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Lin G, Tseng KK, Gatalo O, Martinez DA, Hinson JS, Milstone AM, Levin S, Klein E. Cost-effectiveness of carbapenem-resistant Enterobacteriaceae (CRE) surveillance in Maryland. Infect Control Hosp Epidemiol 2022; 43:1162-1170. [PMID: 34674791 PMCID: PMC9023597 DOI: 10.1017/ice.2021.361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We analyzed the efficacy, cost, and cost-effectiveness of predictive decision-support systems based on surveillance interventions to reduce the spread of carbapenem-resistant Enterobacteriaceae (CRE). DESIGN We developed a computational model that included patient movement between acute-care hospitals (ACHs), long-term care facilities (LTCFs), and communities to simulate the transmission and epidemiology of CRE. A comparative cost-effectiveness analysis was conducted on several surveillance strategies to detect asymptomatic CRE colonization, which included screening in ICUs at select or all hospitals, a statewide registry, or a combination of hospital screening and a statewide registry. SETTING We investigated 51 ACHs, 222 LTCFs, and skilled nursing facilities, and 464 ZIP codes in the state of Maryland. PATIENTS OR PARTICIPANTS The model was informed using 2013-2016 patient-mix data from the Maryland Health Services Cost Review Commission. This model included all patients that were admitted to an ACH. RESULTS On average, the implementation of a statewide CRE registry reduced annual CRE infections by 6.3% (18.8 cases). Policies of screening in select or all ICUs without a statewide registry had no significant impact on the incidence of CRE infections. Predictive algorithms, which identified any high-risk patient, reduced colonization incidence by an average of 1.2% (3.7 cases) without a registry and 7.0% (20.9 cases) with a registry. Implementation of the registry was estimated to save $572,000 statewide in averted infections per year. CONCLUSIONS Although hospital-level surveillance provided minimal reductions in CRE infections, regional coordination with a statewide registry of CRE patients reduced infections and was cost-effective.
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Affiliation(s)
- Gary Lin
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland, United States
| | - Katie K. Tseng
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland, United States
| | - Oliver Gatalo
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland, United States
| | - Diego A. Martinez
- School of Industrial Engineering, Pontificia Universidad Católica de Valparaíso, Valparaíso, Chile
| | - Jeremiah S. Hinson
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Hospital Epidemiology and Infection Control, The Johns Hopkins Hospital, Baltimore, Maryland, United States
| | - Scott Levin
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, United States
| | - Eili Klein
- Center for Disease Dynamics, Economics & Policy, Silver Spring, Maryland, United States
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, Maryland, United States
- Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland, United States
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Kim BC, Kim H, Lee HS, Kim SH, Cho DH, Jung HJ, Bhatia SK, Yune PS, Joo HS, Kim JS, Kim W, Yang YH. 4-Chloro-2-Isopropyl-5-Methylphenol Exhibits Antimicrobial and Adjuvant Activity against Methicillin-Resistant Staphylococcus aureus. J Microbiol Biotechnol 2022; 32:730-739. [PMID: 35586930 PMCID: PMC9628901 DOI: 10.4014/jmb.2203.03054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/30/2022] [Accepted: 05/02/2022] [Indexed: 12/15/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) causes severe infections and poses a global healthcare challenge. The utilization of novel molecules which confer synergistical effects to existing MRSA-directed antibiotics is one of the well-accepted strategies in lieu of de novo development of new antibiotics. Thymol is a key component of the essential oil of plants in the Thymus and Origanum genera. Despite the absence of antimicrobial potency, thymol is known to inhibit MRSA biofilm formation. However, the anti-MRSA activity of thymol analogs is not well characterized. Here, we assessed the antimicrobial activity of several thymol derivatives and found that 4-chloro-2-isopropyl-5-methylphenol (chlorothymol) has antimicrobial activity against MRSA and in addition it also prevents biofilm formation. Chlorothymol inhibited staphyloxanthin production, slowed MRSA motility, and altered bacterial cell density and size. This compound also showed a synergistic antimicrobial activity with oxacillin against highly resistant S. aureus clinical isolates and biofilms associated with these isolates. Our results demonstrate that chlorinated thymol derivatives should be considered as a new lead compound in anti-MRSA therapeutics.
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Affiliation(s)
- Byung Chan Kim
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Hyerim Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea
| | - Hye Soo Lee
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Su Hyun Kim
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Do-Hyun Cho
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Hee Ju Jung
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Shashi Kant Bhatia
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea
| | - Philip S. Yune
- Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Hwang-Soo Joo
- Department of Biotechnology, College of Engineering, Duksung Women’s University, Seoul 01369, Republic of Korea
| | - Jae-Seok Kim
- Department of Laboratory Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07226, Republic of Korea
| | - Wooseong Kim
- College of Pharmacy and Graduate School of Pharmaceutical Sciences, Ewha Womans University, Seoul 03760, Republic of Korea,
W. Kim Phone: +82-2-3277-3372 Fax: +82-2-3277-4527 E-mail:
| | - Yung-Hun Yang
- Department of Biological Engineering, College of Engineering, Konkuk University, Seoul 05029, Republic of Korea,Corresponding authors Y.-H. Yang Phone: +82-2-3277-3372 Fax: +82-2-3437-8360 E-mail:
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Pannewick B, Baier C, Schwab F, Vonberg RP. Infection control measures in nosocomial MRSA outbreaks-Results of a systematic analysis. PLoS One 2021; 16:e0249837. [PMID: 33826678 PMCID: PMC8026056 DOI: 10.1371/journal.pone.0249837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 03/25/2021] [Indexed: 12/11/2022] Open
Abstract
There is a lack of data on factors that contribute to the implementation of hygiene measures during nosocomial outbreaks (NO) caused by Methicillin-resistant Staphylococcus aureus (MRSA). Therefore, we first conducted a systematic literature analysis to identify MRSA outbreak reports. The expenditure for infection control in each outbreak was then evaluated by a weighted cumulative hygiene score (WCHS). Effects of factors on this score were determined by multivariable linear regression analysis. 104 NO got included, mostly from neonatology (n = 32), surgery (n = 27), internal medicine and burn units (n = 10 each), including 4,361 patients (thereof 657 infections and 73 deaths) and 279 employees. The outbreak sources remained unknown in 10 NO and were not reported from further 61 NO. The national MRSA prevalence did not correlate with the WCHS (p = .714). There were significant WCHS differences for internal medicine (p = 0.014), burn units (p<0.01), for Japanese NO (p<0.01), and NO with an unknown source (p<0.01). In sum, management of a NO due to MRSA does not depend on the local MRSA burden. However, differences of MRSA management among medical departments do exist. Strict adherence to the Outbreak Reports and Intervention Studies Of Nosocomial infection (ORION) statement is highly recommended for. The WCHS may also serve as a useful tool to quantify infection control effort and could therefore be used for further investigations.
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Affiliation(s)
- Béke Pannewick
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Claas Baier
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
| | - Frank Schwab
- Institute for Hygiene and Environmental Health, Charité –University Medicine Berlin, Berlin, Germany
| | - Ralf-Peter Vonberg
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany
- * E-mail:
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Santos VF, Araújo ACJ, Freitas PR, Silva ALP, Santos ALE, Matias da Rocha BA, Silva RRS, Almeida DV, Garcia W, Coutinho HDM, Teixeira CS. Enhanced antibacterial activity of the gentamicin against multidrug-resistant strains when complexed with Canavalia ensiformis lectin. Microb Pathog 2020; 152:104639. [PMID: 33238197 DOI: 10.1016/j.micpath.2020.104639] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/12/2020] [Accepted: 11/13/2020] [Indexed: 12/31/2022]
Abstract
The lectins are carbohydrate-binding proteins that are highly specific to sugar groups associated to other molecules. In addition to interacting with carbohydrates, a number of studies have reported the ability of these proteins to modulate the activity of several antibiotics against multidrug-resistant (MDR) strains. In this study, we report the enhanced antibacterial activity of the gentamicin against MDR strains when complexed with a lectin from Canavalia ensiformis seeds (ConA). Hemagglutination activity test and intrinsic fluorescence spectroscopy revealed that the gentamicin can interact with ConA most likely via the carbohydrate recognition domain (CRD) with binding constant (Kb) value estimated of (0.44 ± 0.04) x 104 M-1. Furthermore, the minimum inhibitory concentrations (MIC) obtained for ConA against all strains studied were not clinically relevant (MIC ≥ 1024 μg/mL). However, when ConA was combined with gentamicin, a significant increase in antibiotic activity was observed against Staphylococcus aureus and Escherichia coli. The present study showed that ConA has an affinity for gentamicin and modulates its activity against MDR strains. These results indicate that ConA improves gentamicin performance and is a promising candidate for structure/function analyses.
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Affiliation(s)
- Valdenice F Santos
- Centro de Ciências Agrárias e Ambientais, Universidade Federal Do Maranhão, Chapadinha, Maranhão, Brazil
| | - Ana C J Araújo
- Departamento de Química Biológica, Universidade Regional Do Cariri, Crato, Ceará, Brazil
| | - Priscilla R Freitas
- Departamento de Química Biológica, Universidade Regional Do Cariri, Crato, Ceará, Brazil
| | - Ana L P Silva
- Centro de Ciências Agrárias e Ambientais, Universidade Federal Do Maranhão, Chapadinha, Maranhão, Brazil
| | - Ana L E Santos
- Centro de Ciências Agrárias e Ambientais, Universidade Federal Do Maranhão, Chapadinha, Maranhão, Brazil
| | | | - Romério R S Silva
- Centro de Ciências Agrárias e Ambientais, Universidade Federal Do Maranhão, Chapadinha, Maranhão, Brazil
| | - Dnane V Almeida
- Centro de Ciências Naturais e Humanas, Universidade Federal Do ABC (UFABC), Santo André, SP, Brazil
| | - Wanius Garcia
- Centro de Ciências Naturais e Humanas, Universidade Federal Do ABC (UFABC), Santo André, SP, Brazil
| | - Henrique D M Coutinho
- Departamento de Química Biológica, Universidade Regional Do Cariri, Crato, Ceará, Brazil.
| | - Claudener S Teixeira
- Instituto de Formação de Educadores, Universidade Federal Do Cariri, Brejo Santo, Ceará, Brazil.
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Telford B, Healy R, Flynn E, Moore E, Ravi A, Geary U. Survey of isolation room equipment and resources in an academic hospital. Int J Health Care Qual Assur 2020; 32:991-1003. [PMID: 31282260 DOI: 10.1108/ijhcqa-10-2018-0254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper, a point prevalence study, is to quantify the incidence of isolation and identify the type of communicable diseases in isolation. The paper evaluates isolation precaution communication, availability of personal protective equipment (PPE) as well as other equipment necessary for maintaining isolation precautions. DESIGN/METHODOLOGY/APPROACH A standardised audit tool was developed in accordance with the National Standards for the Prevention and Control of Healthcare Associated Infections (May 2009). Data were collected from 14 March 2017 to 16 March 2017, through observation of occupied isolation rooms in an academic hospital in Dublin, Ireland. The data were subsequently used for additional analysis and discussion. FINDINGS In total, 14 per cent (125/869) of the total inpatient population was isolated at the time of the study. The most common isolation precaution was contact precautions (96.0 per cent). In all, 88 per cent of known contact precautions were due to multi-drug resistant organisms. Furthermore, 96 per cent of patients requiring isolation were isolated, 92.0 per cent of rooms had signage, 90.8 per cent had appropriate signs and 93.0 per cent of rooms had PPE available. Finally, 31 per cent of rooms had patient-dedicated and single-use equipment and 2.4 per cent had alcohol wipes available. PRACTICAL IMPLICATIONS The audit tool can be used to identify key areas of noncompliance associated with isolation and inform continuous improvement and education. ORIGINALITY/VALUE Currently, the rate of isolation is unknown in Ireland and standard guidelines are not established for the evaluation of isolation rooms. This audit tool can be used as an assessment for isolation room compliance.
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Affiliation(s)
| | | | - Ellen Flynn
- Trinity College, University of Dublin , Dublin, Ireland
| | - Emma Moore
- Trinity College, University of Dublin , Dublin, Ireland
| | - Akshaya Ravi
- Trinity College, University of Dublin , Dublin, Ireland
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Cruz BG, Rodrigues Teixeira AM, Silva PTD, Vasconcelos Evaristo FF, de Vaconcelos MA, Holanda Teixeira E, Dos Santos HS, Bandeira PN, Sena-Júnior DMD, Barreto VP, Coutinho HDM. Antimicrobial activity of the lupane triterpene 3 β,6 β,16 β-trihydroxylup-20(29)-ene isolated from Combretum leprosum Mart. J Med Microbiol 2019; 68:1438-1444. [PMID: 31385784 DOI: 10.1099/jmm.0.001056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Combretum leprosum (Combretaceae) is commonly found in the Northeast Region of Brazil and is known for several bioactivities, including antimicrobial ones. Because of increasing bacterial antibiotic resistance, natural products from several plants have been studied as putative adjuvants to antibiotic activity, including products from C. leprosum. Aims. This study was carried out to investigate the structural properties, bactericidal activity and antibiotic modifying action of the lupane triterpene 3β,6β,16β-trihydroxylup-20(29)-ene (CLF1) isolated from C. leprosum Mart. leaves.Methods. The CLF1 was evaluated by the Fourier transform infrared spectroscopy method and the antibacterial activity of this compound was assayed alone and in association with antibiotics by microdilution assay.Results. Spectroscopic studies confirmed the molecular structure of the CLF1 and permitted assignment of the main infrared bands of this natural product. Microbiological assays showed that this lupane triterpene possesses antibacterial action with clinical relevance against Staphylococcus aureus. The CLF1 triterpene increased antimicrobial activity against the multidrug-resistant Escherichia coli 06 strain when associated with the antibiotics gentamicin and amikacin. Synergistic effects were observed against the S. aureus 10 strain in the presence of the CLF1 triterpene with the antibiotic gentamicin.Conclusion. In conclusion, the CLF1 compound may be useful in the development of antibacterial drugs against the aforementioned bacteria.
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Affiliation(s)
| | | | - Priscila Teixeira da Silva
- Science and Technology Centre - Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | | | - Mayron Alves de Vaconcelos
- Department of Biological Sciences, State University of Rio Grande do Norte, Mossoró, RN, Brazil.,Department of Pathology and Forensic Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Edson Holanda Teixeira
- Department of Pathology and Forensic Medicine, Federal University of Ceará, Fortaleza, CE, Brazil
| | - Hélcio Silva Dos Santos
- Science and Technology Centre - Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
| | - Paulo Nogueira Bandeira
- Science and Technology Centre - Course of Chemistry, State University Vale do Acaraú, Sobral, CE, Brazil
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Macedo I, da Silva JH, da Silva PT, Cruz BG, do Vale JPC, Dos Santos HS, Bandeira PN, de Souza EB, Xavier MR, Coutinho HDM, Braz-Filho R, Teixeira AMR. Structural and Microbiological Characterization of 5-Hydroxy-3,7,4'-Trimethoxyflavone: A Flavonoid Isolated from Vitex gardneriana Schauer Leaves. Microb Drug Resist 2019; 25:434-438. [PMID: 30741597 DOI: 10.1089/mdr.2018.0359] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Staphylococcus aureus represents the most common etiologic agent of purulent infections, affecting humans and animals. Escherichia coli is one of the principal causes of infectious diseases, mainly diarrheal diseases due to enterotoxin action. There are many reports indicating that these bacteria are multidrug-resistant (MDR) pathogens. OBJECTIVE In this study, we investigated the antimicrobial and modulatory activities of 5-hydroxy-3,7,4'-trimethoxyflavone (VG.EF.CLII) against E. coli and S. aureus strains. METHODS 5-Hydroxy-3,7,4'-trimethoxyflavone was isolated from Vitex gardneriana Schauer leaves and structurally characterized using nuclear magnetic resonance. The antibacterial effect of VG.EF.CLII and modulation of antibiotic activity, both determined by minimum inhibitory concentration, were assessed using microtiter plates. RESULTS VG.EF.CLII showed bacterial growth inhibition at concentrations ≤512 μg/mL, and synergistic effects were observed for the modulation of two distinct antibiotic classes (the fluoroquinolone norfloxacin and the aminoglycoside gentamicin). CONCLUSION 5-Hydroxy-3,7,4'-trimethoxyflavone isolated from V. gardneriana showed promising antimicrobial activity against MDR bacterial strains S. aureus 358 and E. coli 27 when associated with the antibiotics norfloxacin and gentamicin. Therefore, this natural product can contribute to the control of bacterial resistance.
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Affiliation(s)
- Iasminy Macedo
- 1 Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil
| | - João H da Silva
- 1 Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil.,2 Science and Technology Centre, Federal University of Cariri, Fortaleza, Brazil
| | - Priscila T da Silva
- 1 Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil
| | - Beatriz G Cruz
- 1 Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil
| | - Jean P C do Vale
- 3 Science and Technology Centre-Chemistry Course, State University Vale do Acaraú, Sobral, Brazil
| | - Hélcio S Dos Santos
- 3 Science and Technology Centre-Chemistry Course, State University Vale do Acaraú, Sobral, Brazil
| | - Paulo N Bandeira
- 3 Science and Technology Centre-Chemistry Course, State University Vale do Acaraú, Sobral, Brazil
| | - Elnatan B de Souza
- 4 Biological Sciences Course, Center for Agrarian and Biological Sciences, Herbarium Professor José de Abreu Matos, State University of Vale do Acaraú, Sobral, Brazil
| | - Maria R Xavier
- 1 Department of Biological Chemistry, Regional University of Cariri, Crato, Brazil
| | | | - Raimundo Braz-Filho
- 5 ICE-UFRRJ/Chemical Sciences Laboratory, FAPERJ/Chemistry Department, CCT-UENF, Campus dos Goytacazes, Brazil
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Reassessing the need for active surveillance of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the neonatal intensive care population. Infect Control Hosp Epidemiol 2018; 39:1436-1441. [PMID: 30345942 DOI: 10.1017/ice.2018.260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the continued need for active surveillance to prevent extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) transmission in a neonatal intensive care unit (NICU). DESIGN This retrospective observational study included patients with ESBL-E colonization or infection identified during their NICU stay at our institution between 1999 and March 2018. Active surveillance was conducted between 1999 and March 2017 by testing rectal swab specimens collected upon admission and weekly thereafter. The overall incidence rates, of ESBL-E colonization or infection (including hospital acquired) before and after active surveillance were calculated. The cost associated with active surveillance was then estimated. RESULTS Overall, 171 NICU patients were found to have ESBL-E colonization or infection, and 150 of those patients (87.7%) were detected by active surveillance. The overall incidence rate was 1.4 per 100 patient admissions. The hospital-acquired incidence rate was 0.41 per 1,000 patient days, and this rate had decreased since 2002, with an average of 6 cases detected annually. A significant decrease was observed in 2009 when the unit moved to a new single-bed unit featuring private rooms. Active surveillance was discontinued with no increase in the number of infections. Of the 150 ESBL-E colonized patients, 14 (9.3%) subsequently developed an infection. Active surveillance resulted in a total of 50,950 specimen collections and a cost of $127,187 for processing, an average of $848 to detect 1 ESBL-E colonized patient. CONCLUSION ESBL-E transmission and infection in our NICU remains uncommon. Active surveillance may have contributed to the decline of ESBL-E transmission when used in conjunction with contact precautions and private rooms, but its relatively high cost could be prohibitive.
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Lima VN, Oliveira-Tintino CD, Santos ES, Morais LP, Tintino SR, Freitas TS, Geraldo YS, Pereira RL, Cruz RP, Menezes IR, Coutinho HD. Antimicrobial and enhancement of the antibiotic activity by phenolic compounds: Gallic acid, caffeic acid and pyrogallol. Microb Pathog 2016; 99:56-61. [DOI: 10.1016/j.micpath.2016.08.004] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Revised: 07/27/2016] [Accepted: 08/02/2016] [Indexed: 10/21/2022]
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Polgreen PM, Beekmann SE, Chen YY, Doern GV, Pfaller MA, Brueggemann AB, Herwaldt LA, Diekema DJ. Epidemiology of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusin a Rural State. Infect Control Hosp Epidemiol 2016; 27:252-6. [PMID: 16532412 DOI: 10.1086/501537] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 06/14/2005] [Indexed: 11/04/2022]
Abstract
Background.Most data on methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant Enterococcus (VRE) isolates come from large tertiary care centers. Infection control personnel need to understand the epidemiology of MRSA and VRE across the continuum of care, including small rural hospitals, to develop effective control strategies.Objective.To describe the epidemiology of MRSA and VRE in Iowa.Setting.Fifteen hospitals in Iowa.Methods.Between July 1998 and June 2001, a total of 1,968S. aureusisolates and 1,845Enterococcusisolates from patients infected with these pathogens were examined. Multivariate models were developed to evaluate patient and institutional risk factors for MRSA infection and VRE infection.Results.The proportion ofS. aureusisolates resistant to methicillin was 31%, and the proportion ofEnterococcusisolates resistant to vancomycin was 6%. Independent risk factors for MRSA infection included residence in a long-term care facility, age of more than 60 years, hospitalization in a hospital with less than 200 short-term care beds, and acquiring the infection in the hospital. Independent risk factors for VRE infection included use of a central venous catheter, residence in a long-term care facility, acquisition of infection in the hospital, and hospitalization in a hospital with more than 200 short-term care beds.Conclusions.In Iowa, the epidemiology of MRSA differ from those of VRE. MRSA has become established in small rural hospitals. Effective MRSA control strategies may require inclusion of all hospitals in a state or region.
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Affiliation(s)
- Philip M Polgreen
- Division of Infectious Diseases, Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, 52246, USA
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Farr BM. What To Think If the Results of the National Institutes of Health Randomized Trial of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusControl Measures Are Negative (and Other Advice to Young Epidemiologists): A Review and an Au Revoir. Infect Control Hosp Epidemiol 2016; 27:1096-106. [PMID: 17006818 DOI: 10.1086/508759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 08/31/2006] [Indexed: 12/27/2022]
Abstract
The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.
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Affiliation(s)
- Barry M Farr
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Raboud J, Saskin R, Simor A, Loeb M, Green K, Low DE, McGeer A. Modeling Transmission of Methicillin-ResistantStaphylococcus AureusAmong Patients Admitted to a Hospital. Infect Control Hosp Epidemiol 2016; 26:607-15. [PMID: 16092740 DOI: 10.1086/502589] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To determine the impact of the screening test, nursing workload, handwashing rates, and dependence of handwashing on risk level of patient visit on methicillin-resistantStaphylococcus aureus(MRSA) transmission among hospitalized patients.Setting:General medical ward.Methods:Monte Carlo simulation was used to model MRSA transmission (median rate per 1,000 patient-days). Visits by healthcare workers (HCWs) to patients were simulated, and MRSA was assumed to be transmitted among patients via HCWs.Results:The transmission rate was reduced from 0.89 to 0.56 by the combination of increasing the sensitivity of the screening test from 80% to 99% and being able to report results in 1 day instead of 4 days. Reducing the patient-to-nurse ratio from 4.3 in the day and 6.8 at night to 3.8 and 5.7, respectively, reduced the number of nosocomial infections from 0.89 to 0.85; reducing the ratio to 1 and 1, respectively, further reduced the number of nosocomial infections to 0.32. Increases in handwashing rates by 0%, 10%, and 20% for high-risk visits yielded reductions in nosocomial infections similar to those yielded by increases in handwashing rates for all visits (0.89, 0.36, and 0.24, respectively). Screening all patients for MRSA at admission reduced the transmission rate to 0.81 per 1,000 patient-days from 1.37 if no patients were screened.Conclusion:Within the ranges of parameters studied, the most effective strategies for reducing the rate of MRSA transmission were increasing the handwashing rates for visits involving contact with skin or bodily fluid and screening patients for MRSA at admission. (Infect Control Hosp Epidemiol 2005;26:607- 615)
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Affiliation(s)
- Janet Raboud
- Department of Public Health Sciences, University of Toronto, and University Health Network, Toronto, Ontario, Canada.
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Vos MC, Verbrugh HA. MRSA: We Can Overcome, But Who Will Lead the Battle? Infect Control Hosp Epidemiol 2016; 26:117-20. [PMID: 16955947 DOI: 10.1086/503507] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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14
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Vriens MR, Blok HEM, Gigengack-Baars ACM, Mascini EM, van der Werken C, Verhoef J, Troelstra A. Methicillin-ResistantStaphylococcus AureusCarriage Among Patients After Hospital Discharge. Infect Control Hosp Epidemiol 2016; 26:629-33. [PMID: 16092743 DOI: 10.1086/502592] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractBackground and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)
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Affiliation(s)
- Menno R Vriens
- University Medical Center Utrecht, Department of Surgery, Utrecht, The Netherlands
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Ridenour GA, Wong ES, Call MA, Climo MW. Duration of Colonization with Methicillin-ResistantStaphylococcus aureusAmong Patients in the Intensive Care Unit: Implications for Intervention. Infect Control Hosp Epidemiol 2016; 27:271-8. [PMID: 16532415 DOI: 10.1086/500649] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2005] [Accepted: 08/01/2005] [Indexed: 11/03/2022]
Abstract
Objectives.To determine the duration of methicillin-resistantStaphylococcus aureus(MRSA) colonization or infection before entry and during hospitalization in the intensive care unit (ICU) and the characteristics of patients who tested positive for MRSA.Design.Prospective observational cohort survey.Setting.A combined medical and coronary care ICU with 16 single-bed rooms in a 427-bed tertiary care Veteran Affairs Medical CenterPatients.A total of 720 ICU patients associated with 845 ICU admissions were followed up for the detection of MRSA from January 13, 2003, to October 12, 2003. MRSA colonization was detected in patients by using active surveillance cultures (ASCs) of nasal swab specimens obtained within 48 hours of ICU entry and 3 times weekly thereafter. The duration of colonization during ICU stay and before ICU entry was calculated after a review of surveillance culture results, clinical culture results, and medical history.Results.Ninety-three (11.0%) of 845 ICU admissions involved patients who were colonized with MRSA at the time of ICU entry, and 21 admissions (2.5%) involved patients who acquired MRSA during ICU stay. ASCs were positive for MRSA in 84 (73.6%) of the 114 admissions associated with MRSA positivity and were the sole means of identifying MRSA in 50 cases (43.8%). More than half of the MRSA-associated admissions involved patients who were transferred from hospital wards. The total bed-days of care for 38 admissions involving patients who tested positive for MRSA before ICU entry (1131 days) was nearly 20% higher than the total bed-days of care for all admissions associated with MRSA positivity (970 days). Admissions involving MRSA-positive patients were associated with a longer length of hospitalization before ICU entry (P<.001), longer length of ICU stay (P<.001), longer overall length of hospitalization (P<.001), and greater inpatient mortality than admissions involving MRSA-negative patients (P<.001). A total of 22.8% of all bed-care days were dedicated to MRSA-positive patients in the ICU, and 55 (48.2%) of 114 admissions associated with MRSA positivity involved patients who were colonized for the duration of their ICU stay.Conclusions.In our unit, ASCs were an effective means to identify MRSA colonization among patients admitted to the ICU. Unfortunately, the majority of identified patients had long durations of stay in our own hospital before ICU entry, with prolonged MRSA colonization. Enhanced efforts to control MRSA will have to account for the prevalence of MRSA within hospital wards and to direct control efforts at these patients in the future.
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Affiliation(s)
- Glenn A Ridenour
- Division of Infectious Disease, Hunter Holmes McGuire Veteran Affairs Medical Center, Richmond, 23249, USA
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Matias EFF, Alves EF, Silva MKN, Carvalho VRA, Medeiros CR, Santos FAV, Bitu VCN, Souza CES, Figueredo FG, Boligon AA, Athayde ML, Costa JGM, Coutinho HDM. Potentiation of antibiotic activity of aminoglycosides by natural products from Cordia verbenacea DC. Microb Pathog 2016; 95:111-116. [PMID: 27033000 DOI: 10.1016/j.micpath.2016.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/19/2016] [Accepted: 03/22/2016] [Indexed: 10/22/2022]
Abstract
Medicinal plants are often the only therapeutic resource for many communities and ethnic groups. Cordia verbenacea DC., "Erva-baleeira," is one of the species of plants currently used to produce a phytotherapeutic product extracted from its leaves. The present study aimed to establish its chemical profile, antibacterial activity and resistance-modulating potential. The C. verbenacea extracts were prepared from fresh leaves using solvents as methanol and hexane. Ethyl Acetate was used for the preparation of the fraction. Phytochemical screening was carried out using HPLC-DAD for determination and quantification of the secondary metabolites present in the fractions. Antibacterial and resistance-modulation assays were performed to determine minimum inhibitory concentration (MIC) using a microdilution assay. The data were subjected to statistical analysis with two-way ANOVA and Bonferroni posttests. Results of phytochemical prospecting and HPLC analysis of the fractions were in agreement with the literature. The natural products presented moderate antibacterial activity when considering the clinical relevance of a MIC of 256 μg/mL against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa, and 512 μg/mL against P. aeruginosa. However, when the fractions were combined with antibiotics we observed a synergic effect, as natural products enhanced the antibacterial effect of aminoglycosides, significantly decreasing the MIC of antibiotics at 12.5%-98.4%. We believe that the data obtained from phytochemical analysis and from antibacterial and resistance modulation assays of C. verbenacea extracts new can open perspectives in the search for new alternatives for the treatment of bacterial infections and stimulate the renewed use of antibiotics with reduced effectiveness due to resistance.
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Affiliation(s)
| | | | - Maria K N Silva
- Faculdade Leão Sampaio - FALS, Juazeiro do Norte, CE, Brazil
| | | | | | | | | | | | | | - Aline A Boligon
- Faculdade Leão Sampaio - FALS, Juazeiro do Norte, CE, Brazil
| | | | - José G M Costa
- Faculdade Leão Sampaio - FALS, Juazeiro do Norte, CE, Brazil
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Phytochemical characterization by HPLC and evaluation of antibacterial and aminoglycoside resistance-modifying activity of chloroform fractions of Cordia verbenacea DC leaf extracts. Eur J Integr Med 2015. [DOI: 10.1016/j.eujim.2015.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE OF REVIEW This review explores the usefulness of surveillance cultures in healthcare-associated pneumonia (HCAP). RECENT FINDINGS The definition of HCAP is controversial. Causative micro-organisms of HCAP resemble those found in hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP). Some types of surveillance cultures have proven useful in hospitalized patients. Whereas numerous studies have investigated the role of surveillance cultures in VAP, one may wonder whether surveillance culture implementation should belong in HCAP management guidelines. SUMMARY Studies exploring the usefulness of obtaining surveillance cultures in VAP are numerous, but are mostly retrospective, observational and/or quasi-experimental in nature. Surveillance cultures may be useful for antibiotic guidance, but positive predictive value and specificity of surveillance cultures are low, obviously negatively impacting on cost effectiveness, especially in the large population at risk for HCAP. On the other hand, multidrug-resistance is increasing and surveillance cultures for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in ICU-admitted patients appeared useful and cost-effective. Furthermore, surveillance cultures for the presence of multidrug-resistant Gram-negative bacilli might be useful for antibiotic guidance. Currently, neither community-acquired pneumonia, HCAP, HAP nor VAP guidelines incorporate surveillance cultures. In the future, surveillance cultures in populations at risk for HCAP may be able to differentiate HCAP from other kinds of pneumonia and authorize its reason for existence.
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Farr BM. Volume 25: An Important Milestone Despite Continuing Infection Control Challenges. Infect Control Hosp Epidemiol 2015; 25:7-9. [PMID: 14756212 DOI: 10.1086/502283] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hopmans TEM, Blok HEM, Troelstra A, Bonten MJM. Prevalence of Hospital-Acquired Infections During Successive Surveillance Surveys Conducted at a University Hospital in The Netherlands. Infect Control Hosp Epidemiol 2015; 28:459-65. [PMID: 17385153 DOI: 10.1086/512640] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Accepted: 12/16/2005] [Indexed: 11/03/2022]
Abstract
Objective.To monitor hospital-wide trends in the prevalence of hospital-acquired infections (HAIs) in order to identify areas where the risk of infection is increasing.Methods.Successive surveillance surveys were conducted twice yearly, from November 2001 until May 2004, to determine the prevalence of HAIs at 2 Dutch hospitals, using Centers for Disease Control and Prevention criteria.Results.In all, 340 HAIs were observed in 295 (11.1%) of 2,661 patients surveyed. The overall prevalence per survey varied from 10.2% to 15.6%, with no significant differences between successive surveys. In the surgical department, the prevalence of HAIs increased from 10.8 cases per 100 surgeries in November 2001 to 20.4 cases per 100 surgeries in May 2002. Further analysis revealed a high prevalence of surgical site infection among patients who had an orthopedic procedure performed. In the neurology-neurosurgery department, the prevalence increased from 13.0 cases per 100 patients in May 2002 to 26.6 cases per 100 patients in May 2003 and involved several types of infection. Further analysis retrieved exceptionally high incidences of infections associated with cerebrospinal fluid drainage. Specific infection control interventions were developed and implemented in both departments. The total cost of the surveys was estimated to be €9,100 per year.Conclusion.Successive performance of surveillance surveys is a simple and cheap method to monitor the prevalence of infection throughout the hospital and appeared instrumental in identifying 2 departments with increased infection rates.
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Affiliation(s)
- T E M Hopmans
- Hospital Hygiene and Infection Prevention, Department of Medical Microbiology, University Medical Center Utrecht, The Netherlands.
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Farr BM. Political Versus Epidemiological Correctness. Infect Control Hosp Epidemiol 2015; 28:589-93. [PMID: 17464920 DOI: 10.1086/515710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Accepted: 02/20/2007] [Indexed: 01/08/2023]
Abstract
In the March issue of the journal, the Joint SHEA and APIC Task Force indicates that the Society for Healthcare Epidemiology of America (SHEA) and the Association for Professionals in Infection Control and Epidemiology (APIC) support the use of active detection and isolation (ADI) for controlling nosocomial infections due to methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) “in appropriate circumstances, as recommended in previously published guidelines”1(p250) (those published by SHEA and the Healthcare Infection Control Practices Advisory Committee [HICPAC]), but that SHEA and APIC oppose the use of legislation for mandating any infection control approach, including this one as tried in 2006 in Illinois and Maryland.
Both supporters and opponents of controlling MRSA and VRE with ADI probably will agree that legislation is not the optimal way to control nosocomial infections in general, but this position statement undoubtedly will please the latter more than it does the former because the SHEA/APIC Task Force argues that ADI is not ready for routine use throughout all healthcare facilities, directly opposing the position of the original SHEA guideline. As an author of that SHEA guideline, I would like to comment. First, the new position seems politically correct (since most infection control professionals have not yet bothered using ADI to control MRSA and VRE), but many of the planks of the SHEA/APIC Task Force position statement are misleading.
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Affiliation(s)
- Barry M Farr
- University of Virginia Health System, Charlottesville, VA 22908, USA.
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Weber SG, Huang SS, Oriola S, Huskins WC, Noskin GA, Harriman K, Olmsted RN, Bonten M, Lundstrom T, Climo MW, Roghmann MC, Murphy CL, Karchmer TB. Legislative Mandates for Use of Active Surveillance Cultures to Screen for Methicillin-ResistantStaphylococcus aureusand Vancomycin-Resistant Enterococci: Position Statement From the Joint SHEA and APIC Task Force. Infect Control Hosp Epidemiol 2015; 28:249-60. [PMID: 17326014 DOI: 10.1086/512261] [Citation(s) in RCA: 92] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2006] [Accepted: 01/05/2007] [Indexed: 01/14/2023]
Abstract
Legislation aimed at controlling antimicrobial-resistant pathogens through the use of active surveillance cultures to screen hospitalized patients has been introduced in at least 2 US states. In response to the proposed legislation, the Society for Healthcare Epidemiology of America (SHEA) and the Association of Professionals in Infection Control and Epidemiology (APIC) have developed this joint position statement. Both organizations are dedicated to combating healthcare-associated infections with a wide array of methods, including the use of active surveillance cultures in appropriate circumstances. This position statement reviews the proposed legislation and the rationale for use of active surveillance cultures, examines the scientific evidence supporting the use of this strategy, and discusses a number of unresolved issues surrounding legislation mandating use of active surveillance cultures. The following 5 consensus points are offered. (1) Although reducing the burden of antimicrobial-resistant pathogens, including methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistant enterococci (VRE), is of preeminent importance, APIC and SHEA do not support legislation to mandate use of active surveillance cultures to screen for MRSA, VRE, or other antimicrobial-resistant pathogens. (2) SHEA and APIC support the continued development, validation, and application of efficacious and cost-effective strategies for the prevention of infections caused by MRSA, VRE, and other antimicrobial-resistant and antimicrobial-susceptible pathogens. (3) APIC and SHEA welcome efforts by healthcare consumers, together with private, local, state, and federal policy makers, to focus attention on and formulate solutions for the growing problem of antimicrobial resistance and healthcare-associated infections. (4) SHEA and APIC support ongoing additional research to determine and optimize the appropriateness, utility, feasibility, and cost-effectiveness of using active surveillance cultures to screen both lower-risk and high-risk populations. (5) APIC and SHEA support stronger collaboration between state and local public health authorities and institutional infection prevention and control experts.
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Affiliation(s)
- Stephen G Weber
- Section of Infectious Diseases, University of Chicago, Chicago, IL 60637, USA.
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Boyce JM, Havill NL, Kohan C, Dumigan DG, Ligi CE. Do Infection Control Measures Work for Methicillin-ResistantStaphylococcus aureus? Infect Control Hosp Epidemiol 2015; 25:395-401. [PMID: 15188845 DOI: 10.1086/502412] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To review evidence regarding the effectiveness of control measures in reducing transmission of methicillin-resistantStaphylococcus aureus(MRSA) in hospitals.Design:Literature review and surveillance cultures of hospitalized patients at high risk for MRSA colonization or infection.Setting:A 500-bed, university-affiliated, community teaching hospital.Results:The percentage of nosocomialS. aureusinfections caused by MRSA increased significantly between 1982 and 2002, despite the use of various isolation and barrier precaution policies. The apparent ineffectiveness of control measures may be due to several factors including the failure to identify patients colonized with MRSA For example, cultures of stool specimens submitted forClostridium difficiletoxin assays at one hospital found that 12% of patients had MRSA in their stool, and 41% of patients with unrecognized colonization were cared for without using barrier precautions. Other factors include the use of barrier precaution strategies that do not account for multiple reservoirs of MRSA, poor adherence of healthcare workers (HCWs) to recommended barrier precautions and handwashing, failure to identify and treat HCWs responsible for transmitting MRSA, and importation of MRSA by patients admitted from other facilities. Control programs that include active surveillance cultures (ASCs) of high-risk patients and use of barrier precautions have reduced MRSA prevalence rates and have been cost-effective. Using a staged approach to implementing ASCs can minimize logistic problems.Conclusion:MRSA control programs are effective if they include ASCs of high-risk patients, use of barrier precautions when caring for colonized or infected patients, hand hygiene, and treating HCWs implicated in MRSA transmission.
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Affiliation(s)
- John M Boyce
- Department of Medicine, Hospital of Saint Raphael, Hospital of Saint Raphael, 1450 Chapel Street, New Haven, CT 06511, USA
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Mangini E, Segal-Maurer S, Burns J, Avicolli A, Urban C, Mariano N, Grenner L, Rosenberg C, Rahal JJ. Impact of Contact and Droplet Precautions on the Incidence of Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Infection. Infect Control Hosp Epidemiol 2015; 28:1261-6. [DOI: 10.1086/521658] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 06/14/2007] [Indexed: 11/03/2022]
Abstract
Objective.To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections.Design.Before-after study.Setting.A 439-bed, university-affiliated community hospital.Methods.To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, “non-ICU areas”), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed.Results.The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P = .03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P = .43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P = .02).Conclusion.The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.
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Boyce JM. Understanding and Controlling Methicillin-ResistantStaphylococcus aureusInfections. Infect Control Hosp Epidemiol 2015; 23:485-7. [PMID: 12269442 DOI: 10.1086/502092] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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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: 5.2] [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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Pfeiffer CD, Beldavs ZG. Much to do about carbapenem-resistant Enterobacteriaceae: why supplementing surveillance may be the key to stopping spread. Infect Control Hosp Epidemiol 2014; 35:984-5. [PMID: 25026613 DOI: 10.1086/677158] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
(See the article by Thaden et al, on pages 978–983.)It is critical to the future of public health to understand the burden of carbapenem-resistant Enterobacteriaceae (CRE) so that we can effectively target efforts to limit potential spread. The Centers for Disease Control and Prevention (CDC) classifies CRE as 1 of 3 “urgent” antibiotic resistance threats to public health because of the high mortality associated with CRE infection and its rapid dissemination in the United States.What is the current burden of CRE disease? We can glean a snapshot of the national epidemiology of CRE from the CDC’s national surveillance. Rapid geographic spread is evident in the CDC’s national map of CRE, which indicates that all but 3 states now have identified CRE. Incidence by facility type, procedure, device, and organism all have considerable variation, providing preliminary indications where future prevention efforts might best be focused. The 2013 CRE Vital Signs states that 3.9% of short-stay acute care hospitals and 17.8% of long-term acute care hospitals have identified cases of CRE infection among those with catheter-associated urinary tract infection (CAUTI) or central line–associated bloodstream infection (CLABSI). The CDC also reported that 10% of Klebsiella species in intensive care unit (ICU) CLABSIs, ICU CAUTIs, and surgical site infections after colon surgery or coronary artery bypass grafting in 2011 were carbapenem resistant. Although CRE have been reported in most states, it is increasingly clear that wide regional variation exists, from regions of hyperendemicity, such as parts of New York City, to regions apparently free of CRE, such as Maine.
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Affiliation(s)
- Christopher D Pfeiffer
- Department of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Oregon; and Department of Medicine, Oregon Health and Science University, Portland, Oregon
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Lavor AKL, Matias EF, Alves EF, Santos BS, Figueredo FG, Lima LF, Leite NF, Sobral-Souza CE, Andrade JC, Alencar LB, Brito DI, Albuquerque RS, Coutinho HD. Association between drugs and herbal products: In vitro enhancement of the antibiotic activity by fractions from leaves of Croton campestris A. (Euphorbiaceae). Eur J Integr Med 2014. [DOI: 10.1016/j.eujim.2014.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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TINTINO SR, F. LUCENA BF, FIGUEREDO FG, DE M. OLIVEIRA CD, DOS S. AGUIAR JJ, DO N. CARDOSO E, A. DE AQUINO PE, C. ANDRADE J, M.COUTINHO HD, F. MATIAS EF. Evaluation of Antibacterial Activity of Aminoglycosides and Modulating the Essential Oil of Cymbopogon citratus (DC.) Stapf. ACTA BIOLÓGICA COLOMBIANA 2014. [DOI: 10.15446/abc.v20n1.41673] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Perlin JB, Hickok JD, Septimus EJ, Moody JA, Englebright JD, Bracken RM. A bundled approach to reduce methicillin-resistant Staphylococcus aureus infections in a system of community hospitals. J Healthc Qual 2014; 35:57-68; quiz 68-9. [PMID: 23648079 DOI: 10.1111/jhq.12008] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections pose a significant challenge to U.S. healthcare facilities, but there has been limited study of initiatives to reduce infection and increase patient safety in community hospitals. To address this need, a multifaceted program for MRSA infection prevention was developed for implementation in 159 acute care facilities. This program featured five distinct tools-active MRSA surveillance of high-risk patients, enhanced barrier precautions, compulsive hand hygiene, disinfection and cleaning, and executive champions and patient empowerment-and was implemented during 1Q-2Q 2007. Postintervention (3Q 2007-2Q 2008), 10.2% of patients with high-risk for infection or complications due to MRSA had nasal colonization. Volume of disposable gown and alcohol-based hand sanitizer use increased substantially following program implementation. Self-reported rates, based on NHSN definitions, of healthcare-associated central line-associated bloodstream infections and ventilator-associated pneumonia due to MRSA decreased 39% (p < .001) and 54% (p < .001), respectively. Infection rates continued to decrease during the follow-up period (1Q-4Q 2009). This sustained improvement demonstrates that reducing healthcare-associated MRSA infections in a large number of diverse facilities is possible and that a "bundled" approach that translates science into clinical and executive performance expectations may aid in overcoming traditional barriers to implementation.
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Shogan BD, Smith DP, Packman AI, Kelley ST, Landon EM, Bhangar S, Vora GJ, Jones RM, Keegan K, Stephens B, Ramos T, Kirkup BC, Levin H, Rosenthal M, Foxman B, Chang EB, Siegel J, Cobey S, An G, Alverdy JC, Olsiewski PJ, Martin MO, Marrs R, Hernandez M, Christley S, Morowitz M, Weber S, Gilbert J. The Hospital Microbiome Project: Meeting report for the 2nd Hospital Microbiome Project, Chicago, USA, January 15(th), 2013. Stand Genomic Sci 2013; 8:571-9. [PMID: 24501640 PMCID: PMC3910697 DOI: 10.4056/sigs.4187859] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Benjamin D Shogan
- Department of Surgery, University of Chicago Medicine, Chicago, IL, 60637, USA
| | | | - Aaron I Packman
- Department of Civil and Environmental Engineering, Northwestern University, Evanston, IL 60208, USA
| | - Scott T Kelley
- Department of Biology, San Diego State University, San Diego, CA, 92182, USA
| | - Emily M Landon
- Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Seema Bhangar
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA 94720, USA
| | - Gary J Vora
- Center for Bio/Molecular Science and Engineering, Naval Research Laboratory, Washington DC, 20375, USA
| | - Rachael M Jones
- Division of Environmental and Occupational Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, 60612, USA
| | - Kevin Keegan
- Argonne National Laboratory, Argonne, IL, 60439, USA
| | - Brent Stephens
- Department of Civil, Architectural and Environmental Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Tiffanie Ramos
- Department of Civil, Architectural and Environmental Engineering, Illinois Institute of Technology, Chicago, IL 60616, USA
| | - Benjamin C Kirkup
- Department of Wound Infections, Walter Reed Army Institute of Research, Silver Spring, MD 20910, USA ; Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Hal Levin
- Building Ecology Research Group, Santa Cruz, California, 95060, USA
| | - Mariana Rosenthal
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Betsy Foxman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109
| | - Eugene B Chang
- Department of Medicine, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Jeffrey Siegel
- Department of Civil Engineering, University of Toronto, Ontario, Canada
| | - Sarah Cobey
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, 60637, USA
| | - Gary An
- Department of Surgery, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - John C Alverdy
- Department of Surgery, University of Chicago Medicine, Chicago, IL, 60637, USA
| | | | - Mark O Martin
- Department of Biology, University of Puget Sound, Tacoma, Washington, 98416, USA
| | - Rachel Marrs
- Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Mark Hernandez
- Department of Civil, Environmental and Architectural Engineering, University of Colorado, Boulder, CO, 80309, USA
| | - Scott Christley
- Department of Surgery, University of Chicago Medicine, Chicago, IL, 60637, USA
| | - Michael Morowitz
- University of Pittsburgh School of Medicine, Children's Hospital of Pittsburgh of UPMC, 4401 Penn Avenue, Pittsburgh, PA 15224
| | - Stephen Weber
- Department of Medicine, Section of Infectious Diseases & Global Health, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Jack Gilbert
- Argonne National Laboratory, Argonne, IL, 60439, USA ; Department of Ecology and Evolution, University of Chicago, Chicago, IL, 60637, USA
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Biological Activities and Chemical Characterization of Cordia verbenacea DC. as Tool to Validate the Ethnobiological Usage. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:164215. [PMID: 23818919 PMCID: PMC3684094 DOI: 10.1155/2013/164215] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 05/01/2013] [Accepted: 05/04/2013] [Indexed: 11/17/2022]
Abstract
Knowledge of medicinal plants is often the only therapeutic resource of many communities and ethnic groups. "Erva-baleeira", Cordia verbenacea DC., is one of the species of plants currently exploited for the purpose of producing a phytotherapeutic product extracted from its leaves. In Brazil, its major distribution is in the region of the Atlantic Forest and similar vegetation. The crude extract is utilized in popular cultures in the form of hydroalcoholic, decoctions and infusions, mainly as antimicrobial, anti-inflammatory and analgesic agents. The aim of the present study was to establish a chemical and comparative profile of the experimental antibacterial activity and resistance modifying activity with ethnopharmacological reports. Phytochemical prospecting and HPLC analysis of the extract and fractions were in agreement with the literature with regard to the presence of secondary metabolites (tannins and flavonoids). The extract and fraction tested did not show clinically relevant antibacterial activity, but a synergistic effect was observed when combined with antibiotic, potentiating the antibacterial effect of aminoglycosides. We conclude that tests of antibacterial activity and modulating the resistance presented in this work results confirm the ethnobotanical and ethnopharmacological information, serving as a parameter in the search for new alternatives for the treatment of diseases.
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Kouyos R, Klein E, Grenfell B. Hospital-community interactions foster coexistence between methicillin-resistant strains of Staphylococcus aureus. PLoS Pathog 2013; 9:e1003134. [PMID: 23468619 PMCID: PMC3585153 DOI: 10.1371/journal.ppat.1003134] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/02/2012] [Indexed: 01/26/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of morbidity and mortality in both hospitals and the community. Traditionally, MRSA was mainly hospital-associated (HA-MRSA), but in the past decade community-associated strains (CA-MRSA) have spread widely. CA-MRSA strains seem to have significantly lower biological costs of resistance, and hence it has been speculated that they may replace HA-MRSA strains in the hospital. Such a replacement could potentially have major consequences for public health, as there are differences in the resistance spectra of the two strains as well as possible differences in their clinical effects. Here we assess the impact of competition between HA- and CA-MRSA using epidemiological models which integrate realistic data on drug-usage frequencies, resistance profiles, contact, and age structures. By explicitly accounting for the differing antibiotic usage frequencies in the hospital and the community, we find that coexistence between the strains is a possible outcome, as selection favors CA-MRSA in the community, because of its lower cost of resistance, while it favors HA-MRSA in the hospital, because of its broader resistance spectrum. Incorporating realistic degrees of age- and treatment-structure into the model significantly increases the parameter ranges over which coexistence is possible. Thus, our results indicate that the large heterogeneities existing in human populations make coexistence between hospital- and community-associated strains of MRSA a likely outcome. One of the most notorious cases of antibiotic-resistant bacteria is methicillin-resistant Staphylococcus aureus (MRSA), which causes diseases ranging from skin and soft-tissue infections to pneumonia and septicemia. Traditionally, MRSA was mainly hospital-associated, but in the past decade community-associated strains have spread widely. Typically drug-resistant bacteria have lower reproduction or transmission rates, called a fitness cost. Because this cost is estimated to be significantly lower for community-associated strains, it has been predicted that these will eventually replace the hospital-associated strains. However, hospital-associated strains are resistant against a greater variety of antibiotics, which may compensate for the higher fitness cost. Here, we integrate realistic data on drug-usage, resistance profiles, contact, and age structures into a mathematical model of MRSA transmission to predict the competition between hospital- and community-associated strains. We find that for a realistic degree of population structure it is likely that both strains of MRSA will coexist in the long term. This results from significantly different hospitalization and antibiotic consumption rates between age groups. In particular, elderly individuals have much higher rates of antibiotic usage and hospitalizations than other age groups. This generates a situation where community-associated strains can predominate in the community but are outcompeted in the hospital, resulting in coexistence in the population.
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Affiliation(s)
- Roger Kouyos
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, New Jersey, United States of America.
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Pan A, Lee A, Cooper B, Chalfine A, Daikos GL, Garilli S, Goossens H, Malhotra-Kumar S, Martínez JA, Patroni A, Harbarth S. Risk factors for previously unknown meticillin-resistant Staphylococcus aureus carriage on admission to 13 surgical wards in Europe. J Hosp Infect 2012. [PMID: 23201397 DOI: 10.1016/j.jhin.2012.09.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Early identification of meticillin-resistant Staphylococcus aureus (MRSA) carriers may be helpful for clinical and epidemiological reasons. AIM To identify and compare risk factors of previously unknown MRSA carriage on admission to 13 surgical wards in France, Greece, Italy, and Spain. METHODS The study was a prospective observational cohort study which enrolled consecutive patients screened for MRSA on admission to surgical wards. Sociodemographic data, comorbidities and possible risk factors for MRSA were recorded. A multivariate logistic regression model was used to predict probabilities of previously unknown MRSA colonization on admission based on patient characteristics. Prediction rules for MRSA carriage were developed and evaluated using the c-statistic. FINDINGS Of 2901 patients enrolled, admission screening identified 111 (3.8%) new MRSA carriers. Independent risk factors for MRSA carriage were urinary catheterization (odds ratio: 4.4; 95% confidence interval: 2.0-9.9), nursing home residency (3.8; 1.9-7.7), chronic skin disease (2.9; 1.5-5.8), wounds/ulcers (2.4; 1.5-4.0), recent hospitalization (2.2; 1.5-3.3), diabetes (1.6, 1.02-2.5), and age >70 years (1.5; 1.03-2.3). However, risk factors varied between centres. The c-statistic for the common prediction rule for all centres was 0.64, indicating limited predictive power. CONCLUSIONS Risk profiles for MRSA carriers vary between surgical wards in European countries. Identifying local risk factors is important, as a common European prediction rule was found to be of limited clinical value.
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Affiliation(s)
- A Pan
- Istituti Ospitalieri di Cremona, Cremona, Italy.
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MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2012; 41:33-40. [DOI: 10.1007/s15010-012-0290-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
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Backman C, Marck PB, Krogman N, Taylor G, Sales A, Bonten MJM, Gigengack-Baars ACM. Barriers and bridges to infection prevention and control: results of a qualitative case study of a Netherlands' surgical unit. BMJ Open 2012; 2:e000511. [PMID: 22397818 PMCID: PMC3298832 DOI: 10.1136/bmjopen-2011-000511] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2011] [Accepted: 02/09/2012] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES The objectives of the study are to observe the overall work environment including infection prevention and control (IP&C) practices on the target surgical unit; to analyse the policies and procedures in the hospital and unit environments; to analyse the barriers and bridges to IP&C that practitioners identify in visual narratives of their unit environment and to collect monthly specific IP&C-related anonymised data. DESIGN In this qualitative case study analysis, a socio-ecological approach on health systems informed the research design and provided a framework to better understand the complexity of implementing effective IP&C. SETTING The study was conducted on a surgical unit at a Netherlands' hospital that reported successful reductions in the prevalence of targeted multidrug-resistant organisms. METHODS Research methods included unit observations (n=3), review of relevant policies and procedures, five practitioner-led photo walkabouts of the unit (n=7), three photo elicitation focus groups with practitioners (n=13) and the review of related IP&C data. RESULTS The findings indicate some conditions and processes present that may influence the low prevalence of multidrug-resistant organisms, including the 'search and destroy' active surveillance strategy, low occupancy rates, a centralised bed cleaning system and the presence of an active grass roots Hygiene in Practice group, which engages practitioners in several ongoing activities to promote IP&C on the units. CONCLUSIONS Further research on the benefits of practitioner-led community of practices on IP&C practices such as the Hygiene in Practice group is also recommended. Additional case studies to compare theses practices with other acute care hospital around the world would be a valuable way to better understand what IP&C programmes are most effective in which contexts and for what reasons. Further data are available by contacting the primary author directly.
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Affiliation(s)
| | - Patricia B Marck
- Faculty of Health and Social Development, University of British Columbia, Okanagan
| | - Naomi Krogman
- Department of Rural Economy, University of Alberta, Edmonton, Alberta, Canada
| | - Geoff Taylor
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Anne Sales
- Veterans Affairs Inpatient Evaluation Center, Ann Arbor Hospital, Ann Arbor, Michigan, USA
| | - Marc J M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Ada C M Gigengack-Baars
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Coutinho H, Costa J, Falcão-Silva V, Siqueira-Júnior J, Lima E. Fruits to potentiate the antibiotic activity: The effect of Eugenia unifloraand Eugenia jambolanumL. against MRSA. ACTA ALIMENTARIA 2012. [DOI: 10.1556/aalim.2011.0004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Simor AE. Staphylococcal decolonisation: an effective strategy for prevention of infection? THE LANCET. INFECTIOUS DISEASES 2012; 11:952-62. [PMID: 22115070 DOI: 10.1016/s1473-3099(11)70281-x] [Citation(s) in RCA: 77] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Staphylococcus aureus decolonisation--treatment to eradicate staphylococcal carriage--is often considered as a measure to prevent S aureus infection. The most common approach to decolonisation has been intranasal application of mupirocin either alone or in combination with antiseptic soaps or systemic antimicrobial agents. Some data support the use of decolonisation in surgical patients colonised with S aureus, particularly in those undergoing cardiothoracic procedures. Although this intervention has been associated with low rates of postoperative S aureus infection, whether overall rates of infection are also decreased is unclear. Patients undergoing chronic haemodialysis or peritoneal dialysis might benefit from decolonisation, although repeated courses of treatment are needed, and the effects are modest. Eradication of meticillin-resistant S aureus (MRSA) carriage has generally been difficult, and the role of decolonisation as an MRSA infection control measure is uncertain. The efficacy of decolonisation of patients with community-associated MRSA has not been established, and the routine use of decolonisation of non-surgical patients is not supported by data.
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Affiliation(s)
- Andrew E Simor
- Department of Microbiology and the Division of Infectious Diseases, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
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Cunha FAB, Matias EFF, Brito SV, Ferreira FS, Braga JMA, Costa JGM, Coutinho HDM. Phytochemical screening, antibacterial activity and in vitro interactions between Costus cf. arabicus L. with UV-A and aminoglycosides. Nat Prod Res 2011; 26:380-6. [PMID: 21995884 DOI: 10.1080/14786419.2010.545776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In this study, the methanol extracts of of Costus cf. arabicus L. were evaluated for antibacterial activity against multiresistant strains of Escherichia coli and Staphylococcus aureus. The antibacterial and modulatory activity of the extracts was assayed by microdilution. The light-enhanced antibacterial activity was assayed by light regimen. The growth of the bacteria tested was not inhibited by the extracts. The minimum inhibitory concentration (MIC) values ranged from 512 to ≥1024 µg·m L(-1). However, the antibiotic activity of the aminoglycosides was synergistically enhanced when these extracts were associated in sub-inhibitory concentrations with the antibiotics. Both extracts showed activity against at two standard bacterial strains. Because of this, we suggest that the ethanol extracts of the stems and leaves of Costus cf. arabicus L. show potential antibacterial, light-induced and synergistic antibiotic activity. With such results, these extracts are proven to be a promising source of antibacterial and modulatory agents.
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Affiliation(s)
- Francisco A B Cunha
- Laboratório de Microbiologia e Biologia Molecular, Universidade Regional do Cariri, Crato (CE), Brazil
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Kateete DP, Namazzi S, Okee M, Okeng A, Baluku H, Musisi NL, Katabazi FA, Joloba ML, Ssentongo R, Najjuka FC. High prevalence of methicillin resistant Staphylococcus aureus in the surgical units of Mulago hospital in Kampala, Uganda. BMC Res Notes 2011; 4:326. [PMID: 21899769 PMCID: PMC3184088 DOI: 10.1186/1756-0500-4-326] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 09/07/2011] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND There is limited data on Methicillin resistant Staphylococcus aureus (MRSA) in Uganda where, as in most low income countries, the routine use of chromogenic agar for MRSA detection is not affordable. We aimed to determine MRSA prevalence among patients, healthcare workers (HCW) and the environment in the burns units at Mulago hospital, and compare the performance of CHROMagar with oxacillin for detection of MRSA. RESULTS One hundred samples (from 25 patients; 36 HCW; and 39 from the environment, one sample per person/item) were cultured for the isolation of Staphylococcus aureus. Forty one S. aureus isolates were recovered from 13 patients, 13 HCW and 15 from the environment, all of which were oxacillin resistant and mecA/femA/nuc-positive. MRSA prevalence was 46% (41/89) among patients, HCW and the environment, and 100% (41/41) among the isolates. For CHROMagar, MRSA prevalence was 29% (26/89) among patients, HCW and the environment, and 63% (26/41) among the isolates. There was high prevalence of multidrug resistant isolates, which concomitantly possessed virulence and antimicrobial resistance determinants, notably biofilms, hemolysins, toxin and ica genes. One isolate positive for all determinants possessed the bhp homologue which encodes the biofilm associated protein (BAP), a rare finding in human isolates. SCCmec type I was the most common at 54% prevalence (22/41), followed by SCCmec type V (15%, 6/41) and SCCmec type IV (7%, 3/41). SCCmec types II and III were not detected and 10 isolates (24%) were non-typeable. CONCLUSIONS Hyper-virulent methicillin resistant Staphylococcus aureus is prevalent in the burns unit of Mulago hospital.
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Affiliation(s)
- David P Kateete
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Sylvia Namazzi
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
- Department of Veterinary Parasitology and Microbiology, School of Veterinary Medicine, Makerere University, Kampala, Uganda
| | - Moses Okee
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Alfred Okeng
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Hannington Baluku
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Nathan L Musisi
- Department of Veterinary Parasitology and Microbiology, School of Veterinary Medicine, Makerere University, Kampala, Uganda
| | - Fred A Katabazi
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Moses L Joloba
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| | - Robert Ssentongo
- Division of Plastic Surgery, Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Florence C Najjuka
- Department of Medical Microbiology, School of Biomedical Sciences, Makerere University College of Health Sciences, Kampala, Uganda
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Cunha FA, Matias EF, Brito SV, Ferreira FS, Braga JMA, Costa JG, Coutinho HD. In Vitro Antibacterial, Phototoxic, and Synergistic Activity of Ethanol Extracts from Costus cf. arabicus L. J Med Food 2011; 14:964-8. [DOI: 10.1089/jmf.2010.0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- Francisco A.B. Cunha
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri, Crato, Ceará State, Brazil
| | - Edinardo F.F. Matias
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri, Crato, Ceará State, Brazil
| | - Samuel V. Brito
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri, Crato, Ceará State, Brazil
| | - Felipe S. Ferreira
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri, Crato, Ceará State, Brazil
| | | | - José G.M. Costa
- Laboratory of Natural Products Research, Regional University of Cariri, Crato, Ceará State, Brazil
| | - Henrique D.M. Coutinho
- Laboratory of Microbiology and Molecular Biology, Regional University of Cariri, Crato, Ceará State, Brazil
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Sun C, Falagas ME, Wang R, Karageorgopoulos DE, Yu X, Liu Y, Cai Y, Liang B, Song X, Liu Z. In vitro activity of minocycline combined with fosfomycin against clinical isolates of methicillin-resistant Staphylococcus aureus. J Antibiot (Tokyo) 2011; 64:559-62. [PMID: 21772306 DOI: 10.1038/ja.2011.52] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study aimed to evaluate the in vitro activity of minocycline combined with fosfomycin against isolates of methicillin-resistant Staphylococcus aureus (MRSA). A total of 87 clinical isolates of MRSA collected from three Chinese hospitals were included in the study. The checkerboard method with determination of the fractional IC index (FICI) was used to determine whether antibiotic combinations act synergistically against these isolates. The susceptibility results for minocycline and fosfomycin were interpreted according to the most relevant criteria. The results demonstrated the following interactions: 76 isolates (87.4%) showed synergistic interactions (FICI0.5) and 11 isolates (12.6%) showed indifferent interactions (0.5<FICI<4). No antagonistic interactions (FICI4) were observed. The combination of minocycline and fosfomycin can be synergistic against MRSA. Further studies are required to determine the potential clinical role of this combination regimen as a therapeutic alternative for certain types of MRSA infections.
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Affiliation(s)
- Chunguang Sun
- Department of Clinical Pharmacology, Chinese PLA General Hospital, Beijing, China
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43
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Modulación de la resistencia a norfloxacina de Staphylococcus aureus por Croton A. campestris y Ocimum gratissimum L. BIOMEDICA 2011. [DOI: 10.7705/biomedica.v31i4.409] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mody L, Bradley SF, Galecki A, Olmsted RN, Fitzgerald JT, Kauffman CA, Saint S, Krein SL. Conceptual model for reducing infections and antimicrobial resistance in skilled nursing facilities: focusing on residents with indwelling devices. Clin Infect Dis 2011; 52:654-61. [PMID: 21292670 DOI: 10.1093/cid/ciq205] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Infections in skilled nursing facilities (SNFs) are common and result in frequent hospital transfers, functional decline, and death. Colonization with multidrug-resistant organisms (MDROs) - including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacilli (R-GNB) - is also increasingly prevalent in SNFs. Antimicrobial resistance among common bacteria can adversely affect clinical outcomes and increase health care costs. Recognizing a need for action, legislators, policy-makers, and consumer groups are advocating for surveillance cultures to identify asymptomatic patients with MDROs, particularly MRSA in hospitals and SNFs. Implementing this policy for all SNF residents may be costly, impractical, and ineffective. Such a policy may result in a large increase in the number of SNF residents placed in isolation precautions with the potential for reduced attention by health care workers, isolation, and functional decline. Detection of colonization and subsequent attempts to eradicate selected MDROs can also lead to more strains with drug resistance. We propose an alternative strategy that uses a focused multicomponent bundle approach that targets residents at a higher risk of colonization and infection with MDROs, specifically those who have an indwelling device. If this strategy is effective, similar strategies can be studied and implemented for other high-risk groups.
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Affiliation(s)
- Lona Mody
- Division of Geriatric Medicine, Veterans Affairs Ann Arbor Health Service Research and Development Center of Excellence, Ann Arbor, MI 48105, USA.
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45
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Matias EF, Santos KK, Almeida TS, Costa JG, Coutinho HD. Phytochemical screening and modulation of antibiotic activity by Ocimum gratissimum L. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.bionut.2010.09.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Matias E, Santos K, Almeida T, Costa J, Coutinho H. Phytochemical Prospection and Modulation of Aminoglycoside Antibiotic Activity by Croton campestris A. Chemotherapy 2011; 57:305-9. [DOI: 10.1159/000328975] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 01/13/2011] [Indexed: 11/19/2022]
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Matias EFF, Santos KKA, Almeida TS, Costa JGM, Coutinho HDM. WITHDRAWN: Phytochemical screening and modulation of antibiotic activity by Ocimum gratissimum L. Biomed Pharmacother 2010:S0753-3322(10)00182-4. [PMID: 21115320 DOI: 10.1016/j.biopha.2010.09.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2010] [Accepted: 09/30/2010] [Indexed: 11/25/2022] Open
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.bionut.2010.09.007. The duplicate article has therefore been withdrawn.
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Affiliation(s)
- Edinardo F F Matias
- Laboratório de Microbiologia e Biologia Molecular, Departamento de Ciências Biológicas (DCB), Universidade Regional do Cariri (URCA), Rua Cel. Antonio Luis 1161, Pimenta 63105-000, Crato (CE), Brazil
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Coutinho HDM, Costa JGM, Falcão-Silva VS, Siqueira-Júnior JP, Lima EO. In vitro additive effect of Hyptis martiusii in the resistance to aminoglycosides of methicillin-resistant Staphylococcus aureus. PHARMACEUTICAL BIOLOGY 2010; 48:1002-1006. [PMID: 20731551 DOI: 10.3109/13880200903382686] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
CONTEXT Bacterial infectious agents represent a risk to populations, where they are responsible for the high morbidity and mortality. In combating these pathogens, our main line of defense is the use of antibiotics. However, the indiscriminate use of these drugs select resistant strains to these same drugs. OBJECTIVE In this study the ethanol extract of Hyptis martiusii Benth. (EEHM) (Lamiaceae) was tested for its antimicrobial activity against aminoglycoside multi-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS In this study, the ethanol extract of H. martiusii was prepared and tested with chlorpromazine for its antimicrobial activity using the microdilution method. Chlorpromazine and the ethanol extract were used alone and also in combination with aminoglycosides against a MRSA strain resistant to these antibiotics to determine the participation of efflux systems in resistance mechanisms. The FIC index was calculated and evaluated by the checkerboard method. RESULTS A potentiating effect between this extract and aminoglycosides was demonstrated. Similarly, a potentiating effect of chlorpromazine with kanamycin was detected, indicating the involvement of an efflux system in the resistance to this aminoglycoside. The checkerboard method with combinations of aminoglycosides and EEHM demonstrated additive effect with kanamycin and gentamicin. It is therefore suggested that extracts from H. martiusii could be used as a source of plant-derived natural products with resistance- modifying activity. CONCLUSION This is the first report about the modifying antibiotic activity of Hyptis martiusii, constituting a new approach against bacterial resistance to antibiotics as aminoglycosides.
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Affiliation(s)
- Henrique D M Coutinho
- Laboratory of Research in Natural Products, University of the Region of Cariri, Crato, CE, Brazil.
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Sousa EO, Silva NF, Rodrigues FFG, Campos AR, Lima SG, Costa JGM. Chemical composition and resistance-modifying effect of the essential oil of Lantana camara Linn. Pharmacogn Mag 2010; 6:79-82. [PMID: 20668570 PMCID: PMC2900066 DOI: 10.4103/0973-1296.62890] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 02/03/2010] [Accepted: 05/05/2010] [Indexed: 11/24/2022] Open
Abstract
In this work, the chemical constituents, antibacterial and modulatory activities of the essential oil of Lantana camara Linn were studied. The essential oil was extracted from the leaves of L. camara by hydrodistillation method using Clevenger's apparatus and its chemical constituents were separated and identified by GC-MS, and the relative content of each constituent was determined by area normalization. Among the 25 identified components, bicyclogermacrene (19.42%), isocaryophyllene (16.70%), valecene (12.94%) and germacrene D (12.34%) were the main constituents. The oil was examined to antibacterial and modulatory activities against the multiresistant strains of Escherichia coli and Staphylococcus aureus by microdilution test. The results show an inhibitory activity to E. coli (MIC 512 μg/ml) and S. aureus (MIC 256 μg/ml). The synergism of the essential oil and aminoglycosides was verified too, with significant reduction of MICs (7 ×, 1250-5 μg/ml) against E. coli. It is suggested that the essential oil of Lantana camara Linn could be used as a source of plant-derived natural products with resistance-modifying activity.
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Affiliation(s)
- Erlânio O Sousa
- Programa de Pós-Graduação em Bioprospecção Molecular, Departamento de Química Biológica, Laboratório de Pesquisa de Produtos Naturais, Universidade Regional do Cariri, Rua Cel. Antônio Luiz 1161, Pimenta, 63105-000, Crato-CE, Brazil
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Population structure of Staphylococcus aureus strains isolated from intensive care unit patients in the netherlands over an 11-year period (1996 to 2006). J Clin Microbiol 2009; 47:4090-5. [PMID: 19812275 DOI: 10.1128/jcm.00820-09] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
The genetic background and the presence of several virulence factors of Staphylococcus aureus isolates from intensive care unit (ICU) patients from 14 hospitals in The Netherlands isolated from 1996 until 2006 were investigated. In total, 936 methicillin-susceptible S. aureus (MSSA) and 7 methicillin-resistant S. aureus (MRSA) isolates were collected. The genetic background was determined by spa typing and multilocus sequence typing (MLST). The virulence determinants Panton-Valentine leukocidin (PVL), toxic shock syndrome toxin 1 (TSST-1), and collagen adhesion (CNA) were detected with real-time PCR assays. On the MRSA isolates, mobile resistance staphylococcal cassette chromosome mec (SCCmec) typing was performed. Among the MSSA isolates, 313 different spa types were observed. A genetic background common to MRSA clones, e.g., MLST clonal complex 1 (CC1), CC5, CC8, CC22, CC30, and CC45, was observed among 62% of the isolates. The remaining isolates were associated with MSSA-related MLST CCs. MLST CC1, CC25, and CC30 were continuously present, and other MLST CCs fluctuated over time. Two percent of the MSSA isolates harbored PVL, 21% had TSST-1, and 46% were positive for CNA. There were no changes in the prevalence of the virulence factors over time. Four MRSA isolates were typed as ST8-MRSA-IV (where ST is the MLST sequence type and IV is the SCCmec type), two were ST5-MRSA-II, and one was ST228-MRSA-I. All MRSA isolates were PVL, CNA, and TSST-1 negative except for the two ST5-MRSA-II isolates, which were TSST-1 positive. No changes in the S. aureus genetic background and the prevalence of the virulence factors PVL, CNA, and TSST-1 were observed in ICU patients in The Netherlands over time.
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