Today this symptom complex has become increasingly rare and has almost turned to a 'forgotten disease'. Methods: We performed a retrospective, descriptive study to identify the clinical features of patients with positive culture of F. necrophorum. Additionally, the antibiotic susceptibility profile of the pathogens was analysed. Results: During a period of 22 years 36 patients with at least one isolate of F. necrophorum were identified. Mostly tonsillar and peritonsillar abscesses were found, 10 patients were identified with bacteraemia, but only 4 patients presented with symptoms like sore throat, fever and swollen cervical lymph nodes, which may suggest Lemierre's. Most of the isolates (33/35) showed sensitivity to all tested antibiotics. Conclusion: Appropriate techniques are needed to detect F. necropho rum, especially from throat swabs, in the microbiological laboratory. Current clinical and microbiological practice may lead to under-diagnosis of infections caused by F. necrophorum. Further research is needed to define the colonization rate and to optimize methods for detection as well as identification of virulence.
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Affiliation(s)
- Romana Klasinc
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria.,Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Austria
| | - Kostiantyn Lupyr
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Iris Zeller
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Helga Paula
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Athanasios Makristathis
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Austria
| | - Felix Tuchmann
- Department of Dermatology, Medical University of Vienna, Austria
| | - Thomas Wrba
- Medical University of Vienna, IT4Science, IT-Systems & Communications, Vienna, Austria
| | - Ojan Assadian
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control & Hospital Epidemiology, Medical University of Vienna, Austria
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Klasinc R, Rieger A, Presterl E, Wrba T, Diab-Elschahawi M. Epidemiology of Urinary Tract Infections in HIV Positive Patients at a Tertiary Care University Hospital in Central Europe (2011 - 2016). Infect Disord Drug Targets 2019; 18:199-206. [PMID: 29621966 DOI: 10.2174/1871526518666180405153616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 01/05/2018] [Accepted: 03/31/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES There is limited published data concerning the recent epidemiology of urinary tract infections (UTI) in HIV-patients, thus we analysed independent risk factors for UTI in HIV positive individuals and antimicrobial resistance rates of E. coli to antimicrobial agents commonly used in UTI. To determine the prevalence of symptomatic urinary tract infections (UTI) in HIV-patients, we performed a retrospective case-control study. METHODS We included 313 HIV-patients, 101 with UTI and 212 age and gendermatched controls, attending the HIV outpatient clinic at the Vienna University Hospital (VUH) over a period from January 2011 to September 2016. The patients' specific data was gathered from the electronic database of the VUH. The statistical analysis was performed using SPSS Software Version 20.0. RESULTS HIV infected individuals with CD4 count >200 cells/mm3 were less likely than HIV infected individuals with CD4 count <200 cells/mm3 to experience UTI (OR 0.811, 95% CI 0.712-0.923 vs. OR 2.555, 95% CI 1.553 - 4.205, respectively). The in vitro resistance rate of E. coli to antimicrobial agents was as follows: ciprofloxacin (41%), mecillinam (20.5%), trimethoprim (61%), ampicillin (67%), ampicillin/ clavulanic acid (23%), cefuroxime (17%), nitrofurantoin (2%), amikacin (0%) and gentamicin (9.5%). CONCLUSION Immunological status (CD4 count) is an important parameter for risk assessment of UTIs in HIV-patients. The increased resistance rate of E. coli to commonly used antimicrobial agents needs to be considered when it comes to the management of UTI, additionally, surveillance strategies should be implemented in HIV-patients.
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Affiliation(s)
- Romana Klasinc
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Armin Rieger
- Department of Dermatology, Division of Immundermatology and Infectious Diseases of the Skin, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Thomas Wrba
- IT4Science, IT-Systems & Communications, Medical University of Vienna, Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
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Presterl E, Diab-El Schahawi M, Lusignani LS, Paula H, Reilly JS. Specific Virology: Viruses as Diseases. Basic Microbiology and Infection Control for Midwives 2019. [PMCID: PMC7123172 DOI: 10.1007/978-3-030-02026-2_13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
1796: Jenner transfers cowpox material from a milkmaid to a boy and shows evidence of immunity generated by re-vaccination with virulent pox material.
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Fochtmann-Frana A, Freystätter C, Vorstandlechner V, Barth A, Bolliger M, Presterl E, Ihra G, Muschitz G, Mittlboeck M, Makristathis A, Rath T, Radtke C, Forstner C. Re: Comment on "Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study". Burns 2018; 45:744-745. [PMID: 30591250 DOI: 10.1016/j.burns.2018.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Alexandra Fochtmann-Frana
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christian Freystätter
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Vera Vorstandlechner
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - André Barth
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Michael Bolliger
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Elisabeth Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria.
| | - Gerald Ihra
- Medical University of Vienna, Department of Anesthesiology and General Intensive Care, Vienna, Austria.
| | - Gabriela Muschitz
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Martina Mittlboeck
- Medical University of Vienna, Center for Medical Statistics Informatics and Intelligent Systems, Section for Clinical Biometrics, Vienna, Austria.
| | - Athanasios Makristathis
- Medical University of Vienna, Division of Clinical Microbiology, Department of Laboratory Medicine, Vienna, Austria.
| | - Thomas Rath
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christine Radtke
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christina Forstner
- Medical University of Vienna, Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Vienna, Austria; Jena University Hospital, Institute of Infectious Diseases and Infection Control, Jena, Germany.
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Abbas M, de Kraker MEA, Aghayev E, Astagneau P, Aupee M, Behnke M, Bull A, Choi HJ, de Greeff SC, Elgohari S, Gastmeier P, Harrison W, Koek MBG, Lamagni T, Limon E, Løwer HL, Lyytikäinen O, Marimuthu K, Marquess J, McCann R, Prantner I, Presterl E, Pujol M, Reilly J, Roberts C, Segagni Lusignani L, Si D, Szilágyi E, Tanguy J, Tempone S, Troillet N, Worth LJ, Pittet D, Harbarth S. Impact of participation in a surgical site infection surveillance network: results from a large international cohort study. J Hosp Infect 2018; 102:267-276. [PMID: 30529703 DOI: 10.1016/j.jhin.2018.12.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/03/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale. AIM To determine the time-trend of SSI rates in surveillance networks. METHODS SSI surveillance networks provided procedure-specific data on numbers of SSIs and operations, stratified by hospitals' year of participation in the surveillance, to capture length of participation as an exposure. Pooled and procedure-specific random-effects Poisson regression was performed to obtain yearly rate ratios (RRs) with 95% confidence intervals (CIs), and including surveillance network as random intercept. FINDINGS Of 36 invited networks, 17 networks from 15 high-income countries across Asia, Australia and Europe participated in the study. Aggregated data on 17 surgical procedures (cardiovascular, digestive, gynaecological-obstetrical, neurosurgical, and orthopaedic) were collected, resulting in data concerning 5,831,737 operations and 113,166 SSIs. There was a significant decrease in overall SSI rates over surveillance time, resulting in a 35% reduction at the ninth (final) included year of surveillance (RR: 0.65; 95% CI: 0.63-0.67). There were large variations across procedure-specific trends, but strong consistent decreases were observed for colorectal surgery, herniorrhaphy, caesarean section, hip prosthesis, and knee prosthesis. CONCLUSION In this large, international cohort study, pooled SSI rates were associated with a stable and sustainable decrease after joining an SSI surveillance network; a causal relationship is possible, although unproven. There was heterogeneity in procedure-specific trends. These findings support the pivotal role of surveillance in reducing infection rates and call for widespread implementation of hospital-based SSI surveillance in high-income countries.
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Affiliation(s)
- M Abbas
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - M E A de Kraker
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - E Aghayev
- Swiss RDL, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland; Schulthess Klinik, Zürich, Switzerland
| | - P Astagneau
- Reference Centre for Prevention and Control of Healthcare-associated Infections, APHP University Hospital, Paris, France
| | - M Aupee
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - M Behnke
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - A Bull
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia
| | - H J Choi
- Division of Infectious Diseases, Office of Infection Control, Ewha Woman's University Medical Center, Seoul, Republic of Korea
| | - S C de Greeff
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - S Elgohari
- National Infection Service, Public Health England, London, UK
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - W Harrison
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | - M B G Koek
- National Institute for Public Health and the Environment (RIVM), Centre for Infectious Diseases Control (CIb), Epidemiology and Surveillance (EPI), Bilthoven, the Netherlands
| | - T Lamagni
- National Infection Service, Public Health England, London, UK
| | - E Limon
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain
| | - H L Løwer
- Norwegian Institute of Public Health, Department of Infectious Disease Epidemiology, Oslo, Norway
| | - O Lyytikäinen
- Department of Infectious Diseases, National Institute for Health and Welfare (THL), Helsinki, Finland
| | - K Marimuthu
- Department of Infectious Diseases, Institute of Infectious Diseases and Epidemiology, Tan Tock Seng Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - J Marquess
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - R McCann
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - I Prantner
- National Center for Epidemiology, Budapest, Hungary
| | - E Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria
| | - M Pujol
- VINCat Coordinator Center, Catalan Health Department, University of Barcelona, Barcelona, Spain; Hospital Universitari de Bellvitge, Barcelona, Spain; Spanish Network for the Research in Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | - J Reilly
- Healthcare Associated Infection, Antimicrobial Resistance, Decontamination and Infection Control Group, Health Protection Scotland, NHS National Services Scotland, Glasgow, UK; Safeguarding Health Through Infection Prevention (SHIP) Research Group, Glasgow Caledonian University, Glasgow, UK
| | - C Roberts
- Welsh Healthcare Associated Infection Programme (WHAIP), Public Health Wales, Cardiff, UK
| | | | - D Si
- Epidemiology and Research Unit, Communicable Diseases Branch, Department of Health, Queensland, Australia
| | - E Szilágyi
- National Public Health and Medical Officer Service, Budapest, Hungary
| | - J Tanguy
- Coordination Center for Prevention and Control of Nosocomial Infections (CClin) Ouest, Rennes, France
| | - S Tempone
- Healthcare Associated Infection Unit, Communicable Diseases Control Directorate, Department of Health Western Australia, Australia
| | - N Troillet
- Swissnoso, National Center for Infection Prevention, Bern, Switzerland; Service of Infectious Diseases, Central Institute of the Valais Hospital, Sion, Switzerland
| | - L J Worth
- Victorian Healthcare Associated Infection Surveillance System Coordinating Centre, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia
| | - D Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, The University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Farr A, Gasser J, Flunt A, Presterl E, Holzer I, Kiss H, Petricevic L. Evaluation des Schwangerschaftsoutcomes nach vaginaler Kolonisation mit Extended-Spectrum Beta-Lactamase (ESBL) produzierenden Bakterienarten: eine Fallserie. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- A Farr
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Abt. für Geburtshilfe und fetomaternale Medizin, Wien, Österreich
| | - J Gasser
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Abt. für Geburtshilfe und fetomaternale Medizin, Wien, Österreich
| | - A Flunt
- Medizinische Universität Wien, Universitätsklinik für Kinder- und Jugendheilkunde, Klinische Abteilung für Neonatologie, Pädiatrische Intensivmedizin und Neuropädiatrie, Wien, Österreich
| | - E Presterl
- Medizinische Universität Wien, Universitätsklinik für Krankenhaushygiene und Infektionskontrolle, Wien, Österreich
| | - I Holzer
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Abt. für Geburtshilfe und fetomaternale Medizin, Wien, Österreich
| | - H Kiss
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Abt. für Geburtshilfe und fetomaternale Medizin, Wien, Österreich
| | - L Petricevic
- Medizinische Universität Wien, Universitätsklinik für Frauenheilkunde, Abt. für Geburtshilfe und fetomaternale Medizin, Wien, Österreich
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Suchomel M, Brillmann M, Assadian O, Ousey KJ, Presterl E. Chlorhexidine-coated surgical gloves influence the bacterial flora of hands over a period of 3 hours. Antimicrob Resist Infect Control 2018; 7:108. [PMID: 30202521 PMCID: PMC6127898 DOI: 10.1186/s13756-018-0395-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 08/15/2018] [Indexed: 11/10/2022] Open
Abstract
Background The risk of SSI increases in the presence of foreign materials and may be caused by organisms with low pathogenicity, such as skin flora derived from hands of surgical team members in the event of a glove breach. Previously, we were able to demonstrate that a novel antimicrobial surgical glove coated chlorhexidine-digluconate as the active ingredient on its inner surface was able to suppress surgeons' hand flora during operative procedures by a magnitude of 1.7 log10 cfu/mL. Because of the clinical design of that study, we were not able to measure the full magnitude of the possible antibacterial suppression effect of antimicrobial gloves over a full 3 h period. Methods The experimental procedure followed the method for assessment of the 3-h effects of a surgical hand rub's efficacy to reduce the release of hand flora as described in the European Norm EN 12791. Healthy volunteers tested either an antimicrobial surgical glove or non-antimicrobial surgical latex gloves in a standardized laboratory-based experiment over a wear time of 3 h. Results Wearing antimicrobial surgical glove after a surgical hand rub with 60% (v/v) n-propanol resulted in the highest 3-h reduction factor of 2.67 log10. Non-antimicrobial surgical gloves demonstrated significantly lower (p ≤ 0.01) 3-h reduction factors at 1.96 log10 and 1.68 log10, respectively. Antibacterial surgical gloves are able to maintain a sustainable bacterial reduction on finger tips in a magnitude of almost 3 log10 (log10 2.67 cfu) over 3 h wear time. Conclusion It was demonstrated that wear of an antibacterial surgical glove coated with chlorhexidine-digluconate is able to suppress resident hand flora significantly over a period of 3-h.
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Affiliation(s)
- Miranda Suchomel
- 1Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Markus Brillmann
- 1Institute for Hygiene and Applied Immunology, Medical University of Vienna, Kinderspitalgasse 15, 1090 Vienna, Austria
| | - Ojan Assadian
- 2Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria.,3Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Karen J Ousey
- 3Institute for Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield, UK
| | - Elisabeth Presterl
- 2Department for Hospital Epidemiology and Infection Control, Medical University of Vienna, Vienna, Austria
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Tschelaut L, Assadian O, Strauss R, Matiasek J, Beer M, Angerler G, Berger-Grabner D, Presterl E. A survey on current knowledge, practice and beliefs related to preoperative antimicrobial decolonization regimens for prevention of surgical site infections among Austrian surgeons. J Hosp Infect 2018; 100:386-392. [PMID: 30031167 DOI: 10.1016/j.jhin.2018.07.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Various measures are considered to reduce the risk of surgical site infection (SSI), including preoperative decolonization. Details of preoperative decolonization practices in surgical departments have not been investigated in Austria. AIM To analyse the current situation of pre-surgical patient decolonization in national hospitals and to assess the current knowledge on this procedure among surgeons of different surgical disciplines. METHODS A 12-point structured questionnaire was distributed to all Austrian hospitals with at least one surgical department. FINDINGS Two-thirds (103/158; 65%) of responding surgeons stated that any type of preoperative decolonization is implemented in their surgical department. There was heterogeneity of different protocols, ranging from decolonization of only known S. aureus carriers, of a subgroup of patients, or universal decolonization of all patients before elective surgery. Octenidine was the most frequently used antimicrobial compound (60.2%), followed by mupirocin (38.8%), triclosan (14.6%), polyhexanide (12.6%), chlorhexidine (11.7%), and didecyldimonium chloride (7.8%). CONCLUSION Preoperative decolonization seems to be performed in Austrian hospitals on a routine basis. However, this measure is implemented using a variety of modalities, antimicrobial compounds, and staff. Since our survey also demonstrated that those who are better informed about preoperative decolonization are also those who are more convinced of the usefulness of the preventive measure, future activities should not only focus on generating more comparable studies in this field, but should also include targeted education.
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Affiliation(s)
- L Tschelaut
- Department of Business, IMC University of Applied Science, Krems, Austria
| | - O Assadian
- Department for Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria; Austrian Society for Infection Control, Vienna, Austria
| | - R Strauss
- Federal Ministry of Health and Women's Affairs, Department III/1, Vienna, Austria
| | - J Matiasek
- Department of Plastic and Reconstructive Surgery, St Josef Hospital Vienna, Austria
| | - M Beer
- University of Veterinary Medicine, Vienna, Austria
| | - G Angerler
- Unit for Hospital Hygiene, Orthopaedic Hospital Speising, Vienna, Austria
| | - D Berger-Grabner
- Department of Business, IMC University of Applied Science, Krems, Austria.
| | - E Presterl
- Department for Hospital Epidemiology & Infection Control, Medical University of Vienna, Vienna, Austria
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Fochtmann-Frana A, Freystätter C, Vorstandlechner V, Barth A, Bolliger M, Presterl E, Ihra G, Muschitz G, Mittlboeck M, Makristathis A, Rath T, Radtke C, Forstner C. Incidence of risk factors for bloodstream infections in patients with major burns receiving intensive care: A retrospective single-center cohort study. Burns 2018; 44:784-792. [PMID: 29395408 DOI: 10.1016/j.burns.2017.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 12/12/2017] [Accepted: 12/15/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective was primarily to identify risk factors for bloodstream infections (BSI) caused by different pathogens. METHODS A retrospective single-center cohort study was performed on 472 burn patients with an abbreviated burn severity index (ABSI)≥3, a total burn surface area (TBSA)≥10%, and an ICU stay of at least 24h. Risk factors for different BSI pathogens were analyzed by competing risks regression model of Fine and Gray. RESULTS A total of 114 burn patients developed 171 episodes of BSIs caused by gram-negative bacteria (n=78;46%), gram-positive bacteria (n=69;40%), and fungi (n=24;14%) median after 14days (range, 1-164), 16days (range, 1-170), and 16days (range, 0-89), respectively. A total of 24/114 patients (21%) had fatal outcomes. Isolation of the most common bloodstream isolates Enterococcus sp. (n=26), followed by Candida sp. and Pseudomonas sp. (n=22 for both) was significantly associated with increased TBSA (p≤0.006) and ABSI (p<0.0001) and need for fasciotomy (p<0.01). The death risk of patients with MDR gram-negative bacteremia was significantly increased by a hazard ratio of 12.6 (95% CI:4.8-32.8; p<0.0001). CONCLUSIONS A greater TBSA and ABSI were associated with a significantly higher incidence of BSIs caused by Pseudomonas sp., Enterococcus sp. and Candida sp.
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Affiliation(s)
- Alexandra Fochtmann-Frana
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christian Freystätter
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Vera Vorstandlechner
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - André Barth
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Michael Bolliger
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Elisabeth Presterl
- Medical University of Vienna, Department of Infection Control and Hospital Epidemiology, Vienna, Austria.
| | - Gerald Ihra
- Medical University of Vienna, Department of Anesthesiology and General Intensive Care, Vienna, Austria.
| | - Gabriela Muschitz
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Martina Mittlboeck
- Medical University of Vienna, Center for Medical Statistics, Informatics, and Intelligent Systems, Section for Clinical Biometrics, Vienna, Austria.
| | - Athanasios Makristathis
- Medical University of Vienna, Division of Clinical Microbiology, Department of Laboratory Medicine, Vienna, Austria.
| | - Thomas Rath
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christine Radtke
- Medical University of Vienna, Clinical Division of Plastic and Reconstructive Surgery, Department of Surgery, Vienna, Austria.
| | - Christina Forstner
- Medical University of Vienna, Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Vienna, Austria; Jena University Hospital, Center of Infectious Diseases and Infection Control, Jena, Germany.
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Gattringer KB, Suchomel M, Eder M, Lassnigg AM, Graninger W, Presterl E. Time-Dependent Effects of Rifampicin on Staphylococcal Biofilms. Int J Artif Organs 2018; 33:621-6. [DOI: 10.1177/039139881003300907] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2010] [Indexed: 11/15/2022]
Abstract
Objective To test the time-dependent effects of rifampicin on established biofilms of Staphylococcus epidermidis isolated from patients with cardiac implant infections and catheter-related bacteremia. Methods Biofilms were grown in microtiter plates for 24 hours, dyed and stained with crystal violet. The mean optical density (OD) was used for quantification. The OD ratio (ODr = OD of the treated biofilm/OD of the untreated biofilm) was used to measure changes in the thickness of the biofilms over the time. Biofilms were incubated with rifampicin (0.6 mg/mL) for 1, 5, 15, 30 and 60 minutes. Unstained biofilms were sonicated and plated on Columbia agar for time-kill curves. Results The incubation of the biofilms with rifampicin led to a significant reduction of the OD of the biofilms within 1 minute (ODr baseline: 1; ODr 1 min: 0.333 ± 0.131) (p<0.001). With regard to bacterial killing, rifampicin reduced the mean log count, but viable bacteria were still grown from biofilms in 13 out of 28 isolates despite MIC values < 0.01 mg/L. Conclusions In conclusion, our results confirm that rifampicin at a concentration of 1.2 mg/mL immediately reduces established biofilms formed by S. epidermidis although it is not bactericidal despite very low MICs at planktonic conditions.
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Affiliation(s)
| | - Miranda Suchomel
- Department of Medical Microbiology, Institute of Hygiene, Medical University of Vienna, Vienna - Austria
| | - Michaela Eder
- Department of Biomaterials, Max-Planck-Institute of Colloids and Interfaces, Medical University of Vienna, Vienna - Austria
| | - Andrea M. Lassnigg
- Department of Anesthesia and General Intensive Care Medicine, Div. of Cardiothoracic Anesthesia, Medical University of Vienna, Vienna - Austria
| | - Wolfgang Graninger
- Department of Medicine I, Div. Infectious Diseases, Medical University of Vienna, Vienna - Austria
| | - Elisabeth Presterl
- Department of Medicine I, Div. Infectious Diseases, Medical University of Vienna, Vienna - Austria
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Presterl E, Lassnigg A, Parschalk B, Yassin F, Adametz H, Graninger W. Clinical Behavior of Implant Infections Due to Staphylococcus Epidermidis. Int J Artif Organs 2018; 28:1110-8. [PMID: 16353117 DOI: 10.1177/039139880502801108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Surgical implants and other foreign material are increasingly used in modern medicine to restore or to improve the function of the human body. Infection of an implant is associated with considerable morbidity due to frequent hospitalizations, surgery and antimicrobial treatment. The underlying mechanism is the formation of a bacterial biofilm on the surface of the implanted body. The recognition and diagnosis of implant infections is essential for further therapy and, above all, the decision to remove and exchange the implant. Methods We compared the data of 60 patients with implant infections with those of 60 patients with transient bacteremia caused by Staphylococcus epidermidis. The pathogens isolated from blood were characterized with regard to antimicrobial susceptibility and formation of biofilms using a static microtiter plate model. Wild type skin isolates from non-hospitalized healthy volunteers served as control with regard to antimicrobial susceptibility and biofilm formation. Results Clinical signs and symptoms, underlying diseases and outcome were not different in either group. However, patients with implant infection had fever over a longer time (mean 12 days versus 3 days, respectively, p & 0.05) and more often positive blood cultures than patients with transient bacteremia (3.1 versus 1.2, p & 0.05). Thrombocytopenia was observed in patients with implant infections but not in patients with transient bacteremia (p & 0.05). Biofilms were formed in 86.4 % of the isolates in implant infection, in 88.8 % in transient bacteremia and in 76.9 % of the isolates from healthy volunteers (not significant). Multi-resistance to penicillin, oxacillin, erythromycin, clindamycin, ciprofloxacin and trimethoprim was more common in the hospital strains than in the wild type strains (75.6 % versus 48.7 %, p & 0.05). Conclusions The clinical features of implant infections are indistinguishable from those of transient bacteremia. Persisting fever and multiple blood culture yielding the growth of skin flora bacteria are strong indicators for infection of implanted material. Biofilm formation and antimicrobial multiresistance, as common in implant infection as in transient bacteremia, seem to be accessory factors in infections due to Staphylococcus epidermidis.
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Affiliation(s)
- E Presterl
- Department of Medicine I, Division of Infectious Diseases, Medical University of Vienna, Vienna, Austria.
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Arciola CR, Balaban N, Baldassarri L, Fromm K, HÄnsch GM, Obst U, Presterl E, Stefani S, Verran J, Visai L, Arciola CR, Balaban N, Baldassarri L, Fromm K, Hänsch GM, Obst U, Presterl E, Stefani S, Verran J, Visai L. Combating Implant Infections. Remarks by a Women's Team. Int J Artif Organs 2018; 31:858-64. [DOI: 10.1177/039139880803100915] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Research on implant infections requires cooperative efforts and integration between basic and clinical expertises. An international group of women scientists is acting together in this field. The main research topics of the participants of this group are described. Formation of bacterial biofilms, antibiotic resistance and production of virulence factors like adhesins and toxins are investigated. New biomaterials, coatings and drugs designed to inhibit microbial adhesion are evaluated, and infection-resistant biomaterials are under study, such as a novel heparinizable polycarbonate-urethane (Bionate) or incorporation of diamino-diamide-diol (PIME) to reduce bacterial attachment. The correlation between biofilm production and the accessory-gene-regulator (agr) is investigated in Staphylococcus aureus. The ability to form biofilm has also been shown to be one of the important virulence factors of Enterococcus faecalis, favouring colonization of inert and biological surfaces. The study of quorum sensing has led to the discovery of a quorum sensing inhibitor termed RIP that suppresses staphylococcal biofilm and infections. The immune response and the local defence mechanisms of the host against implant-associated infections, activation and infiltration of immunocompetent cells into the sites of infection have been studied in patients with implant-associated osteomyelitis. Production of monoclonal antibodies (mAbs) as possible vaccines against the staphylococcal collagen-binding MSCRAMMs is in progress. (Int J Artif Organs 2008; 31: 858–64)
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Affiliation(s)
- C. R. Arciola
- Research Unit on Implant Infections, Rizzoli Orthopedic Institute and Experimental Pathology Department, University of Bologna, Bologna - Italy
| | - N. Balaban
- Department of Biomedical Sciences, Tufts University Cummings School of Veterinary Medicine, North Grafton, Massachusetts - USA
| | - L. Baldassarri
- Department of Infectious, Parasitic and Immunomediated Diseases, National Institute of Health, Rome - Italy
| | - K. Fromm
- Chemistry Department, University of Fribourg, Fribourg - Switzerland
| | - G. M. HÄnsch
- Institute for Immunology of the University of Heidelberg, Heidelberg - Germany
| | - U. Obst
- Department of Environmental Microbiology, Institute for Technical Chemistry-Water Technology and Geotechnology, Eggenstein-Leopoldshafen - Germany
| | - E. Presterl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, University of Vienna, Vienna - Austria
| | - S. Stefani
- Department of Microbiological and Gynecological Sciences, University of Catania, Catania - Italy
| | - J. Verran
- Manchester Metropolitan University, Manchester - United Kingdom
| | - L. Visai
- University of Pavia, Department of Biochemistry, Pavia - Italy
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Presterl E, Lassnigg A, Eder M, Reichmann S, Hirschl AM, Graninger W. Effects of Tigecycline, Linezolid and Vancomycin on Biofilms of Viridans Streptococci Isolates from Patients with Endocarditis. Int J Artif Organs 2018; 30:798-804. [DOI: 10.1177/039139880703000909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Endocarditis, and prosthetic valve endocarditis in particular, is a serious disease with high morbidity and mortality. We investigate the effects of tigecycline, linezolid and vancomycin on biofilms of viridans group streptococci (VGS) isolated from patients with definite native or prosthetic valve endocarditis. Methods and Results Ten of 20 VGS blood stream isolates from patients with endocarditis formed biofilms in the microtiter plate biofilm model. The minimal inhibitory concentrations (MIC) for tigecycline, linezolid and vancomycin were determined using the microdilution broth method. Biofilms were grown for 24 hours and were incubated with tigecycline, linezolid and vancomycin at increasing concentrations from 1-128x MIC of the isolate being tested. Biofilm thickness was quantified by measuring the optical density (OD) after dyeing it with crystal violet. The incubation of the biofilms with tigecycline, linezolid or vancomycin resulted in a significant reduction of OD compared to the control biofilm without antibiotic (p<0.05). The optical density ratio (Odr) decreased significantly at 2x MIC for tigecycline, and at 8x MIC for linezolid and vancomycin (p<0.05). Although biofilms persisted even at the highest antibiotic concentrations of 128x MIC, bacterial growth was eradicated starting at concentrations of 16x MIC for vancomycin and of 32x MIC for linezolid, but not for tigecycline, up to a concentration of 128x MIC. Conclusions In the present study on viridans streptococci isolated from patients with endocarditis, tigecycline and linezolid reduced the density of the biofilms as effectively as vancomycin. However, linezolid and vancomycin were bactericidal at higher concentrations. Linezolid and vancomycin at very high doses may be useful in the treatment of biofilm-associated diseases caused by VGS infections.
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Affiliation(s)
- E. Presterl
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna - Austria
- Institute of Hygiene and Medical Microbiology, Division of Clinical Microbiology, Medical University of Vienna, Vienna - Austria
| | - A. Lassnigg
- Department of Anesthesia and General Intensive Care Medicine, Division of Cardiothoracic and Vascular Anesthesia, Medical University of Vienna, Vienna - Austria
| | - M. Eder
- Max-Planck-Institute Of Colloids And Interfaces, Department Of Biomaterials, Potsdam - Germany
| | - S. Reichmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna - Austria
| | - A. M. Hirschl
- Institute of Hygiene and Medical Microbiology, Division of Clinical Microbiology, Medical University of Vienna, Vienna - Austria
| | - W. Graninger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna - Austria
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Zatorska B, Presterl E. Letter to the Editor: CORR Insights ®: Does Extracellular DNA Production Vary in Staphylococcal Biofilms Isolated From Infected Implants Versus Controls? Clin Orthop Relat Res 2017; 475:3116-3117. [PMID: 29052127 PMCID: PMC5670078 DOI: 10.1007/s11999-017-5509-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 09/14/2017] [Indexed: 01/31/2023]
Affiliation(s)
- Beata Zatorska
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria.
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
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Klasinc R, Augustin LA, Below H, Baguhl R, Assadian O, Presterl E, Kramer A. Evaluation of three experimental in vitro models for the assessment of the mechanical cleansing efficacy of wound irrigation solutions. Int Wound J 2017; 15:140-147. [PMID: 29171152 DOI: 10.1111/iwj.12850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 10/03/2017] [Indexed: 12/01/2022] Open
Abstract
The aim of this study was to compare different wound-rinsing solutions to determine differences in the efficiency and to evaluate three different in vitro models for wound cleansing. Different wound-rinsing solutions (physiological saline solution, ringer lactate solution for wound irrigation, water and a solution containing polihexanide and the surfactant undecylenamidopropyl-betain) were applied on standardised test models (one- and three-chamber model, flow-cell method and a biofilm model), each challenged with three different standardised wound test soils. In the one-chamber model saline showed a better effect on decontaminating proteins than the ringer lactate solution. In the flow-cell method, water performed better than physiological saline solution, whereas ringer lactate solution demonstrated the lowest cleansing effect. No obvious superiority between the two electrolyte-containing solutions was detectable in the biofilm model. Unfortunately, it was not possible to assess the protein decontamination qualities of the surfactant-containing solution because of the interference with the protein measurement. The flow-cell method was able to detect differences between different rinse solutions because it works at constant flow mechanics, imitating a wound-rinsing procedure. The three-chamber and the less-pronounced modified one-chamber method as well as the biofilm model had generated inhomogeneous results.
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Affiliation(s)
- Romana Klasinc
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Institute for Hygiene and Applied Immunology, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
| | - Lee Ann Augustin
- Department of Gynaecology and Obstetrics, University of Marburg, Marburg, Germany.,Institute for Hygiene and Environmental Medicine, Universitymedicine Greifswald, Greifswald, Germany
| | - Harald Below
- Institute for Hygiene and Environmental Medicine, Universitymedicine Greifswald, Greifswald, Germany
| | - Romy Baguhl
- Institute for Hygiene and Environmental Medicine, Universitymedicine Greifswald, Greifswald, Germany
| | - Ojan Assadian
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Axel Kramer
- Institute for Hygiene and Environmental Medicine, Universitymedicine Greifswald, Greifswald, Germany
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Segagni Lusignani L, Starzengruber P, Dosch V, Assadian O, Presterl E, Diab-Elschahawi M. Molecular epidemiology of multidrug-resistant clinical isolates of Acinetobacter baumannii : A 10-year analysis in a large tertiary care university hospital in central Europe with international admissions. Wien Klin Wochenschr 2017; 129:816-822. [PMID: 28776101 PMCID: PMC5676840 DOI: 10.1007/s00508-017-1242-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 07/12/2017] [Indexed: 11/29/2022]
Abstract
Background Over the last 10 years, multidrug resistant Acinetobacter baumannii has been spreading worldwide as emerging microorganisms that negatively impact on the outcome of in-hospital patients. Methods Between 2007 and 2016, all isolates of patients of the Vienna General Hospital (VGH), tested positive for multidrug resistant Acinetobacter baumannii (MDR A. baumannii) strains, were investigated with respect to their genetic relationship. Patient medical histories were reviewed in order to collect discriminating factors related to MDR A. baumannii colonization or infection. Results A total of 79 isolates of 76 patients were obtained. For 44 of them (55.7%) the first diagnosis ward was an intensive care unit (ICU). A total of 10 genotype clusters were identified and 35 cases (44.3%) of in-hospital acquisition in our institution could be detected. Multidrug resistant Acinetobacter baumannii isolates were acquired before admission to our hospital in 44 cases (55.7%) and in 31 (70.5%) they belonged to patients who had previous exposure to the healthcare setting of high prevalence countries for MDR A. baumannii. Conclusion Patients admitted to our hospital with a previous healthcare contact in a high prevalence country for multidrug resistant Acinetobacter baumannii should be screened before admission to high-risk wards. Isolation of these patients until microbiological results could reduce negative outcome in these wards.
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Affiliation(s)
- Luigi Segagni Lusignani
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Peter Starzengruber
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Verena Dosch
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ojan Assadian
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Zatorska B, Groger M, Moser D, Diab-Elschahawi M, Lusignani LS, Presterl E. Does Extracellular DNA Production Vary in Staphylococcal Biofilms Isolated From Infected Implants versus Controls? Clin Orthop Relat Res 2017; 475:2105-2113. [PMID: 28194715 PMCID: PMC5498371 DOI: 10.1007/s11999-017-5266-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 01/24/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUND Prosthetic implant infections caused by Staphylococcus aureus and epidermidis are major challenges for early diagnosis and treatment owing to biofilm formation on the implant surface. Extracellular DNA (eDNA) is actively excreted from bacterial cells in biofilms, contributing to biofilm stability, and may offer promise in the detection or treatment of such infections. QUESTIONS/PURPOSES (1) Does DNA structure change during biofilm formation? (2) Are there time-dependent differences in eDNA production during biofilm formation? (3) Is there differential eDNA production between clinical and control Staphylococcal isolates? (4) Is eDNA production correlated to biofilm thickness? METHODS We investigated eDNA presence during biofilm formation in 60 clinical and 30 control isolates of S aureus and S epidermidis. The clinical isolates were isolated from patients with infections of orthopaedic prostheses and implants: 30 from infected hip prostheses and 30 from infected knee prostheses. The control isolates were taken from healthy volunteers who had not been exposed to antibiotics and a hospital environment during the previous 3 and 12 months, respectively. Control S epidermidis was isolated from the skin of the antecubital fossa, and control S aureus was isolated from the nares. For the biofilm experiments the following methods were used to detect eDNA: (1) fluorescent staining with 4',6-diamidino-2-phenylindole (DAPI), (2) eDNA extraction using a commercial kit, and (3) confocal laser scanning microscopy for 24-hour biofilm observation using propidium iodide and concanavalin-A staining; TOTO®-1 and SYTO® 60 staining were used for observation and quantification of eDNA after 6 and 24 hours of biofilm formation. Additionally antibiotic resistance was described. RESULTS eDNA production as observed by confocal laser scanning microscopy was greater in clinical isolates than controls (clinical isolates mean ± SD: 1.84% ± 1.31%; control mean ± SD: 1.17% ± 1.37%; p < 0.005) after 6 hours of biofilm formation. After 24 hours, the amount of eDNA was greater in biofilms of S epidermidis than in biofilms of S aureus (S aureus mean ± SD: 1.35% ± 2.0%; S epidermidis mean ± SD: 6.42% ± 10.6%; p < 0.05). Clinical isolates of S aureus and S epidermidis produced more eDNA than control isolates at 6 hours of biofilm formation. The extraction method also showed that clinical isolates produced substantially greater amounts of eDNA than controls. CONCLUSIONS S aureus and S epidermidis exhibit a differential production of DNA with time. Clinical isolates associated with implant infections produce greater amounts of eDNA than controls. Future research might focus on the diagnostic value of eDNA as a surrogate laboratory marker for biofilm formation in implant infections. CLINICAL RELEVANCE eDNA should be considered as a potential future diagnostic tool or even a possible target to modify biofilms for successful treatment of biofilm-associated infections.
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Affiliation(s)
- Beata Zatorska
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Marion Groger
- Department of Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Doris Moser
- Department of Cranio-Maxillofacial and Oral Surgery, Medical University of Vienna, Vienna, Austria
| | - Magda Diab-Elschahawi
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Luigi Segagni Lusignani
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
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Puchner SE, Döring K, Staats K, Böhler C, Lass R, Hirschl AM, Presterl E, Windhager R, Holinka J. Sonication culture improves microbiological diagnosis of modular megaprostheses. J Orthop Res 2017; 35:1383-1387. [PMID: 27572456 DOI: 10.1002/jor.23406] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/25/2016] [Indexed: 02/04/2023]
Abstract
Modular megaprostheses are known for high infection rates followed by high rates of revisions. Microbial biofilms growing adherently on prosthetic surfaces may inhibit the detection of the pathogens causing prosthetic joint infections. We sought to answer the following questions: Does sonication culture (SC) improve the microbiological diagnosis of periprosthetic infections of megaprostheses compared to conventional tissue culture (TC)? Which pathogens were detected on the surface of megaprostheses with either SC or TC and do the findings help to identify low-grade infections? Included were 31 patients with modular megaprostheses, whose implant had been explanted due to suspected joint infection or revision surgery. SCs were performed according to the protocol by Trampuz et al. The diagnosis of infection was evaluated according to the definition of the Musculoskeletal Infection Society. The sensitivity of SC was 91.3% compared to 52.2% for TC and the specificity was 100% for SC and TC (p = 0.004). Under preoperative antibiotic therapy, the sensitivity of SC was 83.3% while the sensitivity of TC was 50%. Without preoperative antibiotic therapy the sensitivity of SC was 100% compared to 54.5% for TC. In nine cases, SCs detected microorganisms, while TC was negative. Detected bacteria were Staphylococcus epidermidis in four, Micrococcus species in one, Finegoldia magna in one, Brevibacterium casei in one, Pseudomonas fluorescens in one, and Enterococcus faecium in one. SC is a reliable method for dislodging pathogens from orthopedic implants. The SC of modular megaprostheses showed significantly higher pathogen detection than the periprosthetic TC, especially for low virulence pathogens. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1383-1387, 2017.
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Affiliation(s)
- Stephan E Puchner
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Kevin Döring
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Kevin Staats
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Christoph Böhler
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Richard Lass
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Alexander M Hirschl
- Department of Clinical Microbiology, Clinical Institute of Hygiene and Medical Microbiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Elisabeth Presterl
- Deparment of Infection Control and Hospital Epidemiology, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Reinhard Windhager
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
| | - Johannes Holinka
- Department of Orthopaedics, Medical University of Vienna, Waehringer Guertel 18-20, Vienna, 1090, Austria
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Zingg W, Hopkins S, Gayet-Ageron A, Holmes A, Sharland M, Suetens C, Almeida M, Asembergiene J, Borg MA, Budimir A, Cairns S, Cunney R, Deptula A, Berciano PG, Gudlaugsson O, Hadjiloucas A, Hammami N, Harrison W, Heisbourg E, Kolman J, Kontopidou F, Kristensen B, Lyytikäinen O, Märtin P, McIlvenny G, Moro ML, Piening B, Presterl E, Serban R, Smid E, Sorknes NK, Stefkovicova M, Sviestina I, Szabo R, Tkadlecova H, Vatcheva-Dobrevska R, VerjatTrannoy D. Health-care-associated infections in neonates, children, and adolescents: an analysis of paediatric data from the European Centre for Disease Prevention and Control point-prevalence survey. The Lancet Infectious Diseases 2017; 17:381-389. [DOI: 10.1016/s1473-3099(16)30517-5] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/03/2016] [Accepted: 11/23/2016] [Indexed: 10/20/2022]
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de With K, Allerberger F, Amann S, Apfalter P, Brodt HR, Eckmanns T, Fellhauer M, Geiss HK, Janata O, Krause R, Lemmen S, Meyer E, Mittermayer H, Porsche U, Presterl E, Reuter S, Sinha B, Strauß R, Wechsler-Fördös A, Wenisch C, Kern WV. Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases. Infection 2017; 44:395-439. [PMID: 27066980 PMCID: PMC4889644 DOI: 10.1007/s15010-016-0885-z] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Introduction In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute. Materials and methods A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development. Conclusion The guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.
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Affiliation(s)
- K de With
- Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - F Allerberger
- Division Public Health, Austrian Agency for Health and Food Safety (AGES), Vienna, Austria
| | - S Amann
- Hospital Pharmacy, Munich Municipal Hospital, Munich, Germany
| | - P Apfalter
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - H-R Brodt
- Department of Infectious Disease Medical Clinic II, Goethe-University Frankfurt, Frankfurt, Germany
| | - T Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - M Fellhauer
- Hospital Pharmacy, Schwarzwald-Baar Hospital, Villingen-Schwenningen, Germany
| | - H K Geiss
- Department of Hospital Epidemiology and Infectiology, Sana Kliniken AG, Ismaning, Germany
| | - O Janata
- Department for Hygiene and Infection Control, Danube Hospital, Vienna, Austria
| | - R Krause
- Section of Infectious Diseases and Tropical Medicine, Medical University of Graz, Graz, Austria
| | - S Lemmen
- Division of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Aachen, Germany
| | - E Meyer
- Institute of Hygiene and Environmental Medicine, Charité, University Medicine Berlin, Berlin, Germany
| | - H Mittermayer
- Institute for Hygiene, Microbiology and Tropical Medicine (IHMT), National Reference Centre for Nosocomial Infections and Antimicrobial Resistance, Elisabethinen Hospital Linz, Linz, Austria
| | - U Porsche
- Department for Clinical Pharmacy and Drug Information, Landesapotheke, Landeskliniken Salzburg (SALK), Salzburg, Austria
| | - E Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - S Reuter
- Clinic for General Internal Medicine, Infectious Diseases, Pneumology and Osteology, Klinikum Leverkusen, Leverkusen, Germany
| | - B Sinha
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - R Strauß
- Department of Medicine 1, Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Erlangen, Germany
| | - A Wechsler-Fördös
- Department of Antibiotics and Infection Control, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - C Wenisch
- Medical Department of Infection and Tropical Medicine, Kaiser Franz Josef Hospital, Vienna, Austria
| | - W V Kern
- Division of Infectious Diseases, Department of Medicine, Freiburg University Medical Center, Freiburg, Germany
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Paula H, Tribl B, Presterl E, Diab-El Schahawi M. Prospective microbiologic evaluation of the forceps elevator in closed-channel duodenoscopes after reprocessing. Am J Infect Control 2017; 45:121-125. [PMID: 28341284 DOI: 10.1016/j.ajic.2016.08.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Endoscopes are well-known sources of bacterial transmission in health care facilities offering endoscopy services. The association between multidrug-resistant bacterial infections in patients who had undergone an endoscopic retrograde cholangiopancreatography procedure with reprocessed duodenoscopes has been much discussed. Bacterial contamination of duodenoscopes has been attributed to difficulties with reprocessing these devices, specifically the distal end of the scope, which features a movable forceps elevator. In light of a recent Food and Drug Administration warning letter to Olympus regarding their closed-channel duodenoscope model TJF-Q180V, the aim of our study was to prospectively evaluate the efficacy and safety of our current reprocessing procedures with regard to the TJF-Q180V duodenoscope models used in our hospital. METHODS From August 2015-March 2016, we prospectively collected microbiologic surveillance samples from 6 TJF-Q180V model duodenoscopes in routine use at the Division of Gastroenterology and Hepatology using the ESwab collection system (COPAN Diagnostics Inc, Murrieta, CA). RESULTS A total of 237 microbiologic samples from the forceps elevator were obtained during the survey period. None of the samples yielded microorganism growth. CONCLUSION These findings suggest that when following a diligent and validated reprocessing standard in accordance with manufacturer's recommendations, closed-channel endoscope models can still be used. Nevertheless, validated adaptions of current closed-channel duodenoscope models are needed to allow for simple and safe reprocessing. Furthermore, comprehensive postmarket surveillance needs to be established.
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Segagni Lusignani L, Blacky A, Starzengruber P, Diab-Elschahawi M, Wrba T, Presterl E. A national point prevalence study on healthcare-associated infections and antimicrobial use in Austria. Wien Klin Wochenschr 2016; 128:89-94. [DOI: 10.1007/s00508-015-0947-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 12/28/2015] [Indexed: 10/22/2022]
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Harrison N, Mitterbauer M, Tobudic S, Kalhs P, Rabitsch W, Greinix H, Burgmann H, Willinger B, Presterl E, Forstner C. Incidence and characteristics of invasive fungal diseases in allogeneic hematopoietic stem cell transplant recipients: a retrospective cohort study. BMC Infect Dis 2015; 15:584. [PMID: 26715563 PMCID: PMC4696168 DOI: 10.1186/s12879-015-1329-6] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/18/2015] [Indexed: 11/10/2022] Open
Abstract
Background Allogeneic hematopoietic stem cell transplant (HSCT) recipients experience an increased risk for invasive fungal diseases (IFDs). Methods This retrospective cohort study at the Medical University of Vienna aspired to assess the incidence, characteristics and the outcome of IFDs as well as the associated risk factors in a setting where only 43 % of patients were given systemic antifungal prophylaxis during aplasia. IFDs were classified as probable or proven according to the EORTC/MSG consensus group. All adult patients (n = 242) receiving an allogeneic HSCT at the University Hospital of Vienna from January 2009 to December 2013 were enrolled. Results The primary outcome of this study was the one-year incidence for IFDs after HSCT, which was 10.3 % (25/242). Overall 28 patients experienced an IFD – 20 probable and 8 proven – with invasive aspergillosis being the predominant IFD (n = 18), followed by invasive candidiasis (n = 7) and pneumocystis pneumonia (n = 3). Patients with an IFD were more likely to be admitted to an intensive care unit (64 % versus 12 %, p < 0.0001) and had a significantly higher mortality in the first year after HSCT (48 % versus 25 %, p = 0.02). Multivariate regression analysis revealed that intensified immunosuppressive therapy (high-dose cortisone and basiliximab or etanercept) because of severe graft-versus-host disease (adjusted odds ratio (AOR) 3.6, p = 0.01) and transplant-associated microangiopathy (AOR 3.7, p = 0.04) were associated with an increased risk for IFD, while antifungal prophylaxis given during aplasia and post-engraftment was associated with a decreased risk (AOR 0.3, p = 0.02). Conclusions We documented a one-year incidence for IFDs of 10.3 % and no selection of rare pathogens at a centre with moderate use of antifungal prophylaxis. Intensified immunosuppressive therapy and transplant-associated microangiopathy were significant risk factors for IFDs.
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Affiliation(s)
- Nicole Harrison
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Margit Mitterbauer
- Department of Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Selma Tobudic
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Peter Kalhs
- Department of Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Werner Rabitsch
- Department of Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria
| | - Hildegard Greinix
- Department of Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria.,Division of Hematology, Medical University of Graz, Graz, Austria
| | - Heinz Burgmann
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Birgit Willinger
- Department of Laboratory Medicine, Division of Clinical Microbiology, Medical University of Vienna, Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Medical University of Vienna, Vienna, Austria
| | - Christina Forstner
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria. .,Center of Infectious Diseases, Jena University Hospital, Jena, Germany.
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Forstner C, Diab-Elschahawi M, Kivaranovic D, Graninger W, Mitteregger D, Macher M, Wrba T, Presterl E. Non-linear significant relationship between use of glycopeptides and isolation of vancomycin-resistant Enterococcus species in a university hospital setting. Antimicrob Resist Infect Control 2015; 4:25. [PMID: 26078865 PMCID: PMC4466807 DOI: 10.1186/s13756-015-0064-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2015] [Accepted: 05/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergence of colonization and infection with vancomycin-resistant enterococci (VRE) has become a worldwide challenge. To investigate whether the increasing incidence of VRE isolation can be correlated with use of glycopeptides in the hospital setting, we conducted a hospital-wide two-year study in the university hospital of Vienna. METHODS Within the period from January 2011 through December 2012 all patients with isolation of invasive or non-invasive VRE were retrospectively included. Specialty-specific data concerning the consumption of vancomycin and teicoplanin, fluoroquinolones and third generation cephalosporins in defined daily doses (DDDs) from June 2010 through May 2012 were extracted from the hospital pharmacy computer system. To assess the relationship between the usage of those antibiotics and the incidence of VRE (VRE-rate per 10 000 patients) a Poisson regression was performed. FINDINGS In the study period 266 patients were colonized or infected with VRE. Specialty-specific VRE isolation was as follows: general surgical units (44 patients), bone marrow transplant unit (35 patients), general medical units (33 patients), cardiothoracic surgery (27 patients), nephrology (26 patients), haematooncology (22 patients), gastroenterology (17 patients), urology (17 patients), and the infectious diseases unit (11 patients). Hospital-wide consumption of glycopeptides was higher for teicoplanin than for vancomycin (26 242 versus 8677 DDDs). Specialty-specific VRE incidence significantly increased with the use of glycopeptides, fluoroquinolones or third generation cephalosporins (p < 0.001). The results of the Poisson regression for vancomycin (p = 0.0018) and teicoplanin (p < 0.0001) separately were both highly significant. Spearman's correlation coefficient indicated a strong correlation between the two variables (rho = 0.8). CONCLUSION Overall usage of glycopeptides, fluoroquinolones or third generation cephalosporins contributed to the emergence of VRE in the hospital setting.
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Affiliation(s)
- Christina Forstner
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria ; Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Magda Diab-Elschahawi
- Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Danijel Kivaranovic
- Section for Medical Statistics, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Wolfgang Graninger
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Dieter Mitteregger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Maria Macher
- Hospital Pharmacy, General Hospital of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Thomas Wrba
- Center of Medical Statistics, Informatics and Systems Intelligence, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
| | - Elisabeth Presterl
- Department of Hospital Epidemiology and Infection Control, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna Austria
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Diab-Elschahawi M, Lusignani LS, Starzengruber P, Mitteregger D, Wagner A, Assadian O, Presterl E. The strength of coughing may forecast the likelihood of spread of multi-drug resistant microorganisms from the respiratory tract of colonized patients. Antimicrob Resist Infect Control 2014; 3:38. [PMID: 25530847 PMCID: PMC4271473 DOI: 10.1186/s13756-014-0038-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 11/20/2014] [Indexed: 12/01/2022] Open
Abstract
Background Current recommendations indicate that patients who are coughing and have multidrug resistant microorganisms (MDROs) in their sputum are considered to be shedders and should be cared for in single room isolation at least until symptoms resolve. Airborne spread and subsequent contamination of surfaces adjacent to patients may contribute to transmission. Hence, isolation measures for patients colonized or infected with MDRO at their respiratory tract are intended to interrupt such transmission. However, the potential for microbial shedding in patients with MDRO-positive microbiological reports from their respiratory tract and factors justifying the need for single room isolation are viewed controversially. Methods Cough aerosol produced by patients colonized with MDROs was measured for viable counts. Descriptive analysis together with logistic regression analysis was performed to assess the impact of strength of cough on growth of MDRO on culture plates. Results In 18% (23/128) MDRO were transmitted. Multivariate analysis revealed that strength of cough significantly predicts the yield of MDRO on culture plates (P = 0.012). Conclusion Based on these results it can be concluded that risk stratification for decision of single room isolation of patients colonized or infected with MDROs at their respiratory tract may also take the severity of cough into consideration. However, more work is required in order to assess the severity of cough objectively.
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Affiliation(s)
- Magda Diab-Elschahawi
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Luigi Segagni Lusignani
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Peter Starzengruber
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Dieter Mitteregger
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University Vienna, Vienna, Austria
| | - Andrea Wagner
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Ojan Assadian
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Elisabeth Presterl
- Department of Hospital Hygiene and Infection Control, Vienna General Hospital, Medical University Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
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Matt B, Mitteregger D, Renner S, Presterl E, Assadian O, Diab-Elschahawi M. Successful implementation of infection control strategies prevents P. aeruginosa transmission among cystic fibrosis patients inside the hospital. GMS Hyg Infect Control 2014; 9:Doc20. [PMID: 25285264 PMCID: PMC4184043 DOI: 10.3205/dgkh000240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: The aim of this study was to characterise the epidemiology of P. aeruginosa isolated from cystic fibrosis (CF) patients at the Vienna General Hospital (VGH) by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols. Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for P. aeruginosa during the study period. Fifty P. aeruginosa isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab® method. Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each. Nine patients presented with two or more phenotypically diverse P. aeruginosa isolates. In five of these cases the retrieved isolates belonged to the same genotype. Conclusion: The broad genetic heterogeneity of P. aeruginosa in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire P. aeruginosa from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of P. aeruginosa among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.
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Affiliation(s)
- Benedikt Matt
- Department for Hospital Hygiene and Infecion Control, Medical University of Vienna, Vienna General Hospital, Wien, Austria
| | - Dieter Mitteregger
- Clinical Department for Clinical Microbiology, Medical University of Vienna, Vienna General Hospital, Wien, Austria
| | - Sabine Renner
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Vienna General Hospital, Wien, Austria
| | - Elisabeth Presterl
- Department for Hospital Hygiene and Infecion Control, Medical University of Vienna, Vienna General Hospital, Wien, Austria
| | - Ojan Assadian
- Department for Hospital Hygiene and Infecion Control, Medical University of Vienna, Vienna General Hospital, Wien, Austria
| | - Magda Diab-Elschahawi
- Department for Hospital Hygiene and Infecion Control, Medical University of Vienna, Vienna General Hospital, Wien, Austria
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