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Rahman A, Sardar S, Niaz Z, Khan A, Sheheryar S, Alrefaei AF, Hamayun M, Ali S. Lipase and Protease Production Ability of Multi-drug Resistant Bacteria Worsens the Outcomes of Wound Infections. Curr Pharm Des 2024; 30:1307-1316. [PMID: 38629357 DOI: 10.2174/0113816128302189240402043330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/05/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND Surgical site infections are one of the major clinical problems in surgical departments that cost hundreds of millions of dollars to healthcare systems around the world. AIM The study aimed to address the pressing issue of surgical site infections, which pose significant clinical and financial burdens on healthcare systems globally. Recognizing the substantial costs incurred due to these infections, the research has focused on understanding the role of lipase and protease production by multi-drug resistant bacteria isolated from surgical wounds in the development of post-surgical wound infections. METHODS For these purposes, 153 pus specimens were collected from patients with severe post-surgical wound infections having prolonged hospital stays. The specimens were inoculated on appropriate culture media. Gram staining and biochemical tests were used for the identification of bacterial growth on suitable culture media after 24 hours of incubation. The isolated pathogens were then applied for lipase and protease, key enzymes that could contribute to wound development, on tributyrin and skimmed milk agar, respectively. Following the CSLI guidelines, the Kirby-Bauer disc diffusion method was used to assess antibiotic susceptibility patterns. The results revealed that a significant proportion of the samples (127 out of 153) showed bacterial growth of Gram-negative (n = 66) and Gram-positive (n = 61) bacteria. In total, isolated 37 subjects were declared MDR due to their resistance to three or more than three antimicrobial agents. The most prevalent bacteria were Staphylococcus aureus (29.13%), followed by S. epidermidis (18.89%), Klebsiella pneumoniae (18.89%), Escherichia coli (14.96%), Pseudomonas aeruginosa (10.23%), and Proteus mirabilis (7.87%). Moreover, a considerable number of these bacteria exhibited lipase and protease activity with 70 bacterial strains as lipase positive on tributyrin agar, whereas 74 bacteria showed protease activity on skimmed milk agar with P. aeruginosa as the highest lipase (69.23%) and protease (76.92%) producer, followed by S. aureus (lipase 62.16% and protease 70.27%). RESULTS The antimicrobial resistance was evaluated among enzyme producers and non-producers and it was found that the lipase and protease-producing bacteria revealed higher resistance to selected antibiotics than non-producers. Notably, fosfomycin and carbapenem were identified as effective antibiotics against the isolated bacterial strains. However, gram-positive bacteria displayed high resistance to lincomycin and clindamycin, while gram-negative bacteria were more resistant to cefuroxime and gentamicin. CONCLUSION In conclusion, the findings suggest that lipases and proteases produced by bacteria could contribute to drug resistance and act as virulence factors in the development of surgical site infections. Understanding the role of these enzymes may inform strategies for preventing and managing post-surgical wound infections more effectively.
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Affiliation(s)
- Attaur Rahman
- Laboratório de Hanseníase, Department of Parasitology, Institute Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Saiqa Sardar
- Malaria Research Laboratory, Departament of Parasitology, Institute Oswaldo Cruz-Fiocruz, Rio de Janeiro, RJ, Brazil
| | - Zeeshan Niaz
- Department of Microbiology, Hazara University, Mansehra, Pakistan
| | - Asif Khan
- Laboratory of Phytochemistry, Department of Botany, University of São Paulo, São Paulo, Brazil
| | - Sheheryar Sheheryar
- Department of Biochemistry and Molecular Biology, Federal University of Ceara, Fortaleza, Brazil
| | | | - Muhammad Hamayun
- Department of Botany, Abdul Wali Khan University Mardan, Mardan, Pakistan
| | - Sajid Ali
- Department of Horticulture and Life Science, Yeungnam University, Gyeongsan, South Korea
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Mitra SS, Pachpute SR. Surveillance of bacterial carriage in the nose and hands of healthcare workers and patients attending maternity and children's hospital. J Family Med Prim Care 2023; 12:3262-3265. [PMID: 38361861 PMCID: PMC10866213 DOI: 10.4103/jfmpc.jfmpc_741_23] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 02/17/2024] Open
Abstract
Introduction Nosocomial infections have been acknowledged as a significant pathogen responsible for human illness due to the rise in the incidence of these infections that are mainly caused by resistant strains. As a result, it is important to prevent nosocomial infections. Therefore, in the epidemiology and pathogenesis of infection bacterial carriage appears to be of great importance and in healthy persons, three patterns of carriage are observed over time. The common ecological niches of microorganisms are the anterior nares and hands; hence, the present study aims to evaluate the surveillance of bacterial carriage from the hands and noses of healthcare workers that involve doctors, nurses, and housekeeping staffs and patients involving pregnant women or mothers. Materials and Methods An observational prospective study was conducted for 1.5 years in which collection of swabs from both the hands and nose were taken and inoculated on mannitol salt agar, blood agar, and MacConkey agar and incubated at 37°C for 24 h following which biochemical reactions were performed from isolates and 160 nasal swabs and hand swabs were studied for bacterial growth. Results The percentages of bacterial growth in the hands of mothers, doctors, housekeeping staff, and nurses were 17.5, 12.5, 52.5, and 25%, respectively, and in the nose were 7.5, 5, 32.5, and 12.5%, respectively. Total bacterial carriage in hand and nose swabs were 26.87 and 14.37%, respectively. Conclusion Methicillin-resistant Staphylococcus aureus was the most common microorganism isolated and as a result to prevent its spread along with other nosocomial microorganisms, appropriate precautions should be taken as the spreading of these organisms can lead to drug resistance strains.
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Affiliation(s)
- Sohini S. Mitra
- Department of Microbiology, MGM Medical College and Hospital, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
| | - Samir R. Pachpute
- Department of Microbiology, MGM Medical College and Hospital, MGM Institute of Health Sciences, Navi Mumbai, Maharashtra, India
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Yousaf A, Ahmad S, Ahsan MZ, Ahsan MJ. Bivalvular infective endocarditis complicated by perivalvular abscess and aorto-right atrium fistula. BMJ Case Rep 2023; 16:e255993. [PMID: 37899086 PMCID: PMC10619057 DOI: 10.1136/bcr-2023-255993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2023] Open
Abstract
Infective endocarditis caused by Pseudomonas aeruginosa in patients without a history of intravenous drug abuse and endovascular procedures is rare. We present a middle-aged man with fever, chills, night sweats and dyspnoea for 2 weeks. Physical examination and blood cultures were drawn, and the patient was empirically started on antibiotics. Unfortunately, the patient experienced progressive clinical deterioration requiring endotracheal intubation and vasopressor support. Transthoracic echocardiogram followed by transesophageal echocardiogram was performed that showed bicuspid aortic valve, severe aortic regurgitation, membranous ventricular septal defect, vegetations on aortic and tricuspid valves, dilated aortic root, and a fistula between the aorta and right atrium. The patient underwent emergent aortic valve and aortic root replacement along with tricuspid commissuroplasty and ventricular septal defect (VSD) closure. Later, intraoperative tissue cultures grew P. aeruginosa, and antipseudomonal antibiotic coverage was added. This case highlights that P. aeruginosa endocarditis can occur without risk factors and can lead to fatal cardiovascular complications.
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Affiliation(s)
- Amman Yousaf
- Internal Medicine, McLaren Health Care Corp, Flint, Michigan, USA
| | - Soban Ahmad
- Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
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Kandathil AM, Aslam SA, Abidha R, Cherian MP, Soman S, Sudarsanan M. Evaluation of Microbial Adherence on Antibacterial Suture Materials during Intraoral Wound Healing: A Prospective Comparative Study. J Contemp Dent Pract 2023; 24:515-520. [PMID: 38193173 DOI: 10.5005/jp-journals-10024-3553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2024]
Abstract
AIM To assess the efficacy of antiseptic-coated silk sutures with triclosan-coated polyglactin 910 suture in reducing bacterial colonization after oral surgical procedures. MATERIALS AND METHODS The patients who required multiple sutures after surgical procedures in the mandible were the study subjects. The sites of suturing were divided into three groups. Group A - surgical site receiving black-braided silk suture (control group). Group B - surgical site receiving triclosan-coated Polyglactin 910 suture (experimental group). Group C - surgical site receiving antiseptic-coated silk suture (experimental group). Evaluation was done on the 3rd postoperative and 7th postoperative day. Microbial adherence was evaluated by microbiological study. RESULTS The mean comparison of microbial count between 3rd and 7th post-op day in the three groups shows an increased microbial colonization in the control group when compared with the experimental groups. The combined mean microbial adherence in the three groups showed microbial count in the uncoated silk suture (group A) as 10.35 ± 3.74, triclosan-coated suture (group B) as 6.28 ± 2.17 and iodoform + calendula oil-coated suture (group C) as 7.1 ± 2.02 which is statistically significant (p < 0.05). CONCLUSION The present research concluded that the pomade-coated silk suture is as efficient as triclosan-coated VICRYL PLUS Polyglactin 910 sutures in reducing the bacterial colonization in intraoral wound healing. CLINICAL SIGNIFICANCE The pomade (iodoform + calendula oil) may be advocated in the field of oral and maxillofacial surgery for impregnating the suture materials which act as an antiseptic agent and a promoter of wound healing which is easily accessible and also cost-effective.
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Affiliation(s)
- Ayisha Moonnam Kandathil
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India, Phone: +91 8589899343, e-mail:
| | - Sachin Aslam Aslam
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India
| | - Roshni Abidha
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India
| | - Mathew Pynummoottil Cherian
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India
| | - Sooraj Soman
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India
| | - Manju Sudarsanan
- Department of Oral and Maxillofacial Surgery, MES Dental College and Hospital, Perinthalmanna, Kerala, India
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Goh MF, Hollewand CE, McBride S, Mathy JA. Microbiology of surgical site infections (SSIs) following skin cancer surgery. ANZ J Surg 2022; 92:2269-2273. [PMID: 35912956 DOI: 10.1111/ans.17957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUNDS Surgical site infections (SSIs) represent one of the most common and potentially preventable sources of morbidity and healthcare cost escalation associated with skin cancer surgery. There is a lack of data reporting organisms cultured from SSIs in skin surgery, with guidelines for antibiotic prophylaxis based on common skin pathogens rather than actual cultured organisms. In this study, we sought to define the cultured microbiology of SSIs specific to skin cancer surgery and test these against empiric treatment guidelines. METHODS All consenting patients presenting to the Auckland regional skin cancer treatment centre over a 6-month period were included. Patients receiving any form of antibiotics within a week prior to surgery were excluded. All wounds were assessed postoperatively, with clinically significant infections identified as those with a standardized wound infection score of 4 (range 0-7) and/or prescribed post-operative antibiotics within 3 weeks of surgery. Wound cultures were recorded. RESULTS About 104 clinically significant SSIs were identified from 333 lesions treated, with cultures available in 27%. Cultured organisms included MSSA (79%), MRSA (14%), coagulase-negative Staphylococci (11%), and 'skin flora' (14%). Empiric guidelines inaccurately predicted effective treatment in 14% of cases, exclusively due to MRSA. CONCLUSION To our knowledge this is the first comprehensive report of SSI microbiology following skin cancer surgery. The overwhelmingly predominant organisms were Staphylococcus sp. (76%), with the rate of MRSA approaching prevalence warranting empiric first-line treatment. These data help inform effective rationalized empiric antibiotic treatment, when indicated, for optimal outcome following skin surgery.
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Affiliation(s)
- Maple F Goh
- Auckland Regional Plastic & Reconstructive Surgery Unit, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Clare E Hollewand
- Auckland Regional Plastic & Reconstructive Surgery Unit, Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Stephen McBride
- Department of Infectious Diseases, Counties Manukau Health, Auckland, New Zealand
| | - Jon A Mathy
- Auckland Regional Plastic & Reconstructive Surgery Unit, Te Whatu Ora Counties Manukau, Auckland, New Zealand.,Faculty of Medical and Health Sciences, Surgery, Waipapa Taumata Rau - The University of Auckland, Auckland, New Zealand
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Surgical Antimicrobial Prophylaxis in Neonates and Children Undergoing Neurosurgery: A RAND/UCLA Appropriateness Method Consensus Study. Antibiotics (Basel) 2022; 11:antibiotics11070856. [PMID: 35884111 PMCID: PMC9311924 DOI: 10.3390/antibiotics11070856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/22/2022] [Indexed: 11/25/2022] Open
Abstract
Pediatric neurosurgery is a highly specialized branch of surgery in which surgical site infections (SSIs) are potentially serious complications that can also adversely affect a good surgical outcome, compromising functional recovery and, in some cases, even putting the patient’s life at risk. The main aim of this consensus document is to provide clinicians with a series of recommendations on antimicrobial prophylaxis for neonates and children undergoing neurosurgery. The following scenarios were considered: (1) craniotomy or cranial/cranio-facial approach to craniosynostosis; (2) neurosurgery with a trans-nasal-trans-sphenoidal approach; (3) non-penetrating head injuries; (4) penetrating head fracture; (5) spinal surgery (extradural and intradural); (6) shunt surgery or neuroendoscopy; (7) neuroendovascular procedures. Patients undergoing neurosurgery often undergo peri-operative antibiotic prophylaxis, with different schedules, not always supported by scientific evidence. This consensus provides clear and shared indications, based on the most updated literature. This work has been made possible by the multidisciplinary contribution of experts belonging to the most important Italian scientific societies, and represents, in our opinion, the most complete and up-to-date collection of recommendations on the behavior to be held in the peri-operative setting in this type of intervention, in order to guide physicians in the management of the patient, standardize approaches and avoid abuse and misuse of antibiotics.
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Kumagai G, Wada K, Asari T, Nitobe Y, Ishibashi Y. Association of Methicillin-Resistant Coagulase-Negative Staphylococci on Preoperative Skin and Surgical Site Infection in Patients Undergoing Spinal Surgery: A Retrospective Cohort Study. Spine Surg Relat Res 2022; 6:596-603. [PMID: 36561166 PMCID: PMC9747210 DOI: 10.22603/ssrr.2021-0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/03/2022] [Indexed: 12/25/2022] Open
Abstract
Introduction The aim of this study was to investigate the association of methicillin-resistant coagulase-negative staphylococci (MRCNS) on preoperative skin and surgical site infections (SSIs) in patients undergoing spinal surgery. Methods A total of 507 cases (239 males and 268 females; mean age: 56.1 years) were included in this retrospective study, using prospectively collected data. All patients underwent skin culturing of the surgical site preoperatively. To identify independent risk factors for SSIs as the dependent variable, sequential multivariate logistic regression analyses were conducted. Age, sex, body mass index, presence of rheumatoid arthritis (RA), steroid uses, the American Society of Anesthesiologists Physical Status (ASA-PS) ≥3, MRCNS-positivity on skin bacterial culture, instrumentation, and Japanese Orthopedic Association (JOA) score were used as independent variables. Results Preoperatively, MRCNS was detected from skin culture in 50 (9.9%) cases. The frequency of RA, steroid uses, and ASA-PS ≥3 was significantly higher in MRCNS-positive cases than in MRCNS-negative cases. There were 21 (4.1%) post-spinal surgery SSI cases. Multivariate logistic regression analyses revealed that JOA scores (odds ratio (OR), 0.864; 95% confidence interval (CI), 0.764-0.977) and MRCNS-positivity (OR, 5.060; 95% CI, 1.787-14.323) were significantly associated with SSIs. Conclusions Preoperatively, the incidence of MRCNS was 9.9%; it was the most common cause of postoperative SSIs. MRCNS-positivity was the most associated factor for SSIs.
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Affiliation(s)
- Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yoshiro Nitobe
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Marano L, Carbone L, Poto GE, Calomino N, Neri A, Piagnerelli R, Fontani A, Verre L, Savelli V, Roviello F, Marrelli D. Antimicrobial Prophylaxis Reduces the Rate of Surgical Site Infection in Upper Gastrointestinal Surgery: A Systematic Review. Antibiotics (Basel) 2022; 11:230. [PMID: 35203832 PMCID: PMC8868284 DOI: 10.3390/antibiotics11020230] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/30/2022] [Accepted: 02/09/2022] [Indexed: 11/25/2022] Open
Abstract
Surgical site infection occurs with high frequency in gastrointestinal surgery, contributing to the high incidence of morbidity and mortality. The accepted practice worldwide for the prevention of surgical site infection is providing single- or multiple-dose antimicrobial prophylaxis. However, most suitable antibiotic and optimal duration of prophylaxis are still debated. The aim of the systematic review is to assess the efficacy of antimicrobial prophylaxis in controlling surgical site infection rate following esophagogastric surgery. PubMed and Cochrane databases were systematically searched until 31 October 2021, for randomized controlled trials comparing different antimicrobial regimens in prevention surgical site infections. Risk of bias of studies was assessed with standard methods. Overall, eight studies concerning gastric surgery and one study about esophageal surgery met inclusion criteria. No significant differences were detected between single- and multiple-dose antibiotic prophylaxis. Most trials assessed the performance of cephalosporins or inhibitor of bacterial beta-lactamase. Antimicrobial prophylaxis (AMP) is effective in reducing the incidence of surgical site infection. Multiple-dose antimicrobial prophylaxis is not recommended for patients undergoing gastric surgery. Further randomized controlled trials are needed to determine the efficacy and safety of antimicrobial prophylaxis in esophageal cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Daniele Marrelli
- Surgical Oncology Unit, Department of Medicine, Surgery and Neurosciences, University of Siena, 53100 Siena, Italy; (L.M.); (L.C.); (G.E.P.); (N.C.); (A.N.); (R.P.); (A.F.); (L.V.); (V.S.); (F.R.)
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Penicillin Allergy in Spine Surgery: Increased rates of sepsis, emergency room visits and readmission. World Neurosurg 2022; 162:e91-e98. [DOI: 10.1016/j.wneu.2022.02.079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 02/16/2022] [Accepted: 02/17/2022] [Indexed: 11/22/2022]
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Calderón Parra J, De Castro-Campos D, Muñoz García P, Olmedo Samperio M, Marín Arriaza M, De Alarcón A, Gutierrez-Carretero E, Fariñas Alvarez MC, Miró Meda JM, Goneaga Sanchez MÁ, Rodriguez García R, Ojeda Burgos G, Valcarce-Gonzalez Z, Ramos-Martinez A. Non-HACEK gram negative bacilli endocarditis: Analysis of a national prospective cohort. Eur J Intern Med 2021; 92:71-78. [PMID: 33980395 DOI: 10.1016/j.ejim.2021.04.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Infective endocarditis (IE) due to non-HACEK bacilli (Haemophilus species, Actinobacillus, Cardiobacterium, Eikenella, or Kingella) is uncommon and poorly described. The objectives of this study were to describe non-HACEK Gram-Negative Bacilli (GNB) IE cases and compare characteristic of IE produced by Enterobacterales and non-fermenting (NF) GNB. METHODS From January 2008 to December 2018, 3910 consecutive patients with definitive IE diagnosis, defined with Modified Duke criteria, either clinical or pathological criteria (e.g. demonstration of non-HACEK GNB in valve culture)were prospectively included. RESULTS A total of 104 IE cases were caused by non-HACEK GNB (2.6%). Compared to IE due to other microorganisms (excluding HACEK GNB), patients with non-HACEK GNB IE presented with higher age (71 years [IQR 62-78] vs 68 years [IQR: 57-77]; p = 0.026), higher proportion of women (52% vs 31.5%, p < 0.001), higher Charlson Index (5 [IQR: 4-8] vs 4 [IQR 3-7], p = 0.003) and higher in-hospital mortality (36.5% vs 27.1%, p = 0.034). Enterobacterales cases were more frequently associated with genitourinary focus (32.8% vs 5.0%, p = 0.001). NFGNB endocarditis more frequently affected right valves (20.0% vs. 6.3%, p = 0.033), had more common healthcare-related acquisition (67.5% vs. 43.7%, p = 0.030) and venous catheter as focus (40.0% vs. 17.2%, p = 0.019). In the multivariant model, factors related with hospital mortality were: age (OR 1.05, 95%CI 1.00-1.09, p = 0.042), prosthetic valve (OR 2.31, 95%CI 0.90-5.88, p = 0.080), and not performing surgery when indicated (OR 3.60, 95%CI 1.17-11.05, p = 0.025).Patients treated with quinolone combination had lower mortality (OR 0.29; 95%CI 0.09-0.96; p = 0.043). CONCLUSION Non-HACEK GNB IE is a rare infection characterized by affecting elderly patients with high comorbidity, nosocomial acquisition and unfavorable outcome. Age, prosthetic valve and not performing surgery when indicated are associated with mortality.
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Affiliation(s)
- Jorge Calderón Parra
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
| | | | - Patricia Muñoz García
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Maria Olmedo Samperio
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Mercedes Marín Arriaza
- Clinical Microbiology and Infectious Diseases Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Aristides De Alarcón
- Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Hospital Virgen del Rocío, Sevilla, Spain
| | | | | | | | | | | | - Guillermo Ojeda Burgos
- Infectious Diseases, Microbiology and Preventive Medicine Unit, Hospital Virgen de la Victoria, Malaga, Spain
| | | | - Antonio Ramos-Martinez
- Infectious Diseases Unit, Internal Medicine Department, Hospital Puerta de Hierro, Majadahonda, Madrid, Spain
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Watanabe K, Fukuzaki S, Sugino A, Benson N, Metcalf N, Nakamura M, Matsumoto M. Cobalt-Chromium Alloy Has Superior Antibacterial Effect Than Titanium Alloy: In Vitro and In Vivo Studies. Spine (Phila Pa 1976) 2021; 46:E911-E915. [PMID: 34384089 PMCID: PMC8357039 DOI: 10.1097/brs.0000000000003970] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/09/2020] [Accepted: 12/11/2020] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro and in vivo laboratory studies. OBJECTIVE This study aimed to compare bacterial survival on titanium alloy (Ti) and cobalt-chromium alloy (CC) using in vitro and in vivo experiments. SUMMARY OF BACKGROUND DATA Spinal implants are frequently manufactured from Ti and CC. These foreign materials are thought to be susceptible to biofilm formation that contributes to the development of surgical site infections. Certain metals (i.e., silver, cobalt) are known to have antibacterial properties. METHODS In the in vitro study, discs made of Ti or CC were incubated with one of two common bacteria: Staphylococcus aureus (S. aureus) and Propionibacterium acnes (P. acnes). After incubation, discs were assessed to determine the number of viable bacterial cells. In the in vivo study, the discs that were made of CC or Ti were implanted into the subcutaneous layer of BALB/c mice. After skin closure, a suspension including either S. aureus or P. acnes was directly inoculated on the implanted discs. The discs were retrieved and analyzed to determine the number of viable bacteria at 0.5, 1, and 3 days after inoculation. RESULTS The number of viable S. aureus cultured from the CC discs was 0.9 ± 0.2 × 103 CFU/disc, which was significantly lower than the cultured Ti discs (114.8 ± 18.3 × 103 CFU/disc). Moreover, a significantly lower mean number of P. acnes were cultured with CC (1.9 ± 1.2 × 103 CFU/disc) compared with the Ti (180.0 ± 72.1 × 103 CFU/disc). The in vivo infection model testing against S. aureus or P. acnes showed a significantly lower number of viable S. aureus or P. acnes on CC discs than Ti discs. The result was seen at all measured time points. CONCLUSION CC suppressed S. aureus and P. acnes proliferation compared with Ti in vitro and in an in vivo infection model.Level of Evidence: N/A.
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Affiliation(s)
- Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | | | | | | | | | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Feng J, Xiang F, Cheng J, Gou Y, Li J. Comparative Efficacy and Safety of Vancomycin, Linezolid, Tedizolid, and Daptomycin in Treating Patients with Suspected or Proven Complicated Skin and Soft Tissue Infections: An Updated Network Meta-Analysis. Infect Dis Ther 2021; 10:1531-1547. [PMID: 34143418 PMCID: PMC8322192 DOI: 10.1007/s40121-021-00456-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 11/27/2022] Open
Abstract
Introduction Skin and soft structure infections (SSTIs) caused by methicillin-resistant Staphylococcus aureus (MRSA) pose serious health risks and cause significant cost burdens, and a conclusive recommendation about antibiotics has not yet been generated. Therefore, we performed this updated network meta-analysis to determine the preferred drug for the treatment of MRSA-caused SSTIs. Methods We searched PubMed, Embase, and Cochrane Library to identify any potentially eligible randomized controlled trials (RCTs) investigating the comparative efficacy and safety of any two of vancomycin, linezolid, tedizolid, and daptomycin in MRSA-caused SSTIs. All statistical analyses were conducted with RevMan, ADDIS, and STATA software. Results Twenty eligible RCTs involving 7804 patients were included for the final analysis. Direct meta-analysis suggested that linezolid was superior to vancomycin in improving clinical (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.07–1.99; P = 0.02) and microbiological (OR, 1.89; 95% CI, 1.24–2.86; P = 0.003) success, which were all confirmed by network meta-analyses. No statistical differences were identified regarding other comparisons. Meanwhile, there were no significant differences between any two antibiotics related to safety. Moreover, ranking probabilities indicated that linezolid had the highest probability of being ranked best in terms of clinical and microbiological success. Conclusion Based on the limited evidence, linezolid may be a preferred antibiotic for the treatment of MRSA-caused SSTIs because it showed superiority in clinical and microbiological success without difference regarding safety. Supplementary Information The online version contains supplementary material available at 10.1007/s40121-021-00456-0.
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Affiliation(s)
- Jingjuan Feng
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, 646000, Sichuan, China.,Department of Chinese Medicine Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China
| | - Feng Xiang
- Department of Chinese Medicine Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, Sichuan, China
| | - Jian Cheng
- Department of Chinese Medicine Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, Sichuan, China
| | - Yeli Gou
- Department of Chinese Medicine Surgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, Sichuan, China.,Chinese Academy of Sciences Sichuan Translational Medicine Research Hospital, Chengdu, 610072, Sichuan, China
| | - Jun Li
- School of Clinical Medical Sciences, Southwest Medical University, Luzhou, 646000, Sichuan, China.
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Lalitha AV, Rebello G, Chettri S, Reddy M. Demographic and Clinical Profile of Invasive Staphylococcal Infections in Children Admitted to Pediatric Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2020; 24:890-891. [PMID: 33132582 PMCID: PMC7584829 DOI: 10.5005/jp-journals-10071-23589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Staphylococcal infections are common cause of morbidity and mortality in pediatric intensive care unit (PICU). The objective of this study was to describe the clinical and microbial features, and outcome of patients with invasive staphylococcal infection. MATERIALS AND METHODS We conducted a retrospective chart review of the children admitted to PICU with invasive staphylococcal infections. Invasive staphylococcal infection was defined as clinical infection with isolation of Staphylococcus aureus from a normally sterile body site. RESULTS A total of 50 children (1 month to 16 years) were identified with staphylococcal infections during the study period. There was male preponderance (75%) with high prevalence in school going children. Among these children, 36% (18) were coagulase-negative (CONS), which were excluded. Of the remaining, 64% (32) were coagulase-positive Staphylococcus aureus, 54% (27) were methicillin-resistant Staphylococcus aureus (MRSA), and 10% (5) were methicillin-susceptible Staphylococcus aureus (MSSA). Community-acquired staphylococcal infections were present in 24 children (CA-MRSA). Pneumonia with empyema was the most common 20 (62%) site of primary staphylococcal infection, followed by blood stream infection 9 (28%) and skin and soft tissue infection 3 (9%). Of the soft tissue infection, three were MRSA, with two had pyopericardium with infective endocarditis. Resistance in MSSA was found to be maximum to penicillin, erythromycin, and ciprofloxacin with no resistance with vancomycin. CONCLUSION There is an increase incidence of MRSA among community-acquired staphylococcal infections requiring intensive care management. A larger study on clinical profile of Staphylococcus infection in pediatrics is urgently needed to define the exact magnitude of the problem. HOW TO CITE THIS ARTICLE Lalitha AV, Rebello G, Chettri S, Reddy M. Demographic and Clinical Profile of Invasive Staphylococcal Infections in Children Admitted to Pediatric Intensive Care Unit: A Retrospective Study. Indian J Crit Care Med 2020;24(9):890-891.
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Affiliation(s)
| | - Gitanjali Rebello
- Department of Pediatrics, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Subhash Chettri
- Department of Pediatric Intensive Care, St John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Mounika Reddy
- Department of Pediatric Intensive Care, St John's Medical College Hospital, Bengaluru, Karnataka, India
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14
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Does preventive care bundle have an impact on surgical site infections following spine surgery? An analysis of 9607 patients. Spine Deform 2020; 8:677-684. [PMID: 32162198 DOI: 10.1007/s43390-020-00099-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES The purpose was to analyze the effect of care bundle protocol on SSI in our institution. Postoperative surgical site infections (SSI) pose significant health burden. In spite of the use of prophylactic antibiotics, surgical advances and postoperative care, wound infection continues to affect patient outcomes after spine surgery. METHODS Retrospective analysis of 9607 consecutive patients who underwent spine procedures from 2014 to 2018 was performed. Preventive care bundle was implemented from January 2017 consisting of (a) preoperative bundle-glycemic control, chlorhexidine gluconate (CHG) bath, (b) intra-operative bundle-time specified antibiotic prophylaxis, CHG+ alcohol-based skin preparation (c) postoperative bundle-five moments of hand hygiene, early mobilization and bundle auditing. Patients operated from January 2017 were included in the post-implementation cohort and prior to that the pre-implementation cohort was formed. Data were drawn from weekly and yearly spine audits from the hospital infection committee software. Infection data were collected based on CDC criteria, further sub classification was done based on procedure, spinal disorders and spine level. Variables were analyzed and level of significance was set as < 0.05. RESULTS A total of 7333 patients met the criteria. The overall SSI rate decreased from 3.42% (131/3829) in pre-implementation cohort to 1.22% (43/3504, p = 0.0001) in post-implementation cohort (RR = 2.73, OR = 2.79). Statistically significant reduction was seen in all the groups (a) superficial and deep, (b) early and late and (c) instrumented and uninstrumented groups but was more pronounced in early (p = 0.0001), superficial (p = 0.0001) and instrumented groups (p = 0.0001). On subgroup analysis based on spine level and spinal disorders, significant reduction was seen in lumbar (p = 0.0001) and degenerative group (p = 0.0001). CONCLUSIONS Our study revealed significant reduction of SSI secondary to strict bundle adherence and monitored compliance compared to patients who did not receive these interventions. LEVEL OF EVIDENCE III.
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15
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de Vermandois JAR, Cochetti G, Zingaro MD, Santoro A, Panciarola M, Boni A, Marsico M, Gaudio G, Paladini A, Guiggi P, Cirocchi R, Mearini E. Evaluation of Surgical Site Infection in Mini-invasive Urological Surgery. Open Med (Wars) 2019; 14:711-718. [PMID: 31572804 PMCID: PMC6749724 DOI: 10.1515/med-2019-0081] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Accepted: 06/24/2019] [Indexed: 01/09/2023] Open
Abstract
Surgical Site Infection (SSI) is the most frequent source of infection in surgical patients and the second most frequent cause of hospital-acquired infection. The primary aim of this prospective study was to compare SSI occurrences between minimally invasive surgery (MIS) and open urological surgery. Secondly, perioperative outcomes were evaluated in two different approaches. A consecutive group of 60 patients undergoing urological surgery were prospectively enrolled in a single high-volume center between May and October 2018. We included procedures that were performed by minimally invasive or traditional techniques. We evaluated and compared the incidence of SSI and perioperative outcomes in terms of intraoperative bleeding, post-operative complications, postoperative pain, patient satisfaction with the analgesic treatment, time to flatus, time of oral intake and mobilization, and length of hospital stay. The two groups were homogeneous with regard to demographic data. Superficial incisional SSIs were diagnosed in 10% of cases (3/30) in the second group and 0% in the first (p<0.05); space/organ SSIs developed in 4 patients, which were diagnosed by ultrasound scan and confirmed by abdominal CT: 1 patient (3.3%) in group 1 showed an infected lymphocele, whereas 1 case of infected lymphocele and 2 cases of pelvic abscess were detected in group 2 (10%, p<0.05). All the perioperative outcomes as well as were overall complication rate favored MIS (p<0.05). The use of minimally invasive techniques in urological surgery reduced the risk of SSI by comparison with a traditional approach. In addition, MIS was associated with better perioperative outcomes and a lower overall complication rate.
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Affiliation(s)
| | - Giovanni Cochetti
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Michele Del Zingaro
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alberto Santoro
- Department of General Surgery and Surgical Specialties "Paride Stefanini";, Sapienza University of Rome, Rome, Italy
| | - Mattia Panciarola
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Andrea Boni
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Matteo Marsico
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Gianluca Gaudio
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Alessio Paladini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Paolo Guiggi
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
| | - Roberto Cirocchi
- Department of Digestive Surgery and Liver Unit, University of Perugia, Perugia, Italy
| | - Ettore Mearini
- University of Perugia, Dept. of Surgical and Biomedical Sciences, Urology clinic, Perugia, Italy
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Dragovic M, Pejovic M, Stepic J, Colic S, Dozic B, Dragovic S, Lazarevic M, Nikolic N, Milasin J, Milicic B. Comparison of four different suture materials in respect to oral wound healing, microbial colonization, tissue reaction and clinical features—randomized clinical study. Clin Oral Investig 2019; 24:1527-1541. [DOI: 10.1007/s00784-019-03034-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
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17
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Sanclemente G, Bodro M, Cervera C, Linares L, Cofán F, Marco F, Bosch J, Oppenheimer F, Dieckmann F, Moreno A. Perioperative prophylaxis with ertapenem reduced infections caused by extended-spectrum betalactamase-producting Enterobacteriaceae after kidney transplantation. BMC Nephrol 2019; 20:274. [PMID: 31331289 PMCID: PMC6647261 DOI: 10.1186/s12882-019-1461-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/09/2019] [Indexed: 12/17/2022] Open
Abstract
Backgound In recent years we have witnessed an increase in infections due to multidrug-resistant organisms in kidney transplant recipients (KTR). In our setting, we have observed a dramatic increase in infections caused by extended-spectrum betalactamase-producing (ESBL) Enterobacteriaceae in KTR. In 2014 we changed surgical prophylaxis from Cefazolin 2 g to Ertapenem 1 g. Methods We compared bacterial infections and their resistance phenotype during the first post-transplant month with an historical cohort collected during 2013 that had received Cefazolin. Results During the study period 110 patients received prophylaxis with Cefazolin and 113 with Ertapenem. In the Ertapenem cohort we observed a non-statistically significant decrease in the percentage of early bacterial infection from 57 to 47%, with urine being the most frequent source in both. The frequency of infections caused by Enterobacteriaceae spp. decreased from 64% in the Cefazolin cohort to 36% in the Ertapenem cohort (p = 0.005). In addition, percentage of ESBL-producing strains decreased from 21 to 8% of all Enterobacteriaceae isolated (p = 0.015). After adjusted in multivariate Cox regression analysis, male sex (HR 0.16, 95%CI: 0.03–0.75), cefazolin prophylaxis (HR 4.7, 95% CI: 1.1–22.6) and acute rejection (HR 14.5, 95% CI: 1.3–162) were associated to ESBL- producing Enterobacteriaceae infection. Conclusions Perioperative antimicrobial prophylaxis with a single dose of Ertapenem in kidney transplant recipients reduced the incidence of early infections due to ESBL-producing Enterobacteriaceae without increasing the incidence of other multidrug-resistant microorganisms or C. difficile.
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Affiliation(s)
- Gemma Sanclemente
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain.
| | - Carlos Cervera
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Laura Linares
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Frederic Cofán
- Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Francesc Marco
- Department of Microbiology, Centre Diagnòstic Biomèdic (CDB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Jordi Bosch
- Department of Microbiology, Centre Diagnòstic Biomèdic (CDB), Instituto de Salud Global de Barcelona (ISGlobal), Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Federico Oppenheimer
- Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Fritz Dieckmann
- Kidney Transplant Unit, Hospital Clinic - IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clinic - IDIBAPS, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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18
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Ramstedt M, Ribeiro IAC, Bujdakova H, Mergulhão FJM, Jordao L, Thomsen P, Alm M, Burmølle M, Vladkova T, Can F, Reches M, Riool M, Barros A, Reis RL, Meaurio E, Kikhney J, Moter A, Zaat SAJ, Sjollema J. Evaluating Efficacy of Antimicrobial and Antifouling Materials for Urinary Tract Medical Devices: Challenges and Recommendations. Macromol Biosci 2019; 19:e1800384. [PMID: 30884146 DOI: 10.1002/mabi.201800384] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 01/18/2019] [Indexed: 01/05/2023]
Abstract
In Europe, the mean incidence of urinary tract infections in intensive care units is 1.1 per 1000 patient-days. Of these cases, catheter-associated urinary tract infections (CAUTI) account for 98%. In total, CAUTI in hospitals is estimated to give additional health-care costs of £1-2.5 billion in the United Kingdom alone. This is in sharp contrast to the low cost of urinary catheters and emphasizes the need for innovative products that reduce the incidence rate of CAUTI. Ureteral stents and other urinary-tract devices suffer similar problems. Antimicrobial strategies are being developed, however, the evaluation of their efficacy is very challenging. This review aims to provide considerations and recommendations covering all relevant aspects of antimicrobial material testing, including surface characterization, biocompatibility, cytotoxicity, in vitro and in vivo tests, microbial strain selection, and hydrodynamic conditions, all in the perspective of complying to the complex pathology of device-associated urinary tract infection. The recommendations should be on the basis of standard assays to be developed which would enable comparisons of results obtained in different research labs both in industry and in academia, as well as provide industry and academia with tools to assess the antimicrobial properties for urinary tract devices in a reliable way.
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Affiliation(s)
| | - Isabel A C Ribeiro
- Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa, 1649-004, Lisbon, Portugal
| | - Helena Bujdakova
- Department of Microbiology and Virology, Faculty of Natural Sciences, Comenius University in Bratislava, 81499, Bratislava 1, Slovakia
| | - Filipe J M Mergulhão
- Laboratory for Process Engineering, Environment, Biotechnology and Energy (LEPABE), Faculty of Engineering, University of Porto, Rua Dr. Roberto Frias, 4200-465, Porto, Portugal
| | - Luisa Jordao
- Department of Environmental Health, Research and Development Unit, National Institute of Health Dr. Ricardo Jorge (INSA), Avenida Padre Cruz, 1649-016, Lisbon, Portugal
| | - Peter Thomsen
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Martin Alm
- BioModics ApS, Stengårds Alle 31A, DK-2800, Lyngby, Denmark
| | - Mette Burmølle
- Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Todorka Vladkova
- Department of Polymers, University of Chemical Technology and Metallurgy (UCTM), 8 Kliment Ohridski Blvd, 1756, Sofia, Bulgaria
| | - Fusun Can
- Department of Medical Microbiology, School of Medicine, Koc University, 34450, Sariyer, Istanbul, Turkey
| | - Meital Reches
- Institute of Chemistry and the Center for Nanoscience and Nanotechnology, The Hebrew University of Jerusalem, Jerusalem, 91904, Israel
| | - Martijn Riool
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Alexandre Barros
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Rui L Reis
- 3B's Research Group, I3Bs Research Institute on Biomaterials, Biodegradables and Biomimetics, University of Minho, Guimarães, 4710-057, Braga, Portugal
| | - Emilio Meaurio
- Department of Mining-Metallurgy Engineering and Materials Science, POLYMAT, School of Engineering, University of the Basque Country, 48940 Leina, Bizkaia, Bilbao, Spain
| | - Judith Kikhney
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Annette Moter
- Biofilmcenter, Department of Microbiology, Infectious Diseases and Immunology, Charité University Medicine Berlin, Hindenburgdamm 30, 12203, Berlin, Germany
| | - Sebastian A J Zaat
- Department of Medical Microbiology, Amsterdam UMC, Amsterdam Infection and Immunity Institute, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Jelmer Sjollema
- University of Groningen, University Medical Center Groningen, Department of Biomedical Engineering, Antonius Deusinglaan 1, 9713 AV, Groningen, The Netherlands
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Prats MI, Nelson BP, Gold DL, Branditz LD, Boulger CT, Bahner DP. CLEAR: A Novel Approach to Ultrasound Equipment Homeostasis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:767-773. [PMID: 30121948 DOI: 10.1002/jum.14757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 06/20/2018] [Accepted: 06/20/2018] [Indexed: 06/08/2023]
Abstract
Protocols for the sanitation and maintenance of point-of-care ultrasound (US) equipment are lacking. This study introduces the CLEAR protocol (clean, locate, energize, augment supplies, and remove patient identifiers) as a tool to improve the readiness of US equipment, termed US equipment homeostasis. The state of US equipment homeostasis in the emergency department of a single academic center was investigated before and after implementing this protocol, with an improvement in outcomes. These findings demonstrate that the CLEAR protocol can improve US homeostasis. CLEAR can function as a teaching tool to promote homeostasis as well as a checklist to assess compliance.
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Affiliation(s)
- Michael I Prats
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Bret P Nelson
- Department of Emergency Medicine, Division of Emergency Ultrasound, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Delia L Gold
- Department of Pediatrics, Division of Emergency Medicine, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Lauren D Branditz
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Creagh T Boulger
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - David P Bahner
- Department of Emergency Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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20
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Evidence-based Care Bundles for Preventing Surgical Site Infections in Spinal Instrumentation Surgery. Spine (Phila Pa 1976) 2018; 43:1765-1773. [PMID: 29794586 DOI: 10.1097/brs.0000000000002709] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A retrospective study, using prospectively collected data. OBJECTIVE The aim of this study was to evaluate the impact of evidence-based care bundles for preventing surgical site infections (SSIs) in spinal instrumentation surgery. SUMMARY OF BACKGROUND DATA About half of all SSIs are preventable via evidence-based methods. For successful SSI prevention, the bacterial load must be minimized, and methicillin-resistant Staphylococcus aureus (MRSA) protection must be maximized. However, it is difficult to cover all of these requirements by single preventative method. METHODS We screened consecutive patients scheduled for spinal instrumentation surgeries at a single tertiary referral hospital for high surgical, SSI, and MRSA colonization risks. Evidence-based care bundles were implemented for high-risk patients and included 1) additional vancomycin prophylaxis, 2) diluted povidone-iodine irrigation, and 3) nasal and body decontamination. Patient demographics, comorbidities, operative features, and SSIs reported to the Japanese Nosocomial Infections Surveillance system were prospectively obtained in the same method by the same assessor and were used for the analyses. The results were compared before and after the application of the bundle. RESULTS There were 1042 spinal instrumentation surgeries (741 before and 301 after care bundles) performed from November 2010 to December 2015. Of 301 surgeries, 57 cases (18.9%) received care bundles. There were no significant differences in patient backgrounds before and after the intervention. The SSI rate decreased significantly from 3.8% to 0.7% (P < 0.01) after the intervention, with an overall 82% relative risk reduction. A significant protective effect was observed in the multivariate analysis (adjusted odds ratio 0.18, 95% confidence interval: 0.04-0.77, P = 0.02). There were no MRSA-related SSIs among those that received care bundles, even though MRSA was the predominant pathogen in the study population. CONCLUSION Evidence-based care bundles, applied in selected high-risk spinal instrumentation cases, minimized bacterial load, maximized MRSA protection, and significantly reduced SSI rates without topical vancomycin powder. LEVEL OF EVIDENCE 4.
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Kramer A, Pochhammer J, Walger P, Seifert U, Ruhnke M, Harnoss JC. [Spectrum of pathogens in postoperative complications of visceral surgery : The problem of multidrug resistance]. Chirurg 2018; 88:369-376. [PMID: 28229205 DOI: 10.1007/s00104-017-0382-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
In general surgery the etiology of surgical site infections has not significantly changed over the last 30 years. Gram-positive bacteria, e.g. coagulase negative staphylococci (CNS), Staphylococcus aureus and Enterococcus spp. as well as Gram-negative bacteria, e.g. Escherichia coli, Enterobacter spp., Klebsiella spp. and Pseudomonas aeruginosa, are the most common findings. Although in general surgery 10% of the S. aureus causing postoperative wound infections were methicillin resistant (MRSA), no cases of multidrug-resistant Gram-negative (MRGN) bacteria were reported. Yeasts (particularly Candida spp.) are rarely the pathogen causing surgical site infections (≤3%) and concomitant risk factors are typical (e.g. diabetes, chemotherapy, immunosuppression and malnutrition). Viruses are rarely the cause of surgical site infections. Transmission can occur by HBV, HCV or HIV positive surgical staff or in organ transplantations and postoperative reactivation of persistent infections is possible (especially for HBV, HCV, CMV, EBV and HIV). The principles for prevention of surgical site infections are dealt with as consequences of preoperative colonization by MRSA, methicillin-sensitive S. aureus (MSSA) and MRGN and reviewed with respect to screening, perioperative antibiotic prophylaxis and decolonization. In nosocomial peritonitis, the selection of antibiotics should consider previous antibiotic treatment. A single intra-abdominal detection of Candida spp. usually does not require antimycotic treatment in postoperatively stable and immunocompetent patients but is recommended in severe community-acquired or nosocomial peritonitis. Viral infections can be avoided by screening of organ donors and serological surveillance of surgery personnel.
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Affiliation(s)
- A Kramer
- Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Walther-Rathenau-Str. 49a, 17495, Greifswald, Deutschland.
| | - J Pochhammer
- Klinik für Allgemein-, Viszeral- und Thoraxchirurgie, Marienhospital Stuttgart, Vinzenz von Paul Kliniken, Stuttgart, Deutschland
| | - P Walger
- Internistische Intensivmedizin und Infektiologie, Johanniterkrankenhaus, Johanniterkliniken Bonn, Bonn, Deutschland
| | - U Seifert
- Friedrich-Loeffler-Institut für Medizinische Mikrobiologie, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - M Ruhnke
- Paracelsus-Klinik Osnabrück, Osnabrück, Deutschland
| | - J C Harnoss
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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Abstract
Surgical site infections (SSIs) lead to adverse patient outcomes, including prolonged hospitalization and death. Wound contamination occurs with each incision, but proven strategies exist to decrease the risk of SSI. In particular, improved adherence to evidence-based preventative measures related to appropriate antimicrobial prophylaxis can decrease the rate of SSI. Aggressive surgical debridement and effective antimicrobial therapy are needed to optimize the treatment of SSI.
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Affiliation(s)
- Bronwen H Garner
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA
| | - Deverick J Anderson
- Division of Infectious Diseases, Duke University Medical Center, Durham, NC, USA.
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Tawfik DM, Ahmad TA, Sheweita SA, Haroun M, El-Sayed LH. The detection of antigenic determinants of Acinetobacter baumannii. Immunol Lett 2017; 186:59-67. [PMID: 28427887 DOI: 10.1016/j.imlet.2017.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/07/2017] [Accepted: 04/09/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Acinetobacter baumannii continues to pose a threat to burdened patients in ICUs all around the world. Lately, infection control techniques are not sufficient to curb A. baumannii's progression and chemotherapeutics are losing their potency against it. Thus, immunization became a key player in providing an ideal solution to the dilemma. None of the vaccines under investigation have reached the market and the search for a tailored vaccine remains a challenge. The notion of unravelling the bacterial antigens to design a novel epitope-based vaccine proved its merits. METHODS In this work, the propitious polysaccharide and protein antigenic determinants of A. baumannii were mapped by mimicking the infection. The immune response was evaluated by western blot, ELISA, and cellular proliferation assay techniques. RESULTS The screening showed that OMPs induced the most eminent sustained IgG response. In addition, OMP gave the highest cellular proliferation and a fold increase in ELISA that reached up to 10-fold by week 6. Whilst, the LPS gave a rapid IgM response, that reached 5-fold and the response was visible from week 1 in the western blot. The OMPs had a more pronounced effect in eliciting a cellular immune response. CONCLUSION The results elaborated the valuable role of using pure OMPs and detoxified LPS together; as a major cornerstone in designing an ideal vaccine against A. baumannii.
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Affiliation(s)
- Dina M Tawfik
- Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt; SeptivaK Research Group, Immunology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Tarek A Ahmad
- SeptivaK Research Group, Immunology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; Special Projects Department, Bibliotheca Alexandrina, Alexandria, Egypt.
| | - Salah A Sheweita
- Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Medhat Haroun
- Biotechnology Department, Institute of Graduate Studies and Research, Alexandria University, Alexandria, Egypt
| | - Laila H El-Sayed
- SeptivaK Research Group, Immunology Department, Medical Research Institute, Alexandria University, Alexandria, Egypt; Immunology and Allergy Department, Medical Research Institute, Alexandria University, Alexandria, Egypt
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Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands. Infect Control Hosp Epidemiol 2017. [DOI: 10.1017/s0195941700045112] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.
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Esposito S, Bassetti M, Concia E, De Simone G, De Rosa FG, Grossi P, Novelli A, Menichetti F, Petrosillo N, Tinelli M, Tumbarello M, Sanguinetti M, Viale P, Venditti M, Viscoli C. Diagnosis and management of skin and soft-tissue infections (SSTI). A literature review and consensus statement: an update. J Chemother 2017; 29:197-214. [PMID: 28378613 DOI: 10.1080/1120009x.2017.1311398] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Skin and soft-tissue infections (SSTIs) are among the most common bacterial infections, posing considerable diagnostic and therapeutic challenges. Fourteen members of the Italian Society of Infectious Diseases, after a careful review of the most recent literature using Medline database and their own clinical experience, updated a previous paper published in 2011 by preparing a draught manuscript of the statements. The manuscript was successively reviewed by all members and ultimately re-formulated the present manuscript during a full day consensus meeting. The microbiological and clinical aspects together with diagnostic features were considered for necrotizing and not necrotizing SSTIs in the light of the most recent guidelines and evidences published in the last five years. The antimicrobial therapy was considered as well - both empirical and targeted to methicillin-resistant Staphylococcus aureus and/or other pathogens, also taking into account the epidemiological and bacterial resistance data and the availability of new antibacterial agents.
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Affiliation(s)
- Silvano Esposito
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Matteo Bassetti
- b Infectious Diseases Division , Santa Maria Misericordia Hospital , Udine , Italy
| | - Ercole Concia
- c Division of Infectious Diseases, Department of Pathology , AOU di Verona, Policlinico 'G.B. Rossi' , Verona , Italy
| | - Giuseppe De Simone
- a Department of Infectious Diseases, AOU San Giovanni di Dio e Ruggi d'Aragona , University of Salerno , Salerno , Italy
| | - Francesco G De Rosa
- d Department of Medical Science , University of Turin, Infectious Diseases Amedeo di Savoia Hospital , Turin , Italy
| | - Paolo Grossi
- e Infectious Diseases Unit , University of Insubria and University Hospital 'ASST Sette Laghi' , Varese , Italy
| | - Andrea Novelli
- f Department of Health Sciences, Section of Clinical Pharmacology and Oncology , University of Florence , Florence , Italy
| | | | - Nicola Petrosillo
- h National Institute for Infectious Diseases Lazzaro Spallanzani-INMU IRCCS , Rome , Italy
| | - Marco Tinelli
- i Division of Infectious and Tropical Diseases , Hospital of Lodi , Lodi , Italy
| | - Mario Tumbarello
- j Institute of Infectious Diseases , Catholic University of the Sacred Hearth, A. Gemelli Hospital , Rome , Italy
| | - Maurizio Sanguinetti
- k Institute of Microbiology , Università Cattolica del Sacro Cuore , Rome , Italy
| | - Pierluigi Viale
- l Department of Medical Surgical Sciences , Alma Mater Studiorum University of Bologna , Bologna , Italy
| | - Mario Venditti
- m Department of Public Health and Infectious Diseases , 'Sapienza' University of Rome , Italy
| | - Claudio Viscoli
- n Infectious Diseases Division , University of Genoa and IRCCS San Martino-IST , Genoa , Italy
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Scalise A, Calamita R, Tartaglione C, Pierangeli M, Bolletta E, Gioacchini M, Gesuita R, Di Benedetto G. Improving wound healing and preventing surgical site complications of closed surgical incisions: a possible role of Incisional Negative Pressure Wound Therapy. A systematic review of the literature. Int Wound J 2016; 13:1260-1281. [PMID: 26424609 PMCID: PMC7950088 DOI: 10.1111/iwj.12492] [Citation(s) in RCA: 150] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Revised: 06/20/2015] [Accepted: 08/07/2015] [Indexed: 01/01/2023] Open
Abstract
Advances in preoperative care, surgical techniques and technologies have enabled surgeons to achieve primary closure in a high percentage of surgical procedures. However, often, underlying patient comorbidities in addition to surgical-related factors make the management of surgical wounds primary closure challenging because of the higher risk of developing complications. To date, extensive evidence exists, which demonstrate the benefits of negative pressure dressing in the treatment of open wounds; recently, Incisional Negative Pressure Wound Therapy (INPWT) technology as delivered by Prevena™ (KCI USA, Inc., San Antonio, TX) and Pico (Smith & Nephew Inc, Andover, MA) systems has been the focus of a new investigation on possible prophylactic measures to prevent complications via application immediately after surgery in high-risk, clean, closed surgical incisions. A systematic review was performed to evaluate INPWT's effect on surgical sites healing by primary intention. The primary outcomes of interest are an understanding of INPWT functioning and mechanisms of action, extrapolated from animal and biomedical engineering studies and incidence of complications (infection, dehiscence, seroma, hematoma, skin and fat necrosis, skin and fascial dehiscence or blistering) and other variables influenced by applying INPWT (re-operation and re-hospitalization rates, time to dry wound, cost saving) extrapolated from human studies. A search was conducted for published articles in various databases including PubMed, Google Scholar and Scopus Database from 2006 to March 2014. Supplemental searches were performed using reference lists and conference proceedings. Studies selection was based on predetermined inclusion and exclusion criteria and data extraction regarding study quality, model investigated, epidemiological and clinical characteristics and type of surgery, and the outcomes were applied to all the articles included. 1 biomedical engineering study, 2 animal studies, 15 human studies for a total of 6 randomized controlled trials, 5 prospective cohort studies, 7 retrospective analyses, were included. Human studies investigated the outcomes of 1042 incisions on 1003 patients. The literature shows a decrease in the incidence of infection, sero-haematoma formation and on the re-operation rates when using INPWT. Lower level of evidence was found on dehiscence, decreased in some studies, and was inconsistent to make a conclusion. Because of limited studies, it is difficult to make any assertions on the other variables, suggesting a requirement for further studies for proper recommendations on INPWT.
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Affiliation(s)
- Alessandro Scalise
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Roberto Calamita
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Caterina Tartaglione
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Marina Pierangeli
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Elisa Bolletta
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Matteo Gioacchini
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
| | - Rosaria Gesuita
- Interdepartmental Centre of EpidemiologyBiostatistics and Medical Informatics (EBI Centre), Università Politecnica delle MarcheAnconaItaly
| | - Giovanni Di Benedetto
- Department of Plastic and Reconstructive SurgeryUniversità Politecnica delle MarcheAnconaItaly
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Guo S, Xu J, Wei Y, Xu J, Li Y, Xue R. Clinical and molecular characteristics of Klebsiella pneumoniae ventilator-associated pneumonia in mainland China. BMC Infect Dis 2016; 16:608. [PMID: 27782809 PMCID: PMC5080764 DOI: 10.1186/s12879-016-1942-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 10/19/2016] [Indexed: 12/04/2022] Open
Abstract
Background Klebsiella pneumoniae is a prominent nosocomial pathogen that accounts for up to 10 % of all hospital-acquired infections. It is a frequent cause of ventilator-associated pneumonia (VAP). The purpose of this study was to investigate the clinical characteristics of K. pneumoniae-associated VAP and the molecular characteristics of K. pneumoniae strains. Methods We retrospectively reviewed 70 mechanically ventilated patients with K. pneumoniae isolated. All K. pneumoniae strains were examined to determine hypermucoviscosity (HV) phenotype, capsular serotypes, virulence genes, multilocus sequence typing and antimicrobial susceptibility. Results Hypermucoviscosity was found in 14 of 70 (20 %) isolates of K. pneumoniae. Among the 70 patients, 43 cases (61.4 %) developed VAP. Furthermore, VAP was more frequently induced by HV-positive K. pneumoniae (14/14, 100 %) than by HV-negative strains (29/56, 51.7 %). HV-positive K. pneumoniae-associated VAP patients were more inclined to develop bacteremia and had a higher mortality rate than HV-negative strains VAP patients. Antibiotic resistance was more frequent in HV- negative strains- than in HV- positive strains-infected patients. The prevalence of rmpA and aerobactin genes were 85.7 % and 85.7 % respectively, and serotypes K1 and K2 accounted for 14.3 % and 28.6 % of the hypermucoviscosity strains, respectively. Strains carrying rmpA and aerobactin genes were significantly associated with HV-phenotype, and rmpA and aerobactin coexisted in HV-positive strains. Multilocus sequence typing analysis identified 24 different sequence types from K. pneumoniae VAP samples. Conclusions HV-phenotype is the major virulence determinant for mechanically ventilated patients. There was a specific sequence typing (ST) distribution between HV-positive and HV-negative strains.
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Affiliation(s)
- Si Guo
- Department of Clinical Microbiology, Henan Provincial People's Hospital, Zhengzhou, China.,Department of Infection control, Zhengzhou University People's Hospital, Zhengzhou, China
| | - JingJing Xu
- Department of Pathology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - YanShuan Wei
- Department of Clinical Laboratory, Henan No. 2 Provincial people's Hospital, Zhengzhou, China
| | - JunHong Xu
- Department of Clinical Microbiology, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yi Li
- Department of Clinical Microbiology, Henan Provincial People's Hospital, Zhengzhou, China.
| | - Rui Xue
- Department of Key Laboratory, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Cowie SE, Ma I, Lee SK, Smith RM, Hsiang YN. Nosocomial MRSA Infection in Vascular Surgery Patients: Impact on Patient Outcome. Vasc Endovascular Surg 2016; 39:327-34. [PMID: 16079941 DOI: 10.1177/153857440503900404] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although methicillin-resistant Staphylococcus aureus(MRSA) infection is a worldwide problem, data on its significance among vascular surgery patients remain scant and conflicting. This study was designed to evaluate the association between nosocomial MRSA infection and patient outcome following vascular surgery procedures. Outcomes among patients with MRSA infection were also compared to those infected with methicillin-sensitive Staphylococcus aureus(MSSA). All patients admitted to a tertiary care Vascular Surgery ward during the year 2002 were included in this retrospective review. In addition to information on demographic and comorbid conditions, data on surgical interventions, nosocomial infection incidence rates as defined by the Center for Disease Control guidelines, and MRSA screening results were collected. Primary outcome was in-hospital death. Secondary outcomes measures included length of hospital stay, readmissions, or repeat surgeries, and ICU admissions. Of a total of 408 subjects, 110 were documented with a nosocomial infection (27.0%). Of these, 16 patients (3.9%) were colonized with MRSA on screening at time of admission, 22 (5.4%) had acquired MRSA infection during hospitalization, and 15 (3.7%) had MSSA infection. Patients with MRSA, MSSA, and non-MRSA infection had similar baseline characteristics except for hypertension and tobacco use. Age and MRSA infection were significant risk factors for in-hospital deaths (OR 1.07, 95% CI 1.01–1.13, p = 0.01 and OR 7.44, 95% CI 1.63–33.9, p = 0.01, respectively). Adjusted for the effects of age, MRSA infection remained a significant independent risk factor associated with in-hospital deaths (OR 4.38, 95% CI 1.09–17.7, p = 0.04). After adjustment for baseline risk factors, MRSA infection was also independently associated with secondary outcome measures. Although risks of non-MRSA infections were also associated with adverse outcomes in the multivariate analyses, MRSA posed higher risks, as reflected by higher odds ratio in all instances. The 22 patients with documented MRSA infection had significantly longer hospital stays than those with MSSA infection (median 24 days vs 8 days, p = 0.02). However, no significant differences were noted between the 2 groups in terms of secondary outcome. These results show that MRSA infection is a significant risk factor for adverse clinical outcomes among patients undergoing vascular surgery procedures. Infection with MRSA results in a greater risk of these outcomes when compared with non-MRSA infection. However, despite concerns regarding the virulence of this strain of staphylococcus, patients infected with MRSA had no higher rates of morbidity or mortality except for increased length of hospital stay when compared to patients with MSSA.
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Affiliation(s)
- Scott E Cowie
- Department of General Surgery, University of British Columbia, Vancouver, British Columbia.
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Pattern of Bacterial Pathogens and Their Susceptibility Isolated from Surgical Site Infections at Selected Referral Hospitals, Addis Ababa, Ethiopia. Int J Microbiol 2016; 2016:2418902. [PMID: 27446213 PMCID: PMC4944047 DOI: 10.1155/2016/2418902] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 04/22/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022] Open
Abstract
Background. The emergence of multidrug resistant bacterial pathogens in hospitals is becoming a challenge for surgeons to treat hospital acquired infections. Objective. To determine bacterial pathogens and drug susceptibility isolated from surgical site infections at St. Paul Specialized Hospital Millennium Medical College and Yekatit 12 Referral Hospital Medical College, Addis Ababa, Ethiopia. Methods. A cross-sectional study was conducted between October 2013 and March 2014 on 107 surgical site infected patients. Wound specimens were collected using sterile cotton swab and processed as per standard operative procedures in appropriate culture media; and susceptibility testing was done using Kirby-Bauer disc diffusion technique. The data were analyzed by using SPSS version 20. Result. From a total of 107 swabs collected, 90 (84.1%) were culture positive and 104 organisms were isolated. E. coli (24 (23.1%)) was the most common organism isolated followed by multidrug resistant Acinetobacter species (23 (22.1%)). More than 58 (75%) of the Gram negative isolates showed multiple antibiotic resistance (resistance ≥ 5 drugs). Pan-antibiotic resistance was noted among 8 (34.8%) Acinetobacter species and 3 (12.5%) E. coli. This calls for abstinence from antibiotic abuse. Conclusion. Gram negative bacteria were the most important isolates accounting for 76 (73.1%). Ampicillin, amoxicillin, penicillin, cephazoline, and tetracycline showed resistance while gentamicin and ciprofloxacin were relatively effective antimicrobials.
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Manniën J, Wille JC, Snoeren RLMM, van den Hof S. Impact of Postdischarge Surveillance on Surgical Site Infection Rates for Several Surgical Procedures Results From the Nosocomial Surveillance Network in The Netherlands. Infect Control Hosp Epidemiol 2016; 27:809-16. [PMID: 16874640 DOI: 10.1086/506403] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 08/02/2005] [Indexed: 11/03/2022]
Abstract
Objective.To compare the number of surgical site infections (SSIs) registered after hospital discharge with respect to various surgical procedures and to identify the procedures for which postdischarge surveillance (PDS) is most important.Design.Prospective SSI surveillance with voluntary PDS. Recommended methods for PDS in the Dutch national nosocomial surveillance network are addition of a special registration card to the outpatient medical record, on which the surgeon notes clinical symptoms and whether a patient developed an SSI according to the definitions; an alternative method is examination of the outpatient medical record.Setting.Hospitals participating in the Dutch national nosocomial surveillance network between 1996 and 2004.Results.We collected data on 131,798 surgical procedures performed in 64 of the 98 Dutch hospitals. PDS was performed according to one of the recommended methods for 31,134 operations (24%) and according to another active method for 32,589 operations (25%), and passive PDS was performed for 68,075 operations (52%). Relatively more SSIs were recorded after discharge for cases in which PDS was performed according to a recommended method (43%), compared with cases in which another active PDS method was used (30%) and cases in which passive PDS was used (25%). The highest rate of SSI after discharge was found for appendectomy (79% of operations), followed by knee prosthesis surgery (64%), mastectomy (61%), femoropopliteal or femorotibial bypass (53%), and abdominal hysterectomy (53%).Conclusions.For certain surgical procedures, most SSIs develop after discharge. SSI rates will be underestimated if no PDS is performed. We believe we have found a feasible and sensitive method for PDS that, if patients routinely return to the hospital for a postdischarge follow-up visit, might be suitable for use internationally.
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Affiliation(s)
- Judith Manniën
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
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Fujitani S, Ricardo-Dukelow M, Kamiya T, Sullivan L, Low L. Ethnicity and Other Possible Risk Factors for Candidemia at 3 Tertiary Care University Hospitals in Hawaii. Infect Control Hosp Epidemiol 2016; 27:1261-3. [PMID: 17080389 DOI: 10.1086/508831] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 11/28/2005] [Indexed: 11/03/2022]
Abstract
A total of 108 cases of candidemia detected in 3 tertiary care university hospitals in Hawaii between January 2001 and December 2002 were retrospectively reviewed. Candida albicans, Candida glabrata, and Candida tropicalis accounted for 28% of the cases. Mortality among Filipino patients was significantly higher than that among other ethnic groups (71% vs 48%; P<.05).
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Affiliation(s)
- Shigeki Fujitani
- Department of Medicine, University of Hawaii, Honolulu, HI, USA.
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Abtahi H, Farhangnia L, Ghaznavi-Rad E. In Vitro and in Vivo Antistaphylococcal Activity Determination of the New Recombinant Lysostaphin Protein. Jundishapur J Microbiol 2016; 9:e28489. [PMID: 27217919 PMCID: PMC4870841 DOI: 10.5812/jjm.28489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 05/31/2015] [Accepted: 06/14/2015] [Indexed: 11/28/2022] Open
Abstract
Background: Bacterial infection by antibiotic-resistant Staphylococcus aureus strains is a worldwide concern and the development of novel antistaphylococcal agents is acutely needed. Lysostaphin, an example of such novel agents, is a bacteriocin secreted by S. simulans to kill S. aureus through proteolysis of the Staphylococcus cell wall. Objectives: The aim of this study was to evaluate the in vitro and in vivo antistaphylococcal activity of recombinant lysostaphin. Materials and Methods: The in vitro study of the recombinant lysostaphin activity against S. aureus was determined by turbidimetric assay. For in vivo investigation, two groups of rats were inoculated with 1.4 × 109 CFU S. aureus. Five days after the nasal instillation of S. aureus, treatment in one of the groups was performed with a single dose (200 μg/dose) of recombinant lysostaphin formulated in Eucerin-based cream. Results: Recombinant lysostaphin at 100 μg/mL concentration showed a significant decrease of the optical density compared to the control samples. The in vivo study demonstrated that a single dose (200 μg/dose) of recombinant lysostaphin cream significantly reduced nasal colonization in all the treated animals compared to the untreated ones. Conclusions: These results demonstrated that the recombinant lysostaphin produced in this study was able to kill nasal S. aureus in rats. It can be recommended for human clinical trial studies.
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Affiliation(s)
- Hamid Abtahi
- Molecular and Medicine Research Center, Arak University of Medical Sciences, Arak, IR Iran
| | - Leila Farhangnia
- Department of Biotechnology, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR Iran
| | - Ehsanollah Ghaznavi-Rad
- Department of Microbiology and Immunology, Molecular and Medicine Research Center, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR Iran
- Corresponding author: Ehsanollah Ghaznavi-Rad, Department of Microbiology and Immunology, Molecular and Medicine Research Center, Faculty of Medicine, Arak University of Medical Sciences, Arak, IR Iran. Tel/Fax: +98-8634173526, E-mail:
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Staphylococcus aureus-Associated Skin and Soft Tissue Infections: Anatomical Localization, Epidemiology, Therapy and Potential Prophylaxis. Curr Top Microbiol Immunol 2016; 409:199-227. [PMID: 27744506 DOI: 10.1007/82_2016_32] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skin and soft tissue infections (SSTIs) are among the most common infections worldwide. They range in severity from minor, self-limiting, superficial infections to life-threatening diseases requiring all the resources of modern medicine. Community (CA) and healthcare (HA) acquired SSTIs are most commonly caused by Staphylococcus aureus . They have variable presentations ranging from impetigo and folliculitis to surgical site infections (SSIs). Superficial SSTIs may lead to even more invasive infections such as bacteraemia and osteomyelitis. Here we describe the anatomical localization of the different SSTI associated with S. aureus, the virulence factors known to play a role in these infections, and their current epidemiology. Current prevention and treatment strategies are also discussed. Global epidemiological data show increasing incidence and severity of SSTIs in association with methicillin-resistant S. aureus strains (MRSA). CA-SSTIs are usually less morbid compared to other invasive infections caused by S. aureus, but they have become the most prevalent, requiring a great number of medical interventions, extensive antibiotic use, and therefore a high cost burden. Recurrence of SSTIs is common after initial successful treatment, and decolonization strategies have not been effective in reducing recurrence. Furthermore, decolonization approaches may be contributing to the selection and maintenance of multi-drug resistant strains. Clinical studies from the early 1900s and novel autovaccination approaches suggest an alternative strategy with potential effectiveness: using vaccines to control S. aureus cutaneous infections.
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Surgical site infections in dermatologic surgery: etiology, pathogenesis, and current preventative measures. Dermatol Surg 2015; 41:537-49. [PMID: 25888316 DOI: 10.1097/dss.0000000000000364] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) after dermatologic surgery continue to represent undesirable complications that affect patients in several aspects. The etiology and pathogenesis of SSIs are not completely understood, and as a result, current preventative measures are debatable. OBJECTIVE To review and summarize the current available literature specific to SSIs in dermatologic surgery. The pathogenesis of SSIs, factors contributing to SSIs, current preventative guidelines, and evidence supporting their use are explored. METHODS A review of the medical literature. RESULTS AND CONCLUSIONS Most measures used to prevent SSIs in dermatologic surgery are based on studies of wounds in general surgery. Evidence specific to dermatologic surgery is scarce. More research related to the pathogenesis of SSIs is needed to establish effective preventative measures that are key to reducing incidences of SSIs.
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Clinical epidemiology and molecular analysis of extended-spectrum-β-lactamase-producing Escherichia coli in Nepal: characteristics of sequence types 131 and 648. Antimicrob Agents Chemother 2015; 59:3424-32. [PMID: 25824221 DOI: 10.1128/aac.00270-15] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/21/2015] [Indexed: 11/20/2022] Open
Abstract
Recently, CTX-M-type extended-spectrum-β-lactamase (ESBL)-producing Escherichia coli strains have emerged worldwide. In particular, E. coli with O antigen type 25 (O25) and sequence type 131 (ST131), which is often associated with the CTX-M-15 ESBL, has been increasingly reported globally; however, epidemiology reports on ESBL-producing E. coli in Asia are limited. Patients with clinical isolates of ESBL-producing E. coli in the Tribhuvan University teaching hospital in Kathmandu, Nepal, were included in this study. Whole-genome sequencing of the isolates was conducted to analyze multilocus sequence types, phylotypes, virulence genotypes, O25b-ST131 clones, and distribution of acquired drug resistance genes. During the study period, 105 patients with ESBL-producing E. coli isolation were identified, and the majority (90%) of these isolates were CTX-M-15 positive. The most dominant ST was ST131 (n = 54; 51.4%), followed by ST648 (n = 15; 14.3%). All ST131 isolates were identified as O25b-ST131 clones, subclone H30-Rx. Three ST groups (ST131, ST648, and non-ST131/648) were compared in further analyses. ST648 isolates had a proportionally higher resistance to non-β-lactam antibiotics and featured drug-resistant genes more frequently than ST131 or non-ST131/648 isolates. ST131 possessed the most virulence genes, followed by ST648. The clinical characteristics were similar among groups. More than 38% of ESBL-producing E. coli isolates were from the outpatient clinic, and pregnant patients comprised 24% of ESBL-producing E. coli cases. We revealed that the high resistance of ESBL-producing E. coli to multiple classes of antibiotics in Nepal is driven mainly by CTX-M-producing ST131 and ST648. Their immense prevalence in the communities is a matter of great concern.
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Weir G. The use of a surgical incision management system on vascular surgery incisions: a pilot study. Int Wound J 2015; 11 Suppl 1:10-2. [PMID: 24851730 DOI: 10.1111/iwj.12261] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 02/25/2014] [Accepted: 03/04/2014] [Indexed: 11/28/2022] Open
Abstract
Health care-associated infections in hospitals, including surgical site infections, contribute significantly to morbidity as well as mortality. Surgical incision management (SIM) using negative pressure wound therapy (Prevena™ Incision Management System, Kinetic Concepts, Inc., San Antonio, TX, USA) is designed to cover and protect closed surgical incisions from external factors including infectious sources and local trauma, while negative pressure removes fluid and infectious material from the surgical incision. A prospective case-control study assessed wound complications in patients undergoing vascular bypass procedures, where both femoral areas were incised to gain access to the femoral arteries. SIM was placed on one femoral area while a standard postoperative wound dressing was placed on the contralateral femoral area. Eight patients were included in this pilot study. All of them required bilateral femoral artery access. During the follow-up period patients were monitored for wound complications. All wound complications requiring surgical intervention were considered significant. No significant wound complications occurred in wounds treated with SIM, compared with three significant complications in control wounds. These preliminary data would suggest a potential reduction in wound complications and no observed increase in haemorrhage in high-risk patients with severe co-morbidities undergoing vascular surgery.
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Affiliation(s)
- Gregory Weir
- Vascular and Hyperbaric Unit, Eugene Marais Hospital, Pretoria, South Africa
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Davis PJB, Spady D, Gara CD, Forgie SED. Practices and Attitudes of Surgeons Toward the Prevention of Surgical Site Infections: A Provincial Survey in Alberta, Canada. Infect Control Hosp Epidemiol 2015; 29:1164-6. [DOI: 10.1086/592699] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We surveyed 589 surgeons in Alberta, Canada, about the prevention of surgical site infections and compared their practices to the recommendations of evidence-based guidelines. Of the 247 (42%) who responded, most (156 [63%]) were not in compliance with guideline recommendations for preoperative bathing, hair removal, antimicrobial prophylaxis, or intraoperative skin preparation (although 91 [37%] state they are following guidelines).
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Jernigan JA. Is the Burden ofStaphylococcus aureusAmong Patients With Surgical-Site Infections Growing? Infect Control Hosp Epidemiol 2015; 25:457-60. [PMID: 15242191 DOI: 10.1086/502421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anderson DJ, Arduino JM, Reed SD, Sexton DJ, Kaye KS, Grussemeyer CA, Peter SA, Hardy C, Choi YII, Friedman JY, Fowler VG. Variation in the Type and Frequency of Postoperative Invasive Staphylococcus aureus Infections According to Type of Surgical Procedure. Infect Control Hosp Epidemiol 2015; 31:701-9. [DOI: 10.1086/653205] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective.To determine the epidemiological characteristics of postoperative invasive Staphylococcus aureus infection following 4 types of major surgical procedures.Design.Retrospective cohort study.Setting.Eleven hospitals (9 community hospitals and 2 tertiary care hospitals) in North Carolina and Virginia.Patients.Adults undergoing orthopedic, neurosurgical, cardiothoracic, and plastic surgical procedures.Methods.We used previously validated, prospectively collected surgical surveillance data for surgical site infection and microbiological data for bloodstream infection. The study period was 2003 through 2006. We defined invasive S. aureus infection as either nonsuperficial incisional surgical site infection or bloodstream infection. Nonparametric bootstrapping was used to generate 95% confidence intervals (CIs). P values were generated using the Pearson x2 test, Student t test, or Wilcoxon rank-sum test, as appropriate.Results.In total, 81,267 patients underwent 96,455 procedures during the study period. The overall incidence of invasive S. aureus infection was 0.47 infections per 100 procedures (95% CI, 0.43–0.52); 227 (51%) of 446 infections were due to methicillin-resistant S. aureus. Invasive S. aureus infection was more common after cardiothoracic procedures (incidence, 0.79 infections per 100 procedures [95% CI, 0.62–0.97]) than after orthopedic procedures (0.37 infections per 100 procedures [95% CI, 0.32–0.42]), neurosurgical procedures (0.62 infections per 100 procedures [95% CI, 0.53–0.72]), or plastic surgical procedures (0.32 infections per 100 procedures [95% CI, 0.17¬0.47]) (P < .001). Similarly, S. aureus bloodstream infection was most common after cardiothoracic procedures (incidence, 0.57 infections per 100 procedures [95% CI, 0.43–0.72]; P < .001, compared with other procedure types), comprising almost three-quarters of the invasive S. aureus infections after these procedures. The highest rate of surgical site infection was observed after neurosurgical procedures (incidence, 0.50 infections per 100 procedures [95% CI, 0.42–0.59]; P < .001, compared with other procedure types), comprising 80% of invasive S. aureus infections after these procedures.Conclusion.The frequency and type of postoperative invasive S. aureus infection varied significantly across procedure types. The highest risk procedures, such as cardiothoracic procedures, should be targeted for ongoing preventative interventions.
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Lai KK, Baker SP, Fontecchio SA. Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness. Infect Control Hosp Epidemiol 2015; 24:859-63. [PMID: 14649776 DOI: 10.1086/502150] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AbstractObjective:We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.Setting:Medical and surgical intensive care units (ICUs) in a university teaching hospital.Interventions:All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.Results:The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95> 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of $4,947 from the literature, the reduction resulted in cost savings of $178,092 and $148,410 in the medical and surgical ICUs, respectively, for a total of $326,482. In addition, $25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of $351,979. This total cost savings of $351,979 minus the cost of enteral valves of $2,100 resulted in total net savings of $349,899.Conclusion:Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.
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Affiliation(s)
- Kwan Kew Lai
- Department of Medicine, Division of Infectious Diseases, University of Massachusetts Medical School, University of Massachusetts Medical Center, Worcester, MA 01655, USA
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Takahashi H, Kramer MH, Yasui Y, Fujii H, Nakase K, Ikeda K, Imai T, Okazawa A, Tanaka T, Ohyama T, Okabe N. Nosocomial Serratia marcescens Outbreak in Osaka, Japan, From 1999 to 2000. Infect Control Hosp Epidemiol 2015; 25:156-61. [PMID: 14994942 DOI: 10.1086/502367] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjectives:To investigate and control an outbreak of bloodstream infections (BSIs) caused by Serratia marcescens and to identify risk factors for respiratory colonization or infection with S. marcescens.Design:Epidemiologic investigation, including review of medical and laboratory records, procedural investigations, pulsed-field gel electrophoresis (PFGE) typing of environmental and patient isolates, statistical study, and recommendation of control measures.Patients and Setting:All patients admitted to a 380-bed, secondary-care hospital in Osaka Prefecture, Japan, from July 1999 through June 2000 (study period).Results:Seventy-one patients were colonized or infected with S. marcescens; 3 patients who developed primary BSIs on the same ward within 5 days in June 2000 had isolates with indistinguishable PFGE patterns and indwelling intravenous catheters for more than 5 days. On multivariate analysis, among 36 case-patients with positive sputum specimens and 95 control-patients, being bedridden (odds ratio [OR], 15.91; 95% confidence interval [CI95], 4.17-60.77), receiving mechanical ventilation (OR, 7.86; CI95, 2.27-27.16), being older than 80 years (OR, 3.12; CI95, 1.05-9.27), and receiving oral cleaning care (OR 3.10; CI95, 1-9.58) were significant risk factors. S. marcescens was isolated from the fluid tanks of three nebulizers and a liquid soap dispenser. The hospital did not have written infection control standards, and many infection control practices were found to be inadequate (eg, respiratory equipment was used without disinfection between patients).Conclusions:Poor hospital hygiene and the lack of standard infection control measures contributed to infections hospital-wide. Recommendations to the hospital included adoption of written infection control policies.
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Affiliation(s)
- Hiroshi Takahashi
- Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
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Vriens MR, Fluit AC, Troelstra A, Verhoef J, van der Werken C. Is Methicillin-Resistant Staphylococcus Aureus More Contagious than Methicillin-Susceptible S. Aureus in a Surgical Intensive Care Unit? Infect Control Hosp Epidemiol 2015; 23:491-4. [PMID: 12269444 DOI: 10.1086/502094] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background and Objective:In the Netherlands, the prevalence of methicillin resistance among Staphylococcus aureus isolates has been kept to less than 1% by using active screening programs and isolation. At the University Medical Center Utrecht (UMCU), an active screening program for methicillin-resistant S. aureus (MRSA) in the surgical intensive care unit (ICU) was implemented in 1986. Between 1992 and 2001, only 6 patients with MRSA were admitted to the surgical ICU. However, 4 of these 6 strains were able to spread to 23 other patients and 15 healthcare workers (HCWs). We were surprised by the epidemic behavior of these strains and wondered whether this was exceptional for S. aureus or whether methicillin-susceptible S. aureus (MSSA) was also spreading in the ICU.Design:A 2-month, prospective, observational study to investigate the incidence and spread of MSSA in the surgical ICU of UMCU and historical data collected during a 10-year period regarding MRSA.Setting:A 10-bed surgical ICU in a 1,042-bed teaching hospital.Results:Weekly swabs revealed the presence of MSSA in 11 (24%) of 45 patients and 16 (22%) of 72 HCWs. Of all 4,105 patient–HCW contacts, there were only 21 episodes in which both the patient and the HCW were found to carry MSSA. With the use of pulsed-field gel electrophoresis, no identical strains could be identified.Conclusion:In our surgical ICU, MRSA seems to spread more easily than MSSA, probably because of selection under antibiotic pressure or a still unknown intrinsic factor within MRSA.
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Affiliation(s)
- Menno R Vriens
- Department of Surgery, Eijkman Winkler Institute, University Medical Center, Utrecht, The Netherlands
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Bischoff WE, Tucker BK, Wallis ML, Reboussin BA, Pfaller MA, Hayden FG, Sherertz RJ. Preventing the Airborne Spread ofStaphylococcus aureusby Persons With the Common Cold: Effect of Surgical Scrubs, Gowns, and Masks. Infect Control Hosp Epidemiol 2015; 28:1148-54. [PMID: 17828691 DOI: 10.1086/520734] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Accepted: 05/14/2007] [Indexed: 11/04/2022]
Abstract
Objective.Transmission ofStaphylococcus aureusvia air may play an important role in healthcare settings. This study investigates the impact of barrier precautions on the spread of airborneS. aureusby volunteers with experimentally induced rhinovirus infection (ie, the common cold).Design.Prospective nonrandomized study.Setting.Wake Forest University School of Medicine (Winston-Salem, NC).Participants.A convenience sample of 10 individuals with nasalS. aureuscarriage selected from 593 students screened for carriage.Intervention.AirborneS. aureusdispersal was studied in the 10 participants under the following clothing conditions: street clothes, surgical scrubs, surgical scrubs and a gown, and the latter plus a face mask. After a 4-day baseline period, volunteers were exposed to a rhinovirus, and their clinical course was followed for 12 days. Daily swabs of nasal specimens, pharynx specimens, and skin specimens were obtained for quantitative culture, and cold symptoms were documented. Data were analyzed by random-effects negative binomial models.Results.All participants developed a common cold. Incidence rate ratios (IRRs) indicated that, compared with airborne levels ofS. aureusduring sessions in which street clothes were worn, airborne levels decreased by 75% when surgical scrubs were worn (P<.001), by 80% when scrubs and a surgical gown were worn (P<.001), and by 82% when scrubs, a gown, and a face mask were worn (P<.001). The addition of a mask to the surgical scrubs and gown did not reduce the airborne dispersal significantly (IRR, 0.92;P>.05). Male volunteers shed twice as muchS. aureusas females (incidence rate ratio, 2.04;P= .013). The cold did not alter the efficacy of the barrier precautions.Conclusions.Scrubs reduced the spread of airborneS. aureus, independent of the presence of a rhinovirus-induced cold. Airborne dispersal of S. aureus during sessions in which participants wore surgical scrubs was not significantly different from that during sessions in which gowns and gowns plus masks were also worn.
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Affiliation(s)
- Werner E Bischoff
- Section on Infectious Diseases, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA.
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Characterization of the algC gene expression pattern in the multidrug resistant Acinetobacter baumannii AIIMS 7 and correlation with biofilm development on abiotic surface. ScientificWorldJournal 2014; 2014:593546. [PMID: 25544957 PMCID: PMC4269089 DOI: 10.1155/2014/593546] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Revised: 11/10/2014] [Accepted: 11/10/2014] [Indexed: 01/06/2023] Open
Abstract
Relative quantification of algC gene expression was evaluated in the multidrug resistant strain Acinetobacter baumannii AIIMS 7 biofilm (3 to 96 h, on polystyrene surface) compared to the planktonic counterparts. Comparison revealed differential algC expression pattern with maximum 81.59-fold increase in biofilm cells versus 3.24-fold in planktonic cells (P < 0.05). Expression levels strongly correlated with specific biofilm stages (scale of 3 to 96 h), coinciding maximum at initial surface attachment stage (9 h) and biofilm maturation stage (48 h). Cloning, heterologous expression, and bioinformatics analyses indicated algC gene product as the bifunctional enzyme phosphomannomutase/phosphoglucomutase (PMM/PGM) of ∼ 53 kDa size, which augmented biofilms significantly in algC clones compared to controls (lacking algC gene), further localized by scanning electron microscopy. Moreover, molecular dynamics analysis on the three-dimensional structure of PMM/PGM (simulated up to 10 ns) revealed enzyme structure as stable and similar to that in P. aeruginosa (synthesis of alginate and lipopolysaccharide core) and involved in constitution of biofilm EPS (extracellular polymeric substances). Our observation on differential expression pattern of algC having strong correlation with important biofilm stages, scanning electron-microscopic evidence of biofilm augmentation taken together with predictive enzyme functions via molecular dynamic (MD) simulation, proposes a new basis of A. baumannii AIIMS 7 biofilm development on inanimate surfaces.
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Abstract
Surgical site infections are a major contributor to morbidity and mortality in postsurgical care. Risk for surgical site infection is multifactorial and includes a host of microbial, patient-related, and procedure-related factors. Prevention of surgical infection relies on optimization of patient factors and use of a variety of evidence-based pharmacologic and nonpharmacologic measures. At the forefront of these measures is antimicrobial prophylaxis, which has been shown to be effective at reducing risk of surgical site infection. As guidelines for prevention of surgical site infection become increasingly complex and nuanced, surgical infection outcomes are increasing tied to quality outcome and performances measures.
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Affiliation(s)
- Pang Y Young
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada
| | - Rachel G Khadaroo
- Division of General Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada; Division of Critical Care Medicine, Faculty of Medicine and Dentistry, University of Alberta, 8440-112 Street Northwest, Edmonton, Alberta T6G 2B7, Canada.
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Wideroff M, Xing Y, Liao J, Byrn JC. Crohn's disease but not diverticulitis is an independent risk factor for surgical site infections in colectomy. J Gastrointest Surg 2014; 18:1817-23. [PMID: 25091841 DOI: 10.1007/s11605-014-2602-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 07/21/2014] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Surgical site infections (SSIs) after colectomy for colon cancer (CC), Crohn's disease (CD), and diverticulitis (DD) significantly impact both the immediate postoperative course and long-term disease-specific outcomes. We aim to profile the effect of diagnosis on SSI after segmental colectomy using the National Surgical Quality Improvement Program (NSQIP) data set. METHOD NSQIP data from 2006 to 2011 were investigated, and segmental colectomy procedures performed for the diagnoses of Crohn's disease, DD, and colon malignancy were included. SSI complications were compared by diagnosis using univariate and multivariate analysis. RESULT We included 35,557 colectomy cases in the analysis. CD had the highest rate of postoperative SSI (17 vs. 13% DD vs. 10% CC; p < 0.001). Using CC as the comparison group and controlling for multiple variables, the multivariate analysis showed that the CD group had an increased risk for acquiring at least one SSI (odds ratio (OR) = 1.38, p ≤ 0.001), deep incisional SSI (OR = 1.85, p = 0.03), and organ space SSI (OR = 1.51, p = 0.02). CONCLUSION For patients undergoing segmental colectomy in the NSQIP data set, statistically significant increases in SSI are seen in CD, but not DD, when compared to CC, thus confirming CD as an independent risk factor for SSI.
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Affiliation(s)
- Matthew Wideroff
- Department of Surgery, Division of Gastrointestinal, Minimally Invasive, and Bariatric Surgery, The University of Iowa Carver College of Medicine, 200 Hawkins Drive, 4577 JCP, Iowa City, IA, 52242, USA
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Scalise A, Tartaglione C, Bolletta E, Calamita R, Nicoletti G, Pierangeli M, Grassetti L, Di Benedetto G. The enhanced healing of a high-risk, clean, sutured surgical incision by prophylactic negative pressure wound therapy as delivered by Prevena™ Customizable™: cosmetic and therapeutic results. Int Wound J 2014; 12:218-23. [PMID: 25234139 DOI: 10.1111/iwj.12370] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 08/25/2014] [Indexed: 12/20/2022] Open
Abstract
According to the literature, incisional closure complications may range from postoperative surgical site infections, representing 17-22% of health care-associated infections, surgical wound dehiscence and formation of haematomas or seromas, and can lead to delayed or impaired incision healing. These kinds of situations are more common when wounds are closed under tension or in specific patient morbidities. Obesity, in particular, is associated with an impaired blood flow to tissues, predisposing the patient to increased risk of wound complications by various mechanisms. Incisional complications can become relevant economic burdens for health care systems because of an increase in the average length of hospital stay and readmissions, and additional medical and surgical procedures. Thus, a preventive therapy may have a critical role in the management of healing. Negative pressure wound therapy (NPWT) technology as delivered by Prevena™ Customizable™ (Kinetic Concepts Inc., San Antonio, TX) has recently been the focus of a new investigation, as a prophylactic measure to prevent complications via immediate postoperative application in high-risk, clean, closed surgical incisions. The authors present a 62-year-old class II obese female, who underwent bilateral inguinal dermolipectomy. Prophylactic NPWT as delivered by Prevena™ was performed successfully over surgical incisions. Cosmetic and therapeutic results are shown.
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Affiliation(s)
- Alessandro Scalise
- Department of Plastic and Reconstructive Surgery, Università Politecnica delle Marche, Ancona, Italy
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Chia CLK, Shelat VG, Low W, George S, Rao J. The use of Collatamp G, local gentamicin-collagen sponge, in reducing wound infection. Int Surg 2014; 99:565-570. [PMID: 25216422 PMCID: PMC4253925 DOI: 10.9738/intsurg-d-13-00171.1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We conducted a retrospective study to examine the role of Collatamp G in reducing postoperative surgical site infection (SSI) in patients with different wound classes. Ninety-two patients (62 men and 30 women; mean age, 58 years; range, 29-88 years) who had undergone surgery between December 2009 and November 2011 in Tan Tock Seng Hospital and who had application of Collatamp G in their wound before closure were included in the study. The primary endpoint was the development of any superficial wound infection within 1 month postoperatively. Of 92 patients studied, 9 (10%) developed a superficial wound infection. Two of 43 patients with clean-contaminated wounds (5%), 2 of 19 with contaminated wounds (11%), and 5 of 30 with dirty-infected wounds (16%) developed infection. Use of the larger size Collatamp G (10 × 10 cm) also appears to have a lower incidence of SSI compared with the smaller Collatamp G (5 × 5 cm); 4% and 12%, respectively. Our data suggest that postoperative SSI was reduced in the group of patients with dirty-infected wound class. SSI appears to be decreased with use of the larger size Collatamp G.
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Affiliation(s)
| | | | - Wilson Low
- Department of Surgery, Tan Tock Seng Hospital, Singapore
| | - Sheena George
- Department of Surgery, Tan Tock Seng Hospital, Singapore
| | - Jaideepraj Rao
- Department of Surgery, Tan Tock Seng Hospital, Singapore
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Carbapenem Resistance among Enterobacter Species in a Tertiary Care Hospital in Central India. CHEMOTHERAPY RESEARCH AND PRACTICE 2014; 2014:972646. [PMID: 25180095 PMCID: PMC4142386 DOI: 10.1155/2014/972646] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/27/2014] [Revised: 07/12/2014] [Accepted: 07/16/2014] [Indexed: 11/17/2022]
Abstract
Objective. To detect genes encoding carbapenem resistance among Enterobacter species in a tertiary care hospital in central India. Methods. Bacterial identification of Enterobacter spp. isolates from various clinical specimens in patients admitted to intensive care units was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique. PCR amplification and automated sequencing was carried out. Transfer of resistance genes was determined by conjugation. Results. A total of 70/130 (53.84%) isolates of Enterobacter spp. were found to exhibit reduced susceptibility to imipenem (diameter of zones of inhibition ≤13 mm) by disc diffusion method. Among 70 isolates tested, 48 (68.57%) isolates showed MIC values for imipenem and meropenem ranging from 32 to 64 mg/L as per CLSI breakpoints. All of these 70 isolates were found susceptible to colistin in vitro as per MIC breakpoints (<0.5 mg/L). PCR carried out on these 48 MBL (IP/IPI) E-test positive isolates (12 Enterobacter aerogenes, 31 Enterobacter cloacae, and 05 Enterobacter cloacae complex) was validated by sequencing for beta-lactam resistance genes and result was interpreted accordingly. Conclusion. The study showed MBL production as an important mechanism in carbapenem resistance in Enterobacter spp. and interspecies transfer of these genes through plasmids suggesting early detection by molecular methods.
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Su S, Panmanee W, Wilson JJ, Mahtani HK, Li Q, VanderWielen BD, Makris TM, Rogers M, McDaniel C, Lipscomb JD, Irvin RT, Schurr MJ, Lancaster JR, Kovall RA, Hassett DJ. Catalase (KatA) plays a role in protection against anaerobic nitric oxide in Pseudomonas aeruginosa. PLoS One 2014; 9:e91813. [PMID: 24663218 PMCID: PMC3963858 DOI: 10.1371/journal.pone.0091813] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 02/14/2014] [Indexed: 12/30/2022] Open
Abstract
Pseudomonas aeruginosa (PA) is a common bacterial pathogen, responsible for a high incidence of nosocomial and respiratory infections. KatA is the major catalase of PA that detoxifies hydrogen peroxide (H2O2), a reactive oxygen intermediate generated during aerobic respiration. Paradoxically, PA displays elevated KatA activity under anaerobic growth conditions where the substrate of KatA, H2O2, is not produced. The aim of the present study is to elucidate the mechanism underlying this phenomenon and define the role of KatA in PA during anaerobiosis using genetic, biochemical and biophysical approaches. We demonstrated that anaerobic wild-type PAO1 cells yielded higher levels of katA transcription and expression than aerobic cells, whereas a nitrite reductase mutant ΔnirS produced ∼50% the KatA activity of PAO1, suggesting that a basal NO level was required for the increased KatA activity. We also found that transcription of the katA gene was controlled, in part, by the master anaerobic regulator, ANR. A ΔkatA mutant and a mucoid mucA22 ΔkatA bacteria demonstrated increased sensitivity to acidified nitrite (an NO generator) in anaerobic planktonic and biofilm cultures. EPR spectra of anaerobic bacteria showed that levels of dinitrosyl iron complexes (DNIC), indicators of NO stress, were increased significantly in the ΔkatA mutant, and dramatically in a ΔnorCB mutant compared to basal levels of DNIC in PAO1 and ΔnirS mutant. Expression of KatA dramatically reduced the DNIC levels in ΔnorCB mutant. We further revealed direct NO-KatA interactions in vitro using EPR, optical spectroscopy and X-ray crystallography. KatA has a 5-coordinate high spin ferric heme that binds NO without prior reduction of the heme iron (Kd ∼6 μM). Collectively, we conclude that KatA is expressed to protect PA against NO generated during anaerobic respiration. We proposed that such protective effects of KatA may involve buffering of free NO when potentially toxic concentrations of NO are approached.
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Affiliation(s)
- Shengchang Su
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Warunya Panmanee
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Jeffrey J. Wilson
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Harry K. Mahtani
- Departments of Anesthesiology, Cell, Developmental and Integrative Biology, and Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Qian Li
- Departments of Anesthesiology, Cell, Developmental and Integrative Biology, and Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Bradley D. VanderWielen
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Thomas M. Makris
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Melanie Rogers
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Cameron McDaniel
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - John D. Lipscomb
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Randall T. Irvin
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
| | - Michael J. Schurr
- Department of Microbiology, University of Colorado, Aurora, Colorado, United States of America
| | - Jack R. Lancaster
- Departments of Anesthesiology, Cell, Developmental and Integrative Biology, and Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
- Center for Free Radical Biology, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
| | - Rhett A. Kovall
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
| | - Daniel J. Hassett
- Department of Molecular Genetics, Biochemistry and Microbiology, University of Cincinnati, Cincinnati, Ohio, United States of America
- * E-mail:
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