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Jatteppanavar B, Choudhury A, Panda PK, Bairwa M. Community-acquired multidrug-resistant pneumonia, bacteraemia, and infective endocarditis: A case report. World J Crit Care Med 2024; 13:87459. [PMID: 38633471 PMCID: PMC11019630 DOI: 10.5492/wjccm.v13.i1.87459] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 10/03/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND The prevalence of multidrug-resistant (MDR) bacteria has increased globally, with extensive drug-resistant (XDR) bacteria posing a threat to patients. CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health. Despite negative results for tropical fever infections, he had neutrophilic leucocytosis, acute kidney injury, and chest imaging findings suggestive of bilateral consolidations. On day two, he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia, and community-acquired pneumonia. Despite treatment with broad-spectrum antibiotics, he did not respond and succumbed to death on day five. CONCLUSION This case highlights that clinicians/public should be aware of MDR community-acquired pneumonia, bacteraemia, and endocarditis which ultimately culminate in high rates of morbidity and mortality. Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities. Simultaneously, route cause analysis of community-acquired MDR/XDR pathogens is a global need.
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Affiliation(s)
| | - Arnab Choudhury
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Prasan Kumar Panda
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
| | - Mukesh Bairwa
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh 249203, India
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Bono K, Caceda JA, Zhai M, Horng H, Goldstein C, Sifri Z, Jobbagy Z, Glass NE. Timing of Acquisition of Methicillin-Resistant Staphylococcus aureus Nasal Carriage: Can we Limit Repeat Screening? J Surg Res 2024; 295:89-94. [PMID: 38000259 DOI: 10.1016/j.jss.2023.10.026] [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: 03/03/2023] [Revised: 09/12/2023] [Accepted: 10/27/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION Broad-spectrum empiric antibiotics are routinely administered to hospitalized patients with potential infections. These antibiotics provide protection; however, they come with their own negative effects. The utility of Methicillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction (PCR) nasal screening to steward anti-MRSA empiric antibiotics in hospitalized patients is established. With this current study, we look to determine the optimal frequency of MRSA nasal testing to help limit unnecessary testing consistent with the efforts of Choosing Wisely. We hypothesize that MRSA PCR nasal swab conversion will be low within the first 2 wk after index swab collection. METHODS We performed a single-center retrospective chart review of all adult patient encounters from October 2019-July 2021 with MRSA PCR nasal testing. We excluded duplicate patient encounters. Further exclusion criteria included patients with a single MRSA PCR swab and those who tested positive for MRSA colonization on their index swab. We evaluated how many conversions from negative to positive there were, and the timing of those relative to those that did not develop colonization while in the hospital. RESULTS 263 patients had multiple MRSA nares screening. 215 patients had 2 swab collections, 35 patients had 3 swab collections, 9 patients had 4 swab collections, and 4 patients had 5 swab collections. 14 converted from negative to positive. The time of conversions ranged from within 0-36 d, with an overall cumulative conversion of 5%. The rate of cumulative conversion from one week was 1.9%, for 2 wk it was 3.4%. CONCLUSIONS Findings suggest that MRSA PCR nasal swab conversion is unlikely to occur within 2 wk. Therefore, to optimize resources, further investigation should be conducted to target guidelines as well as systems to limit repeat swab testing. We will investigate the utility of this after implementation.
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Affiliation(s)
- Kristy Bono
- Rutgers New Jersey Medical School, Newark, New Jersey
| | | | - Merry Zhai
- Rutgers New Jersey Medical School, Newark, New Jersey
| | - Helen Horng
- Department of Pharmacy, University Hospital, Newark, New Jersey
| | - Carma Goldstein
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Ziad Sifri
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Zsolt Jobbagy
- Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
| | - Nina E Glass
- Department of Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
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Wei H, Dong X, Hu X. Multiple large skin ulcers developed in a colon cancer patient treated with bevacizumab. Asian J Surg 2023; 46:6107-6108. [PMID: 37777414 DOI: 10.1016/j.asjsur.2023.09.088] [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: 08/25/2023] [Accepted: 09/14/2023] [Indexed: 10/02/2023] Open
Affiliation(s)
- Hangping Wei
- Department of Medical Oncology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, 322100, PR China.
| | - Xiaofang Dong
- Department of Medical Oncology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, 322100, PR China
| | - Xiaoyan Hu
- Department of Medical Oncology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang, Zhejiang, 322100, PR China
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Ang T, Cameron C, Tong JY, Wilcsek G, Tan J, Patel S, Selva D. Methicillin-resistant Staphylococcus aureus-associated orbital cellulitis: a case series. Int Ophthalmol 2023; 43:2925-2933. [PMID: 37029211 PMCID: PMC10371901 DOI: 10.1007/s10792-023-02698-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/23/2023] [Indexed: 04/09/2023]
Abstract
PURPOSE In recent years, methicillin-resistant Staphylococcus aureus (MRSA) orbital cellulitis (OC) has drawn increasing clinical and public health concern. We present a case series of MRSA OC encountered at four Australian tertiary institutions. METHODS A multi-centre retrospective case series investigating MRSA OC in Australia from 2013 to 2022. Patients of all ages were included. RESULTS Nine cases of culture-positive non-multi-resistant MRSA (nmMRSA) OC were identified at four tertiary institutions across Australia (7 male, 2 female). Mean age was 17.1 ± 16.7 years (range 13-days to 53-years), of which one was 13 days old, and all were immunocompetent. Eight (88.9%) patients had paranasal sinus disease, and seven (77.8%) had a subperiosteal abscess. Four (44.4%) had intracranial extension, including one (11.1%) case which was also complicated by superior sagittal sinus thrombosis. Empirical antibiotics, such as intravenous (IV) cefotaxime alone or IV ceftriaxone and flucloxacillin, were commenced. Following identification of nmMRSA, targeted therapy consisting of vancomycin and/or clindamycin was added. Nine (100%) patients underwent surgical intervention. Average hospital admission was 13.7 ± 6.9 days (range 3-25 days), with two patients requiring intensive care unit (ICU) admission due to complications related to their orbital infection. All patients had favourable prognosis, with preserved visual acuity and extraocular movements, following an average follow-up period of 4.6 months (range 2-9 months). CONCLUSION NMMRSA OC can follow an aggressive clinical course causing severe orbital and intracranial complications across a wide demographic. However, early recognition, initiation of targeted antibiotics and surgical intervention when required can effectively manage these complications and achieve favourable visual outcomes.
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Affiliation(s)
- Terence Ang
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia.
| | - Cassie Cameron
- Discipline of Ophthalmology and Visual Sciences, The University of Adelaide, Adelaide, SA, 5000, Australia
| | - Jessica Y Tong
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Geoff Wilcsek
- Department of Ophthalmology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Jeremy Tan
- Department of Ophthalmology, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Sandy Patel
- Department of Medical Imaging, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - Dinesh Selva
- Department of Ophthalmology, The Royal Adelaide Hospital, Adelaide, SA, Australia
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Harrell KN, Koestner T, Lloyd J, Carter BL, Hunt D, Dart B, Maxwell R. Methicillin-Resistant Staphylococcus aureus Nasal Swab Is Insufficient to Withhold Empiric Methicillin-Resistant Staphylococcus aureus Pneumonia Coverage in a Trauma Population. J Surg Res 2023; 285:45-50. [PMID: 36640609 DOI: 10.1016/j.jss.2022.12.014] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 10/31/2022] [Accepted: 12/24/2022] [Indexed: 01/15/2023]
Abstract
INTRODUCTION Methicillin-resistant staphylococcus aureus (MRSA) nasal colonization is a predictor of MRSA pneumonia in intensive care unit (ICU) patients. Negative nasal swabs have shown up to a 97% negative predictive value for MRSA pneumonia in nontrauma populations, though little investigation has been pursued in trauma patients. MATERIALS AND METHODS All trauma patients admitted to the ICU from April 2018 to February 2019 were screened for MRSA colonization by nasal swab. Patients with suspicion for pneumonia underwent bronchoalveolar lavage or quantitative sputum culture and were started on empiric antibiotic therapy based on the swab result. Swab-positive patients were started on empiric MRSA coverage and swab-negative patients were not. RESULTS MRSA nasal swab screening was performed in 601 trauma ICU patients. Ninety-six patients subsequently underwent pneumonia workup and were started on an empiric antibiotic regimen based on nasal swab results. Seventeen (17.7%) patients were MRSA nasal swab positive on screening, and 22 (22.9%) patients subsequently had significant growth of MRSA on quantitative respiratory culture. The sensitivity of nasal swab was 50.0% and the specificity was 91.9%. Eleven patients had a negative MRSA nasal swab but a positive MRSA pneumonia (11.5%). Patients with inadequate antibiotic coverage had statistically longer hospital length of stay, ICU length of stay, ventilator days, and rates of unplanned intubation compared to patients with adequate antibiotic coverage. CONCLUSIONS Nasal swab screening was not sensitive enough in a trauma population with a high endemic incidence of MRSA colonization to warrant withholding empiric antibiotic MRSA coverage in patients with suspected pneumonia.
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Affiliation(s)
- Kevin N Harrell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee.
| | - Tyler Koestner
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; Department of Surgery, University of Kentucky School of Medicine, Lexington, Kentucky
| | - Jacob Lloyd
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; Department of Surgery, Prisma Health Greenville, Greenville, South Carolina
| | - Breanna L Carter
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee; Department of Pharmacy, Erlanger Health System, Chattanooga, Tennessee
| | - Darren Hunt
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Benjamin Dart
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
| | - Robert Maxwell
- Department of Surgery, University of Tennessee College of Medicine Chattanooga, Chattanooga, Tennessee
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Shao Q, Ding T, Pan F, Li G, Shen S, Qian J, Zhan C, Wei X. Protein corona mediated liposomal drug delivery for bacterial infection management. Asian J Pharm Sci 2022; 17:855-66. [PMID: 36600900 DOI: 10.1016/j.ajps.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 10/10/2022] [Accepted: 10/15/2022] [Indexed: 11/07/2022] Open
Abstract
Liposomes have been widely investigated as a class of promising antibiotic delivery systems for the treatment of life-threatening bacterial infections. However, the inevitable formation of protein corona on the liposomal surface can heavily impact in vivo performance. A better understanding of the effects of protein corona on liposomal behavior can significantly improve antibacterial liposomal drug development. Here, the critical role of protein corona in mediating liposome-bacteria interactions was elucidated. Adsorption of negatively charged protein on cationic liposome weakened electrostatic attraction-enhanced liposomal binding to the bacteria. Cumulative complement deposition on anionic liposome composed of phosphatidylglycerol (DSPG sLip) contributed to a superior binding affinity of DSPG sLip to planktonic bacteria and biofilms, which was exploited to enhance bacteria-targeted drug delivery. In both S. aureus-related osteomyelitis and pneumonia mice models, DSPG sLip was demonstrated as a promising antibiotic nanocarrier for managing MRSA infection, indicating the benefits of lipid composition-based protein corona modulation in liposomal antibiotic delivery for bacterial infection treatment.
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Barreto JV, Dias CC, Cardoso T. Risk factors for community-onset pneumonia caused by drug-resistant pathogens: A prospective cohort study. Eur J Intern Med 2022; 96:66-73. [PMID: 34670681 DOI: 10.1016/j.ejim.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/30/2021] [Accepted: 10/07/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION There is no consensual definition of risk factors for drug resistant pathogens (DRP) in community-onset pneumonia (COP). Healthcare-associated pneumonia criteria have been abandoned because they were found to have weak discriminative power. Our aim was to identify risk factors for DRP in COP. METHODS Prospective cohort study, conducted over a two years' period, in a community-based hospital, including all adult patients with COP criteria. Univariate and multivariate logistic regression modeling were performed to understand the association of risk factors (demographic, clinical and epidemiological) with COP by a DRP (PES: Pseudomonas aeruginosa, extended-spectrum ß-lactamase producing Enterobacteriaceae, Methicillin-resistant Staphylococcus aureus; and other non-fermenting gram-negative bacteria, namely Acinetobacter baumannii). RESULTS A total of 660 cases of COP were included, with a mean (±SD) age of 74±15 years and 58.9% of males. Microbiological documentation was possible in 32.6% of the cases. There were 197 cases selected for further analysis, of which 37 were cases of PES. The multivariate logistic regression model retained antibiotic use in the previous 90 days (adjusted OR=4.411, 95%CI [1.745-11.148]) and being bed-ridden (adjusted OR=5.492, 95%CI [2.121-14.222]), adjusted for Charlson's Index, CURB 65 and provenience from a long-term care facility. The area under the ROC curve for this model was 0.832, 95%CI [0.756-0.908], higher than the application of the HCAP criteria (AUROC = 0.676, 95%CI [0.582-0.770]). CONCLUSION In this study, antibiotic use in the previous 90 days and being bed-ridden were independently associated with COP caused by DRP, after adjustment for Charlson's Index, CURB 65 and provenience from a long-term care facility.
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Affiliation(s)
- J Vasco Barreto
- Internal Medicine Service, Medicine Department, Hospital Pedro Hispano, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513 Senhora da Hora, Portugal; ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal.
| | - Cláudia Camila Dias
- Knowledge Management Unit and Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal; CINTESIS - Center for Health Technology and Services Research, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal.
| | - Teresa Cardoso
- ICBAS - School of Medicine and Biomedical Sciences, University of Porto, Rua Jorge de Viterbo Ferreira 228, 4050-313 Porto, Portugal; Intensive Care Unit (UCIP) and Hospital Infection Control Committee, Hospital de Santo António, Oporto University Hospital Center, University of Porto, Largo Prof. Abel Salazar, 4099-001 Porto, Portugal
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Nagulapalli Venkata KC, Ellebrecht M, Tripathi SK. Efforts towards the inhibitor design for New Delhi metallo-beta-lactamase (NDM-1). Eur J Med Chem 2021; 225:113747. [PMID: 34391033 DOI: 10.1016/j.ejmech.2021.113747] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 07/16/2021] [Accepted: 08/03/2021] [Indexed: 10/20/2022]
Abstract
Antimicrobial stewardship is imperative when treating bacterial infections because the misuse and overuse of antibiotics have caused pathogens to develop life-threatening resistance mechanisms. The New Delhi metallo-beta-lactamase (NDM-1) is one of many enzymes that enable bacterial resistance. NDM-1 is a more recently discovered beta-lactamase with the ability to inactivate a wide range of beta-lactam antibiotics. Multiple NDM-1 inhibitors have been designed and tested; however, due to the complexity of the NDM-1 active site, there is currently no inhibitor on the market. Consequently, an infection caused by bacteria possessing the gene for the NDM-1 enzyme is a serious and potentially fatal complication. An abundance of research has been invested over the past decade in search of an NDM-1 inhibitor. This review aims to summarize various NDM-1 inhibitor designs that have been developed in recent years.
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Affiliation(s)
| | - Morgan Ellebrecht
- St. Louis College of Pharmacy, University of Health Sciences and Pharmacy, St. Louis, MO, 63110, USA
| | - Siddharth K Tripathi
- National Center for Natural Products Research, School of Pharmacy, The University of Mississippi, University, MS, 38677, USA
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Huang K, Lin BY, Ren HY, Liu YY, Zhang Z, Zhai LF, Ma GP, Zhang C, Guo QF. [Surgical treatment of traumatic osteomyelitis of extremities with MRSA infection]. Zhongguo Gu Shang 2021; 34:550-3. [PMID: 34180176 DOI: 10.12200/j.issn.1003-0034.2021.06.014] [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] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To summarize and discuss the clinical efficacy and application value of intravenous drip of linezolid combined with local targeted sustained-release of vancomycin in the treatment of traumatic osteomyelitis of extremities infected with MRSA. METHODS Thirty patients with traumatic osteomyelitis of extremities infected by MRSA from March 2015 to March 2017 were analyzed retrospectively, including 21 males and 9 females; aged 25 to 64 years old, with an average age of(47.94± 6.23) years old;the course of disease ranged from 9 to 23 months, with an average of (15.68±6.23) months. The lesions were located in tibia in 18 cases and calcaneus in 12 cases. The causes of injury were fall injury in 12 cases, trafficaccident injury in 9 cases and fall injury in 9 cases. There were 22 patients with closed fractures and 8 patients with open fractures. There were 13 cases of internal fixation. Twenty-two patients had sinustract, 8 patients had soft tissue defect with bone and internal fixation exposure, soft tissue defect area ranged from 2.0 cm × 3.0 cm to 8.2 cm × 12.3 cm;10 patients had bone defect, defect area ranged from 0.5 to 3.4 cm;bacterial culture of sinus tract or wound secretion in all patients was MRSA. On the basis of thorough debridement, calcium sulfate artificial bone loaded with vancomycin was implanted in the lesion, and linezolid and glucose injection was given intravenously during the perioperative period. The patients were followed up regularly according to the time of antibiotic use, blood routine, erythrocyte sedimentation rate, high-sensitivity C-reactive protein, liver and kidney function and other related laboratory indexes, X-ray, CT and other imaging examinations, bone healing, flap survival, joint function and McKee's osteomyelitis cure criteria. RESULTS All the patients were followed up, and the duration ranged from 3 to 6 years, with a mean of (4.23±0.76) years. No recurrence of osteomyelitis occurred. Fracture healing, infection control, wound healing and functional recovery were achieved. CONCLUSION Intravenous drip of linezolid combined with local targeted sustained-release of vancomycin for the treatment of MRSA infected traumatic osteomyelitis in limbs have significant effects and low recurrence rates.
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Affiliation(s)
- Kai Huang
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Bing-Yuan Lin
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Hai-Yong Ren
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Yi-Yang Liu
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Zhan Zhang
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Li-Feng Zhai
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Gou-Ping Ma
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Chun Zhang
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
| | - Qiao-Feng Guo
- Department of Orthopaedics, Tongde Hospital of Zhejiang Province, Hangzhou 310012, Zhejiang, China
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Ucgul AY, Behcet M. Comparison of the effect of teicoplanin and vancomycin on experimental methicillin-resistant staphylococcus aureus keratitis. Int Ophthalmol 2021; 41:1395-402. [PMID: 33506369 DOI: 10.1007/s10792-021-01696-2] [Citation(s) in RCA: 3] [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: 06/10/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the early efficacy and safety of intrastromal injection of teicoplanin as the alternative treatment for the methicillin-resistant Staphylococcus aureus (MRSA) keratitis by comparing it with vancomycin. MATERIALS AND METHODS Twenty-four eyes of 24 New Zealand white rabbits were included in the study. MRSA keratitis was induced in the right eye of each rabbit by injecting 0.1 mL MRSA suspension containing 1000 colony-forming units (CFU) intrastromally to the central cornea. The rabbits were divided into three treatment groups 24 h after the inoculation of MRSA. Eight rabbits received intrastromal teicoplanin therapy, eight received intrastromal vancomycin therapy, and eight received balanced salt solution and served as the control group. Nine hours after the treatment, all rabbits were sacrificed and corneal tissues were collected for microbiological analysis. We also examined and scored all the rabbits clinically before and after the treatment. RESULTS The control group scored higher with regard to conjunctival injection, iritis, fibrin, hypopyon, epithelial erosion, and corneal infiltrate than the vancomycin and teicoplanin groups (p = 0.031, 0.010, < 0.001, 0.029, 0.009, and < 0.001, respectively). Chemosis and corneal oedema were similar in all groups (p = 0.731 and 0.075, respectively). The severity of all clinical parameters was similar in both the vancomycin and teicoplanin groups after the treatment. The bacterial load was the highest (7.83 ± 0.71 log10 CFU/g) in the control group. The eyes treated with vancomycin and teicoplanin had similar bacterial loads (6.40 ± 0.69 vs. 6.31 ± 0.75 log10 CFU/g, p = 0.809). CONCLUSION The efficiency of teicoplanin seems to be comparable to that of vancomycin when administered intrastromally in the early treatment of MRSA keratitis. The former may be preferred in the treatment of selected cases with vancomycin hypersensitivity or resistance.
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Yehouenou CL, Kpangon AA, Affolabi D, Rodriguez-Villalobos H, Van Bambeke F, Dalleur O, Simon A. Antimicrobial resistance in hospitalized surgical patients: a silently emerging public health concern in Benin. Ann Clin Microbiol Antimicrob 2020; 19:54. [PMID: 33239061 PMCID: PMC7687776 DOI: 10.1186/s12941-020-00398-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical site infections are related to high morbidity, mortality and healthcare costs. Because the emergence of multidrug-resistant bacteria in hospitals is becoming a worldwide challenge for surgeons who treat healthcare-associated infections, we wished to identify the causative agents involved in these infections and the rate of multidrug-resistant bacteria in six public hospitals in Benin. METHODS Using standard microbiological procedures, we processed pus specimens collected from obstetrics and gastrointestinal surgery wards. Mass spectrometry (MALDI-TOF) was used for confirmation. For the antibiotic susceptibility test, we first used the Kirby-Bauer disk diffusion method. The secondary test (by microdilution) used the Beckton Dickinson Phoenix automated system (Becton Dickinson Diagnostic, USA). RESULTS We included 304 patients, whose median length of stay was 9 days. A total of 259 wound swabs (85.2%) had positive aerobic bacterial growth. In obstetrics, S. aureus (28.5%, n = 42) was the most common isolate. In contrast, Gram-negative bacteria (GNB) were predominant in gastrointestinal surgery, the most dominant being E.coli (38.4%, n = 31). Overall, 90.8% (n = 208) of aerobic bacteria were multidrug resistant. Two-thirds of S. aureus (65.3%, n = 32) were methicillin-resistant Staphylococcus aureus (MRSA), three of which carried both MRSA and induced clindamycin resistance (ICR). GNB showed high resistance to ceftazidime, ceftriaxone and cefepime. Extended-spectrum beta-lactamases were presented by 69.4% of E.coli (n = 43/62) and 83.3% of K. pneumoniae (n = 25/30). Overall, twelve Gram-negative bacteria (5.24%) showed resistance to at least one carbapenem. No isolates showed a wild-type susceptible phenotype. CONCLUSION This study shows the alarming prevalence of multidrug-resistant organisms from surgical site infections in Benin hospitals. To reduce the spread of such bacteria in Benin, periodic surveillance of surgical site infections and strict adherence to good hand-hygiene practice are essential.
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Affiliation(s)
- Carine Laurence Yehouenou
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin
- Faculté des Sciences de La Santé (FSS), Université D’Abomey Calavi (UAC), 01BP188, Cotonou, Benin
| | - Arsène A. Kpangon
- Ecole Nationale des Techniciens Supérieurs en Santé Publique et Surveillance Epidémiologique, Université de Parakou, Parakou, Benin
| | - Dissou Affolabi
- Laboratoire de Référence des Mycobactéries (LRM), Cotonou, Benin
- Centre National Hospitalier et Universitaire Hubert Koutoukou Maga (CNHU-HKM), Cotonou, Benin
- Faculté des Sciences de La Santé (FSS), Université D’Abomey Calavi (UAC), 01BP188, Cotonou, Benin
| | - Hector Rodriguez-Villalobos
- Microbiologie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, UCLouvain, Brussels, Belgium
- Pôle de Microbiologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain UCLouvain, Brussels, Belgium
| | - Françoise Van Bambeke
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium
- Pharmacologie Cellulaire et Moléculaire, Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium
| | - Olivia Dalleur
- Clinical Pharmacy Research Group (CLIP), Louvain Drug Research Institute (LDRI), Université Catholique de Louvain UCLouvain, Brussels, Belgium
- Pharmacy, Clinique Universitaire Saint-Luc, Université Catholique de Louvain, UCLouvain, Brussels, Belgium
| | - Anne Simon
- Microbiologie, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, UCLouvain, Brussels, Belgium
- Pôle de Microbiologie, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain UCLouvain, Brussels, Belgium
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12
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Christie J, Wright D, Liebowitz J, Stefanacci P. Can a nasal and skin decolonization protocol safely replace contact precautions for MRSA-colonized patients? Am J Infect Control 2020; 48:922-924. [PMID: 31937456 DOI: 10.1016/j.ajic.2019.12.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/13/2019] [Accepted: 12/14/2019] [Indexed: 01/27/2023]
Abstract
Contact precautions (CP) are employed in United States hospitals in order to prevent transmission of pathogens via supplies, equipment, and health care worker hands. CP is required in many hospitals for both colonized and infected methicillin-resistant Staphylococcus aureus (MRSA) patients. The isolation of colonized patients often results in a high rate of CP, leading some hospitals to abandon CP for MRSA-colonized patients without adding any safety measure to address transmission risk. Understanding this risk, 7 network hospitals in a US health care system made the decision to replace CP for high-risk MRSA-colonized patients with targeted nasal and body decolonization, leading to significant cost savings and staff satisfaction without any increase in MRSA transmission.
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Affiliation(s)
- Jacqueline Christie
- Departments of Quality and Nursing, Universal Health Services, Inc., King of Prussia, PA.
| | - Don Wright
- Departments of Quality and Nursing, Universal Health Services, Inc., King of Prussia, PA
| | - Jacalyn Liebowitz
- Departments of Quality and Nursing, Universal Health Services, Inc., King of Prussia, PA
| | - Paul Stefanacci
- Departments of Quality and Nursing, Universal Health Services, Inc., King of Prussia, PA
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13
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Tang C, Chen J, Zhang L, Zhang R, Zhang S, Ye S, Zhao Z, Yang D. Exploring the antibacterial mechanism of essential oils by membrane permeability, apoptosis and biofilm formation combination with proteomics analysis against methicillin-resistant staphylococcus aureus. Int J Med Microbiol 2020; 310:151435. [PMID: 32654773 DOI: 10.1016/j.ijmm.2020.151435] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [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: 05/24/2020] [Accepted: 06/01/2020] [Indexed: 12/12/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is one of the important causes of food poisoning and infectious diseases worldwide, it can produce a large number of virulence factors, enhance the colonization ability of the host so that it can quickly colonize and spread on the surface of the objects. Essential oil (EO) is one of the natural products with antimicrobial properties, can be used as an important source of antibacterial agent discovery, and has a broad development prospect. However, the unclear mechanisms of antibacterial action have become an obstacle to its further development and use. Hence, the objective of the present study was to reveal the antibacterial mechanism of EO from Amomum villosum Lour (A villosum Lour) against MRSA using label-free quantitative proteomics, investigate the effect of EO on the bacterial proteome, enzymatic activities and leakage of bacterial intracellular biomacromolecule. Proteomic analysis of MRSA in the presence of EO found that a total of 144 differential expressed proteins (DEPs) between the control and treatment group, in which 42 proteins were distinctly up-regulated and 102 proteins were down-regulated. Besides, sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) analysis, determination of cell membrane permeability and apoptosis, scanning electron microscopy (SEM) observations, bacterial surface hydrophobicity, and biofilm formation measurement were performed. Collectively, the above results indicated that the cell membrane damage by EO leads to the loss of membrane integrity and causes leakage of intracellular macromolecular substances, inhibition of protein, and biofilm synthesis. These findings manifested that EO exerts antibacterial effect by multiple avenues and expands our understanding of the antibacterial mechanism, it has potential application value in food preservative and pharmaceutical industries.
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Affiliation(s)
- Cailin Tang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China; Department of Pharmacy, Guizhou Provincial People's Hospital, Guiyang, Guizhou, China
| | - Jiali Chen
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Lixia Zhang
- Yunnan Branch Institute of Medicinal Plant Development, Chinese Academy of Medical Sciences, Jinghong, China
| | - Rongfei Zhang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Sichen Zhang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Shaoxia Ye
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Zhimin Zhao
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China
| | - Depo Yang
- School of Pharmaceutical Sciences, Sun Yat-Sen University, Guangzhou, China.
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14
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Höring S, Lemmen S. [Management of patients with multidrug-resistant bacteria after hospital discharge]. MMW Fortschr Med 2020; 162:56-60. [PMID: 32248468 DOI: 10.1007/s15006-020-0343-9] [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] [Indexed: 06/11/2023]
Affiliation(s)
- Steffen Höring
- Zentralbereich für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Pauwelsstr. 30, D-52074, Aachen, Deutschland.
| | - Sebastian Lemmen
- Leiter des Zentralbereichs für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Deutschland
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15
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Watanabe K, Itoh K, Park SH, Kaku M, Ishii K, Sasano H, Naitoh T, Unno M, Fukushima K. Resistin-like molecule beta, a colonic epithelial protein, exhibits antimicrobial activity against Staphylococcus aureus including methicillin-resistant strains. Surg Today 2020; 50:920-930. [PMID: 32062787 DOI: 10.1007/s00595-020-01974-z] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 01/10/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Resistin-like molecule beta (RELMβ) is a small cysteine-rich protein secreted by colonic epithelial cells. RELMβ mRNA and protein expressions are dramatically induced by bacterial exposure in germ-free mice. We hypothesized that RELMβ has antimicrobial activity. METHODS The antimicrobial activity of RELMβ was screened by an agar spot test and confirmed by a liquid broth test. The amount of RELMβ in human stools was semi-quantified by Western blot analysis. The induction of RELMβ mRNA and protein expression by bacteria was measured by quantitative RT-PCR using LS174T cells. Electron microscopic immunohistochemistry was performed using polyclonal anti-RELMβ antibody. RESULTS RELMβ showed antimicrobial activity against S. aureus and all MRSAs examined in a dose- and pH-dependent fashion. Western blot study showed that the amount of RELMβ in healthy human stools was comparable to that exhibiting antimicrobial activity in vitro. Both RELMβ mRNA and protein expression were induced by heat-inactivated S. aureus, but not by E. coli in LS174T cells. Electron microscopic immunohistochemistry showed that RELMβ bound to the cell surface of S. aureus, followed by destruction of the bacterial cytoplasm. CONCLUSIONS RELMβ is a colonic antimicrobial protein and its antibacterial activity is species selective. Because RELMβ is abundant in healthy human stool, RELMβ may modulate gut flora.
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Affiliation(s)
- Kazuhiro Watanabe
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Kikuji Itoh
- Laboratory of Veterinary Public Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan
| | - Sang-Hee Park
- Laboratory of Veterinary Public Health, Graduate School of Agricultural and Life Sciences, The University of Tokyo, Tokyo, Japan.,Clinical Research Center, Masan National Tuberculosis Hospital, Changwon, South Korea
| | - Mitsuo Kaku
- Department of Infection Control and Laboratory Diagnostics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiko Ishii
- Department of Medical Microbiology, Mycology and Immunology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Hospital, Sendai, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Kouhei Fukushima
- Laboratory of GI Tract Reconstruction, Tohoku University Graduate School of Biomedical Engineering, Sendai, Japan.,Department of Molecular and Surgical Pathophysiology, Tohoku University Graduate School of Medicine, Sendai, Japan
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16
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Veronese C, Pellegrini M, Maiolo C, Morara M, Armstrong GW, Ciardella AP. Multimodal ophthalmic imaging of staphylococcus aureus bacteremia associated with chorioretinitis, endocarditis, and multifocal brain abscesses. Am J Ophthalmol Case Rep 2019; 17:100577. [PMID: 31886435 PMCID: PMC6920711 DOI: 10.1016/j.ajoc.2019.100577] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 12/09/2019] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Staphylococcus aureus bacteriemia (SAB) as critical condition for the life and occasionally involves the eyes. The aim of this report is to describe the ocular involvement with multimodal imaging. OBSERVATIONS A patient admitted for evaluation of acute onset of confusion, disorientation, and generalized malaise and found to have methicillin-resistant staphylococcus aureus (MRSA)-associated endocarditis and multifocal brain abscesses was evaluated by the ophthalmology service. The patient's visual acuity was 20/20 OU without relative afferent pupillary defect and normal intraocular pressures. Bedside anterior segment examination was normal. Posterior segment examination revealed intraretinal hemorrhages and Roth spots in the posterior pole of the right eye, and two deep well-defined focal white chorioretinal infiltrates and a hemorrhagic pigment epithelium detachment in the temporal quadrant of the left eye. Multimodal imaging was utilized to document these findings and ensure adequate antibiotic therapy. CONCLUSION SAB has the potential for poor visual outcomes as well as significant morbidity and mortality. Multimodal imaging of SAB-related chorioretinitis allows for accurate diagnosis as well as assessment of response to antimicrobial therapy.
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Affiliation(s)
- Chiara Veronese
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | | | - Mariachiara Morara
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Grayson W Armstrong
- Department of Ophthalmology, Massachusetts Eye & Ear Infirmary, Harvard Medical School, Boston, MA, USA
| | - Antonio P Ciardella
- Ophthalmology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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17
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Davis JS, Jones CA, Cheng AC, Howden BP. Australia's response to the global threat of antimicrobial resistance: past, present and future. Med J Aust 2019; 211:106-108.e1. [PMID: 31313300 DOI: 10.5694/mja2.50264] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joshua S Davis
- Menzies School of Health Research, Darwin, NT.,John Hunter Hospital, Newcastle, NSW
| | | | | | - Benjamin P Howden
- Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC.,Austin Health, Melbourne, VIC
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18
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Shi X, Qin YX, Wan XY. [The research of the innate defense regulator peptide on the effects of methicillin resistant staphylococcus aureus biofilm]. Zhonghua Yi Xue Za Zhi 2018; 98:294-8. [PMID: 29397617 DOI: 10.3760/cma.j.issn.0376-2491.2018.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the destruction of the mature biofilm and the inhibitory effect of the biofilm formation of methicillin-resistant Staphylococcus aureus (MRSA) by different concentrations of the innate defense regulatory peptide (IDR-1018). Methods: 1 ×10(5)CFU /ml MRSA was inoculated uniformly into 96 well plates, the biofilm model would be completed after 48 h. Given the different concentration of IDR-1018 solution as the experimental group double diluted with tryptic soy broth (TSB), the concentration in bacteria suspension reached 3.75-1 000 mg/L respectively. Erythromycin is double diluted into different concentration gradient, combined with low concentration (15 mg/L) of IDR-1018 as the mixed group.The same amount of TSB treated as the blank control group. The growth of the biofilm was measured through the measurement of the value of absorbance (A)by the semi-quantitative method of crystal violet staining at 24 h. Using SPSS 18.0 as statistical software to analyze the data. Results: Compared with the control group (A(595)=1.764 ± 0.026), IDR-1018 significantly damaged the mature MRSA biofilm, and function was worked in a dose-dependent method. With decreasing drug concentration, the destruction of the biofilm decreased correspondingly. When the concentration was as low as 15 mg/L, A(595) = 0.946 ± 0.047(t=32.955, P<0.01). When the concentration was 7.5 mg/L, A(595) = 1.211±0.054 (t=12.731, P<0.05). When the concentration was 3.75 mg/L, A(595)=1.360±0.066(t=4.843, P<0.05), the difference was still statistically significant compared with the control group. For the immature biofilm, compared with the control group(A(595)=1.689±0.068), IDR-1018 still had a significant inhibitory effect on the formation process of MRSA biofilm when the concentration was as low as 15 mg/L (A(595)=0.846±0.057, t=34.127, P<0.01). The inhibition of biofilm had a certain decline, when the concentration was 7.5 mg/L (A(595)=1.402 ± 0.181, t=5.240, P<0.05). But the difference was still statistically significant compared with the control group. However, the inhibitory effect was significantly decreased when the concentration was 3.75 mg/L (A(595)=1.631±0.190, t=0.913, P>0.05). When the low concentration (15 mg/L) of IDR-1018 and different concentrations of erythromycin were used together, the destruction and inhibition of MRSA biofilm was significantly higher than using erythromycin or IDR-1018 alone. Conclusion: IDR-1018 can play a good inhibitory role in the formation process of MRSA biofilm, and can play a good role in destroying MRSA biofilm.
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19
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Liu M, Liu T, Chen X, Yang J, Deng J, He W, Zhang X, Lei Q, Hu X, Luo G, Wu J. Nano-silver-incorporated biomimetic polydopamine coating on a thermoplastic polyurethane porous nanocomposite as an efficient antibacterial wound dressing. J Nanobiotechnology 2018; 16:89. [PMID: 30419925 PMCID: PMC6231251 DOI: 10.1186/s12951-018-0416-4] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [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: 08/12/2018] [Accepted: 10/26/2018] [Indexed: 12/21/2022] Open
Abstract
Background Developing an ideal wound dressing that meets the multiple demands of good biocompatibility, an appropriate porous structure, superior mechanical property and excellent antibacterial activity against drug-resistant bacteria is highly desirable for clinical wound care. Biocompatible thermoplastic polyurethane (TPU) membranes are promising candidates as a scaffold; however, their lack of a suitable porous structure and antibacterial activity has limited their application. Antibiotics are generally used for preventing bacterial infections, but the global emergence of drug-resistant bacteria continues to cause social concerns. Results Consequently, we prepared a flexible dressing based on a TPU membrane with a specific porous structure and then modified it with a biomimetic polydopamine coating to prepare in situ a nano-silver (NS)-based composite via a facile and eco-friendly approach. SEM images showed that the TPU/NS membranes were characterized by an ideal porous structure (pore size: ~ 85 μm, porosity: ~ 65%) that was decorated with nano-silver particles. ATR-FITR and XRD spectroscopy further confirmed the stepwise deposition of polydopamine and nano-silver. Water contact angle measurement indicated improved surface hydrophilicity after coating with polydopamine. Tensile testing demonstrated that the TPU/NS membranes had an acceptable mechanical strength and excellent flexibility. Subsequently, bacterial suspension assay, plate counting methods and Live/Dead staining assays demonstrated that the optimized TPU/NS2.5 membranes possessed excellent antibacterial activity against P. aeruginosa, E. coli, S. aureus and MRSA bacteria, while CCK8 testing, SEM observations and cell apoptosis assays demonstrated that they had no measurable cytotoxicity toward mammalian cells. Moreover, a steady and safe silver-releasing profile recorded by ICP-MS confirmed these results. Finally, by using a bacteria-infected (MRSA or P. aeruginosa) murine wound model, we found that TPU/NS2.5 membranes could prevent in vivo bacterial infections and promote wound healing via accelerating the re-epithelialization process, and these membranes had no obvious toxicity toward normal tissues. Conclusion Based on these results, the TPU/NS2.5 nanocomposite has great potential for the management of wounds, particularly for wounds caused by drug-resistant bacteria.
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Affiliation(s)
- Menglong Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Tengfei Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiwei Chen
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Jiacai Yang
- Department of Urology, Second Affiliated Hospital of Third Military Medical University (Army Medical University), Chongqing, 400037, China
| | - Jun Deng
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Weifeng He
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Xiaorong Zhang
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Qiang Lei
- Department of Burns and Reconstructive Surgery, Jinan Military General Hospital, Jinan, 250000, China
| | - Xiaohong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China.
| | - Jun Wu
- Institute of Burn Research, State Key Laboratory of Trauma, Burn and Combined Injury, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China. .,Department of Burns, The First Affiliated Hospital, SunYat-Sen University, Guangzhou, 510080, China.
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20
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Tello K, Richter MJ, Seeger W, Hecker M. [Hospital-acquired pneumonia]. Med Klin Intensivmed Notfmed 2018; 113:685-95. [PMID: 30302527 DOI: 10.1007/s00063-018-0494-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 08/10/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
Hospital-acquired pneumonia (HAP) is a frequent complication of hospitalisation. Due to rising multidrug resistant bacteria an appropriate, empiric and targeted therapy is essential and requires an accurate assessment of risk for multidrug resistant bacteria. A targeted, temporal therapy is indispensable and should begin after a focussed diagnosis. Re-evaluation of therapy is important, as clinical course, microbiological and laboratory results might lead to de-escalation of therapy. In this review article the current German guidelines on the diagnosis and therapy of hospital-acquired pneumonia are summarized. Special focus is put on targeted, risk-adapted therapy.
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21
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Tian H, Zhong C. Postoperation of preauricular fistula cellulitis caused by methicillin-resistant staphylococcus aureus infection. J Otol 2018; 13:111-113. [PMID: 30559776 PMCID: PMC6291634 DOI: 10.1016/j.joto.2018.07.002] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 12/26/2022] Open
Abstract
A one-year-old baby girl with one-month history of recurrent pus fluid exuding from her left preauricular sinus orifice, who failed multiple courses of surgical drainage of the abscess and persistent debridement for the wound, presented with MRSA infection. The patient was treated with linezolid for three days. Her pain and paresthesia resolved, and C-reactive protein decreased to normal.
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Affiliation(s)
- Haiyue Tian
- From the Department of Otolaryngology–Head and Neck Surgery, Lanzhou General Hospital of People's Liberation Army, Gansu Province, PR China
| | - Cuiping Zhong
- Department of Otolaryngology, Department of Otolaryngology–Head and Neck Surgery, Lanzhou General Hospital of People's Liberation Army, 333 Binhenan Road, Qilihe District, Lanzhou, 730050, PR China
- Corresponding author.
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Komuro H, Kato T, Okada S, Nakatani K, Matsumoto R, Nishida K, Iida H, Iida M, Tsujimoto S, Suganuma T. Toxic shock syndrome caused by suture abscess with methicillin-resistant Staphylococcus aureus (MRSA) with late onset after Caesarean section. IDCases 2017; 10:12-14. [PMID: 28791216 PMCID: PMC5536821 DOI: 10.1016/j.idcr.2017.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 07/09/2017] [Revised: 07/12/2017] [Accepted: 07/12/2017] [Indexed: 11/28/2022] Open
Abstract
Toxic shock syndrome (TSS) is a rare but life-threatening multisystem disease known to develop in the early postoperative period after various surgery. We report a rare case in which a patient who underwent Caesarean section developed TSS caused by methicillin-resistant Staphylococcus aureus (MRSA) on the 39th postoperative day. She was treated with debridement because of the possible diagnosis of necrotizing soft tissue infections. Culture test from the resected specimen was positive for MRSA. She was diagnosed with TSS caused by suture abscess and was treated with intensive care including antimicrobials. After a good postoperative course, she was discharged on the 30th postoperative day. TSS occurring 4 weeks after operation is extremely rare, but late-onset of suture abscess is known to occur. We should becognizant of development with TSS beyond early postoperative period.
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Affiliation(s)
- Hiroyasu Komuro
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Takaharu Kato
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama 330-8503, Japan
- Corresponding author at: Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, Saitama 330-8503, Japan.Department of SurgeryYokosuka General Hospital Uwamachi2-36 UwamachiYokosuka CityKanagawa238-8567Japan
| | - Shinichiro Okada
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Kensuke Nakatani
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Risa Matsumoto
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Kazuhiro Nishida
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
| | - Hiroyuki Iida
- Department of Internal Medicine, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Maki Iida
- Department of Pathology, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Shiro Tsujimoto
- Department of Pathology, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka, Kanagawa 238-8567, Japan
| | - Toshiyuki Suganuma
- Department of Surgery, Yokosuka General Hospital Uwamachi, 2-36 Uwamachi, Yokosuka City, Kanagawa 238-8567, Japan
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OHADIAN MOGHADAM S, POURMAND MR, DOURAGHI M, SABZI S, GHAFFARI P. Utilization of PFGE as a Powerful Discriminative Tool for the Investigation of Genetic Diversity among MRSA Strains. Iran J Public Health 2017; 46:351-356. [PMID: 28435821 PMCID: PMC5395531] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is a significant challenge to the burn patient. The implementation of proper monitoring programs and prompt identification of epidemic MRSA strains are critical to consequently control and eradicate potential outbreaks. This study aimed to define the genetic relatedness of MRSA strains isolated from burn patients by analyzing the large fragments of DNA. METHODS In this cross-sectional study, 126 pus/wound swabs from skin and soft tissue infections (SSTIs) were collected from inpatients of Shahid Motahari Burn Center (Tehran, Iran) in 2013. Then, molecular typing of MRSA was achieved by Pulsed-Field Gel Electrophoresis (PFGE). RESULTS The PFGE analysis of MRSA indicated 31 single types and 5 common types. There was a significant diversity in the chromosomal digestion pattern of the MRSA strains explained by the acquisition of MRSA from various sources. CONCLUSION The permanent import of novel types of MRSA strains despite the rigorous infection control measures carried out within the center. The importance of PFGE in understanding the epidemiology of MRSA may serve as a basis for the development of rational control strategies.
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Affiliation(s)
- Solmaz OHADIAN MOGHADAM
- Uro-oncology Research Center, Tehran University of Medical Sciences, Tehran, Iran, Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza POURMAND
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran, Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran,Corresponding Author:
| | - Masoumeh DOURAGHI
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira SABZI
- Dept. of Pathobiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Parisa GHAFFARI
- Biotechnology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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Fussen R, Lemmen S. [Multidrug resistant bacteria in the intensive care unit : Reasonable measures for prevention]. Med Klin Intensivmed Notfmed 2016; 111:743-754. [PMID: 27766376 DOI: 10.1007/s00063-016-0223-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 07/29/2016] [Revised: 08/31/2016] [Accepted: 08/31/2016] [Indexed: 11/24/2022]
Abstract
Multidrug resistant (MDR) bacteria present an increasing threat for intensive care patients. Whereas colonization of intensive care patients with methicillin-resistant staphylococcus aureus (MRSA) in German ICUs has remained at a constant level in recent years and therapeutic options have improved, colonization and infections with MDR gram-negative bacteria and vancomycin-resistant enterococci are increasing year by year. Only a few or even no therapeutic options remain for the treatment of these bacteria. If recommendations and guidelines for the prevention of transmission of MDR bacteria do exist they often are of moderate evidence due to lack of randomized controlled trials. The single most important measure to avoid transmission and infection with sensible and MDR bacteria is still hand disinfection. Screening and barrier precautions must be adapted and implemented to pathogen and local conditions. In addition to those specific measures universal decolonization with antiseptics have been demonstrated to be effective at least in intensive care patients.
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Affiliation(s)
- R Fussen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
| | - S Lemmen
- Zentralbereich für Krankenhaushygiene und Infektiologie, Universitätsklinik RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Deutschland.
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Kim TH, Seap B, Kim SA, Heo GE. Vulvar Abscess Caused by Methicillin-resistant Staphylococcus Aureus (MRSA) in a Postmenopausal Woman. J Menopausal Med 2016; 22:118-21. [PMID: 27617247 PMCID: PMC5016500 DOI: 10.6118/jmm.2016.22.2.118] [Citation(s) in RCA: 4] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/07/2016] [Accepted: 03/14/2016] [Indexed: 11/17/2022] Open
Abstract
Infections of the vulva can present a complex differential to the gynecologist, ranging from superficial skin infections to lifethreatening necrotizing fasciitis. Recognition and timely treatment remain universal to skin and soft-tissue infections as the subcutaneous anatomy of the vulva can facilitate rapid spread to other tissues with significant morbidity and mortality. Employing a multidisciplinary team approach to care for vulvar cellulitis and abscess can guide treatment from antibiotic therapies to more aggressive surgical debridement. In this report, we describe a case of vulvar abscess caused by Methicillin-resistant staphylococcus aureus (MRSA) in a postmenopausal woman with underlying diseases of bronchiectasis and atelectasis.
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Affiliation(s)
- Tae-Hee Kim
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Bel Seap
- Department of Maternity, Khmer-Soviet Friendship Hospital, Phnom Penh, Cambodia
| | - Soo Ah Kim
- Department of Obstetrics and Gynecology, School of Medicine, Chosun University, Gwangju, Korea
| | - Gyeong-Eun Heo
- Department of Obstetrics and Gynecology, Soonchunhyang University College of Medicine, Bucheon, Korea
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Walter J, Espelage W, Adlhoch C, Cuny C, Schink S, Jansen A, Witte W, Eckmanns T, Hermes J. Persistence of nasal colonisation with methicillin resistant Staphylococcus aureus CC398 among participants of veterinary conferences and occurrence among their household members: A prospective cohort study, Germany 2008-2014. Vet Microbiol 2016; 200:13-18. [PMID: 27039883 DOI: 10.1016/j.vetmic.2016.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [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: 11/17/2015] [Revised: 03/15/2016] [Accepted: 03/25/2016] [Indexed: 11/20/2022]
Abstract
There are only few data on the persistence and transmission of methicillin resistant Staphylococcus aureus (MRSA) of the clonal complex (CC) 398 among veterinarians and their household members. We therefore investigated the long-term colonisation with MRSA CC398 among participants of veterinary conferences in Germany in 2008/2009 and their household members. Forty-five initially MRSA CC398 positive and 180 initially MRSA CC398 negative conference participants were included in a longitudinal study. These persons and their household members were tested for nasal colonisation in 2011, 2012 and 2014. Of 31 continuously tested and initially MRSA CC398 positive participants only 8 (26%) were colonized with MRSA CC398at all 4 time points, 4 (13%) of them consistently with the same spa type. Among initially MRSA CC398 negative participants, 13 (7%) were tested MRSA CC398 positive at least once during the follow-up period. Data for household members at least at one time point were available for 185 households. Of these 21 (11%) households had one or more household member who tested positive for MRSA CC398at least once. The odds of household members to be MRSA CC398 positive was 12 times higher (95% confidence interval 4-37) when the conference participant tested MRSA CC398 positive in 2008/2009. This association remained strong when household members working in veterinary medicine or livestock farms were excluded. In summary, these data suggest that colonisation with MRSA CC398 is partially transient and that household members of MRSA CC398 colonized persons are at an increased risk of colonisation with MRSA CC398.
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Affiliation(s)
- Jan Walter
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany.
| | - Werner Espelage
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Cornelia Adlhoch
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Christiane Cuny
- Robert Koch Institute, Department of Infectious Diseases Burgstraße 37, D-38855 Wernigerode, Germany
| | - Susanne Schink
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Andreas Jansen
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Wolfgang Witte
- Robert Koch Institute, Department of Infectious Diseases Burgstraße 37, D-38855 Wernigerode, Germany
| | - Tim Eckmanns
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
| | - Julia Hermes
- Robert Koch Institute, Department for Infectious Disease Epidemiology Seestraße 10, D-13353 Berlin, Germany
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Kavanagh KT, Calderon LE, Saman DM. Viewpoint: a response to "Screening and isolation to control methicillin-resistant Staphylococcus aureus: sense, nonsense, and evidence". Antimicrob Resist Infect Control 2015; 4:4. [PMID: 25729571 PMCID: PMC4345038 DOI: 10.1186/s13756-015-0044-9] [Citation(s) in RCA: 7] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Accepted: 01/09/2015] [Indexed: 12/28/2022] Open
Abstract
Surveillance and isolation for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) has become a controversial topic, one that causes heated debate and appears to be surrounded by both politics and industrial conflicts-of-interest. There have been calls from numerous authors for a movement away from rigid mandates and toward an evidence-based medicine approach. However, much of the evidence can be viewed with an entirely different interpretation. Two major studies with negative findings have had an adverse impact on recommendations regarding active detection and isolation (ADI) for MRSA. However the negative findings in these studies can be explained by shortcomings in study implementation rather than the ineffectiveness of ADI. The use of daily chlorhexidine bathing has also been proposed as an alternative to ADI in ICU settings. There are shortcomings regarding the evidence in the literature concerning the effectiveness of daily chlorhexidine bathing. One of the major concerns with universal daily chlorhexidine bathing is the development of bacterial resistance. The use of surveillance and isolation to address epidemics and common dangerous pathogens should solely depend upon surveillance and isolation's ability to prevent further spread to and infection of other patients through indirect contact. At present, there is a preponderance of evidence in the literature to support continuing use of surveillance and isolation to prevent the spread of MRSA.
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Affiliation(s)
- Kevin T Kavanagh
- />Health Watch USA, 3396 Woodhaven Dr, P.O. Box 1403, Somerset, KY 42503 USA
| | | | - Daniel M Saman
- />Health Watch USA, 3396 Woodhaven Dr, P.O. Box 1403, Somerset, KY 42503 USA
- />Essentia Institute of Rural Health, Duluth, MN USA
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Evans CT, Hill JN, Guihan M, Chin A, Goldstein B, Richardson MSA, Anderson V, Risa K, Kellie S, Cameron KA. Implementing a patient education intervention about Methicillin-resistant Staphylococcus aureus prevention and effect on knowledge and behavior in veterans with spinal cord injuries and disorders: a pilot randomized controlled trial. J Spinal Cord Med 2014; 37:152-61. [PMID: 24090538 PMCID: PMC4066423 DOI: 10.1179/2045772313y.0000000153] [Citation(s) in RCA: 8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To assess the feasibility and effect of a nurse-administered patient educational intervention about Methicillin-resistant Staphylococcus aureus (MRSA) prevention on knowledge and behavior of Veterans with spinal cord injuries and disorders (SCI/D). DESIGN Blinded, block-randomized controlled pilot trial. SETTING Two Department of Veterans Affairs (VA) SCI Centers. PARTICIPANTS Veterans were recruited March-September 2010 through referral by a healthcare provider from inpatient, outpatient, and residential care settings. INTERVENTION Thirty participants were randomized to the nurse-administered intervention and 31 to the usual care group. The intervention included a brochure and tools to assist nurses in conducting the education. OUTCOME MEASURES Pre- and post-intervention measurement of knowledge and behaviors related to MRSA and prevention strategies and feasibility measures related to implementation. RESULTS Participants were primarily male (95.1%), white (63.9%), with tetraplegia (63.9%) and mean age and duration of injury of 64.3 and 20.5 years, respectively. The intervention groups mean knowledge score significantly increased between pre- and post-test (mean change score = 1.70, 95% confidence interval, CI 0.25-3.15) while the usual care groups score did not significantly change (mean change score = 1.45, 95% CI -0.08-2.98). However, the mean knowledge change between intervention and usual care groups was not significantly different (P = 0.81). Overall behavior scores did not significantly differ between treatment groups; however, the intervention group was more likely to report intentions to clean hands (90.0% vs. 64.5%, P = 0.03) and asking providers about MRSA status (46.7% vs. 16.1%, P = 0.01). Nurse educators reported that the quality of the intervention was high and could be implemented in clinical care. CONCLUSIONS A targeted educational strategy is feasible to implement in SCI/D clinical practices and may improve some participants' knowledge about MRSA and increase intentions to improve hand hygiene and engagement with providers about their MRSA status.
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Affiliation(s)
- Charlesnika T. Evans
- Correspondence to: Charlesnika T. Evans, Department of Veterans Affairs, Center for Management of Complex Chronic Care (CMC3), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, 5th & Roosevelt Road, 151H, Hines, IL 60141, USA.
| | - Jennifer N. Hill
- Department of Veterans Affairs, Center for Management of Complex Chronic Care (CMC3), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | | | | | - Barry Goldstein
- Department of Rehabilitation Medicine Seattle, VACO/Patient Care Services, Spinal Cord Injury/Disorders Services, University of Washington, WA, USA
| | | | | | - Kathleen Risa
- Department of Veterans Affairs MRSA Program Office, Office of Patient Care Services, Pittsburgh, PA, USA
| | - Susan Kellie
- Infectious Disease Service, New Mexico VA Health Care System, Albuquerque, NM, USA
| | - Kenzie A. Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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