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Bolikas E, Astrinaki E, Panagiotaki E, Vitsaxaki E, Saplamidou S, Drositis I, Stafylaki D, Chamilos G, Gikas A, Kofteridis DP, Kritsotakis EI. Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece. Antibiotics (Basel) 2023; 12:1088. [PMID: 37508184 PMCID: PMC10376605 DOI: 10.3390/antibiotics12071088] [Citation(s) in RCA: 1] [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: 05/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented stress on healthcare systems worldwide, forming settings of concern for increasing antimicrobial resistance. We investigated the impact of SARS-CoV-2 preventive measures against healthcare-associated infections (HAIs) from antibiotic-resistant bacteria in two tertiary-care hospitals. We compared infection rates between March 2019 and February 2020 (pre-intervention period) and March 2020 and February 2021 (COVID-19 intervention period) from drug-resistant ESKAPEE bacteria (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci; carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli). Over 24 months, 586 drug-resistant ESKAPEE HAIs occurred in 439 patients (0.3% of 179,629 inpatients) with a mean age of 63 years, with 43% being treated in intensive care units (ICUs), and having a 45% inpatient mortality rate. Interrupted time series analysis revealed increasing infection rates before the intervention that were sharply interrupted by abrupt drops for most pathogens and henceforth remained stable in the ICUs but progressively increased in ordinary wards. In the ICUs, the pooled infection rate was 44% lower over the intervention period compared to the pre-intervention period (incidence rate ratio (IRR) 0.56, 95%CI 0.41-0.75, p < 0.001). Pooled infection rates in the wards were slightly higher over the COVID-19 period (IRR 1.12, 95%CI 0.87-1.45, p = 0.368). The findings confirmed the ancillary beneficial impact of the enhanced bundle of transmission-based precautions adopted against SARS-CoV-2 in rapidly constraining antimicrobial-resistant HAIs in two Greek hospitals.
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Affiliation(s)
- Emmanouil Bolikas
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Eirini Astrinaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evangelia Panagiotaki
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Clinical Microbiology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Efsevia Vitsaxaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Stamatina Saplamidou
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Ioannis Drositis
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Medical Oncology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios Chamilos
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Achilleas Gikas
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
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Maltezou HC, Tseroni M, Drositis I, Gamaletsou MN, Koukou DM, Bolikas E, Peskelidou E, Daflos C, Panagiotaki E, Ledda C, Pavli A, Moussas N, Kontogianni S, Svarna E, Ploumidis M, Spyrou A, Chini M, Adamis G, Lourida A, Hatzigeorgiou D, Gargalianos P, Syrogiannopoulos G, Sipsas NV. Vaccination coverage rates and attitudes towards mandatory vaccinations among healthcare personnel in tertiary-care hospitals in Greece. Expert Rev Vaccines 2022; 21:853-859. [PMID: 35382665 DOI: 10.1080/14760584.2022.2063118] [Citation(s) in RCA: 8] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES : Our aim was to estimate vaccination and susceptibility rates against vaccine-preventable diseases among healthcare personnel (HCP) in eight hospitals. METHODS This study was a cross-sectional survey. RESULTS A total of 1284 HCP participated (physicians: 31.3%, nursing personnel: 36.6%, paramedical personnel: 11.1%, administrative personnel: 13.2%, supportive personnel: 7.3%). Vaccination rates were 32.9% against measles and mumps, 38.1% against rubella, 5.7% against varicella, 9.2% against hepatitis A, 65.8% against hepatitis B, 31.8% against tetanus-diphtheria, 7.1% against pertussis, 60.2% against influenza, and 80.1% against COVID-19. Susceptibility rates were: 27.8% for measles, 39.6% for mumps, 33.4% for rubella, 22.2% for varicella, 86.3% for hepatitis A, 34.2% for hepatitis B, 68.2% for tetanus-diphtheria, and 92.9% for pertussis. Older HCP had higher susceptibility rates against mumps, rubella, varicella, hepatitis A, hepatitis B, tetanus-diphtheria, and pertussis (p-values <0.001 for all). Mandatory vaccinations were supported by 81.85% of HCP. CONCLUSIONS Although most HCP supported mandatory vaccinations, significant vaccination gaps and susceptibility rates were recorded. The proportion of susceptible HCP to measles, mumps, rubella, and varicella increased the past decade, mostly because of reduction of acquired cases of natural illness. Vaccination programs for HCP should be developed. A national registry to follow HCP' vaccination rates is urgently needed.
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Affiliation(s)
- Helena C Maltezou
- Directorate of Research, Studies, and Documentation, National Public Health Organization, Athens, Greece
| | - Maria Tseroni
- Directorate of Epidemiological Surveillance of Infectious Diseases, National Public Health Organization, Athens, Greece
| | - Ioannis Drositis
- Medical Oncology Department, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Maria N Gamaletsou
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
| | - Dimitra Maria Koukou
- First Department of Pediatrics, University of Athens, Aghia Sophia Children's Hospital, Athens, Greece
| | - Emmanouil Bolikas
- Infection Control Committee, Venizeleio-Pananeio General Hospital, Heraklion, Greece
| | - Emmanuela Peskelidou
- COVID-19 Intensive Care Unit, 424 General Military Hospital of Thessaloniki, Thessaloniki, Greece
| | - Charalambos Daflos
- Infection Control Committee, Korgialeneio-Benakeio Red Cross General Hospital, Athens, Greece
| | | | - Caterina Ledda
- Occupational Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Androula Pavli
- Department for Travel Medicine, National Public Health Organization, Athens, Greece
| | - Nikolaos Moussas
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Eftychia Svarna
- Department of Pediatrics, University of Thessaly, Larissa, Greece
| | - Michalis Ploumidis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Andronikos Spyrou
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Maria Chini
- Third Department of Internal Medicine and Infectious Diseases Unit, Korgialeneio-Benakeio Red Cross Hospital, Athens, Greece
| | - Georgios Adamis
- First Department of Internal Medicine - Infectious Diseases Unit, Gennimatas General Hospital, Athens, Greece
| | - Athanasia Lourida
- Infection Prevention and Control Committee, Aghia Sofia Children's Hospital, Athens, Greece
| | | | - Panagiotis Gargalianos
- Internal Medicine and Infectious Diseases Clinic, Iatriko Athinon General Hospital, Athens, Greece
| | | | - Nikolaos V Sipsas
- Pathophysiology Department, Medical School, National and Kapodistrian University of Athens, and General Hospital of Athens Laiko, Athens, Greece
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Maraki S, Panagiotaki E, Tsopanidis D, Scoulica E, Miari NM, Hainis K, Dotis G, Katsoula I, Tselentis Y. Nocardia cyriacigeorgica pleural empyema in an immunocompromised patient. Diagn Microbiol Infect Dis 2006; 56:333-5. [PMID: 16854553 DOI: 10.1016/j.diagmicrobio.2006.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2006] [Revised: 05/04/2006] [Accepted: 05/08/2006] [Indexed: 11/30/2022]
Abstract
A case of fatal Nocardia cyriacigeorgica pleural empyema in a patient with chronic obstructive pulmonary disease and long-term corticosteroid therapy is described. The organism was isolated from the pleural fluid in pure culture and was identified by conventional and molecular methods. Despite the early administration of the appropriate antibiotic treatment, the patient died 4 days after hospital admission.
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Affiliation(s)
- Sofia Maraki
- Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, P.O. Box 1352, Heraklion 711 10, Crete, Greece.
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Koulouridis E, Tzilianos M, Katsarou A, Costimba I, Klonou E, Panagiotaki E, Georgalidis C, Krokida A, Delaportas N, Lachanas A, Karaliotas G, Kaliolia I. Homocysteine and C-reactive protein levels in haemodialysis patients. Int Urol Nephrol 2002; 33:207-15. [PMID: 12092633 DOI: 10.1023/a:1015254315839] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [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: 11/12/2022]
Abstract
BACKGROUND Mild to moderate hyperhomocysteinemia is very common among patients undergoing haemodialysis. There is sufficient evidence that hyperhomocysteinemia is an independent risk factor for cardiovascular and or atheromatous disease in end stage renal failure patients. Vitamin supplementation such as vitamin B6, B12 or folate has been proposed to correct this metabolic disturbance and it is to be proved if this intervention benefit these patients, but there is no agreement whether oral folate supplementation is capable to normalize homocysteine levels in end stage renal failure patients. METHODS In 53 patients, undergoing haemodialysis, homocysteine levels (Hcy), folate, vitamin B12, ferritin and C-reactive protein (CRP) were estimated before and after dialysis, without folate supplementation. Thirty voluntary blood donors were used as controls to compare homocysteine levels. After four weeks of oral folate supplementation (10 mg/24 hours) the levels of homocysteine, serum folate and intra-erythrocyte folate were estimated again. Eighteen months later the survival rate of our patients was recorded and analyzed in relation to Hcy and CRP levels. RESULTS The results showed that haemodialysis patients exhibited, almost, fourfold higher homocysteine levels than controls (27.39 +/- 11.54 vs 7.38 +/- 3.5, t = -8.2, p = 0.000000). Folate levels, vitamin B12 and CRP increase significantly after haemodialysis where as homocysteine levels decrease (Hcy1 vs. Hcy2: z = 2.08, p = 0.03). Fourteen (14) patients suffered from coronary heart disease (CHD) and they exhibited the higher levels of homocysteine (Hcy1 vs. CHD: z = -3.4, p = 0.0006). All estimations performed revealed a negative correlation between homocysteine levels and plasma or intra-erythrocyte folate. No other variable exhibited any significant influence upon homocysteine levels. After folate supplementation homocysteine levels in the whole number of patients were unchanged (Hcy(before) vs. Hcy(after): 27.39 +/- 11.54 vs. 26.95 +/- 8.22, z = 0.3, p = 0.7, NS). When patients with homocysteine levels higher than 24 micromol/L were selected, a significant decrease was observed (34.77 +/- 9.32 vs. 30.0 +/- 8.05, z = 2.09, p = 0.02). Forty-two patients were treated with erythropoietin for their anemia and we found a positive correlation between C-reactive protein levels and rhu-Epo dose (CRP vs. Epo: r = 0.45, p = 0.002). Homocysteine levels did not exhibit any significant influence upon short-term survival (U = -0.37, p = 0.3, NS) where as CRP levels exhibit a significant influence upon short-term survival (U = 2.15, p = 0.005). CONCLUSIONS Homocysteine levels in haemodialysis patients are fourfold higher than healthy controls. Folate, vitamin B12 and CRP increases significantly after dialysis. Patients with coronary heart disease exhibit the highest levels of homocysteine. The homocysteine levels are inversely related with the folate levels. The exogenous folate supplementation increase the serum folate levels but decreases homocysteine only in patients with higher than mild hyperhomocysteinemia. Hcy doesn't exert any significant effect upon the short-term survival of the haemodialysis patients but CRP level is a god predictor of the short-term survival of these patients.
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Affiliation(s)
- E Koulouridis
- Nephrology Department, General Hospital of Corfu, Greece.
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