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Novel Designed Surgical Drapes Reducing Fluid Permeability in the Surgical Critical Area of a Sterile Operation Interface: A Randomized Controlled Trial. J Nurs Manag 2023. [DOI: 10.1155/2023/9295307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Aim. To compare the impact and cost effects of medical long fiber polyester drapes and cotton fabric drapes on operative sterile operation interfaces. Background. The comparison of the properties of the commonly used surgical drapes materials in terms of leakage, device slip, and prevention of intraoperative adverse events is not clear. Method. A prospective randomized controlled study was conducted in the operating room of a tertiary hospital in Chengdu, China. A total of 400 patients who underwent urology surgery were enrolled and randomly divided into two groups by computer, the study group (200 cases) selected the new long-fiber polyester cloth, while the control group (200 cases) selected conventional cotton fabric surgical drapes during the operation to maintain a sterile operating interface. The impermeability and water absorption of surgical drapes, the rate of device slip and skin scald in surgical patients, and the cost effect of the two kinds of surgical drapes were compared. Results. The long fiber polyester surgical drapes were superior to conventional cotton cloth in water absorption (g/m2) (835 ± 15.8 VS 225 ± 21.0, t = 328.261,
), preventing surgical site infections (2.5% VS 8.0%, χ2 = 6.081,
), device slip (7.5% VS 17.0%, χ2 = 8.396,
), patients from burning (0 VS 1, Fisher
), and total cost per use ($) (0.83 VS 0.96–1.09). Conclusion. Long fiber polyester fabric has a stronger antipenetration ability of fluid and microorganisms thus forming an effective protective barrier. It also has strong hygroscopicity, and its special design can prevent the occurrence of sliding of surface instruments and skin scald in patients. In addition, its cost effect is superior. Implications for Nursing Management. Operating room nursing managers can introduce long fiber polyester drapes into the selection of medical textiles to construct aseptic surgical barriers and prevent surgical site infection.
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Phenotypic and genotypic characteristics of Acinetobacter baumannii enrolled in the relationship among antibiotic resistance, biofilm formation and motility. Microb Pathog 2021; 155:104922. [PMID: 33932545 DOI: 10.1016/j.micpath.2021.104922] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 04/02/2021] [Accepted: 04/02/2021] [Indexed: 12/30/2022]
Abstract
Acinetobacter baumannii is an important pathogen in clinical. The factors of biofilm formation, antibiotic resistance and motility contribute great to A. baumannii in persisting in stressed environment, and further leads to nosocomial infections. 70 A. baumannii clinical isolates were investigated for their clinical characteristics of infection. Among the tested strains, 54 (77.1%) isolates were obtained from ICUs, with the frequency of multidrug-resistance (MDR) at 55.7%, and that of extensively drug-resistance (XDR) at 31.4%. 97.1% of the clinical isolates could form biofilms, in which 4.3% possessed weak biofilm formation ability, while 41.4% and 51.4% were moderate and strong biofilm producers, respectively. A strong correlation between antibiotic resistance and biofilm formation ability was found that all the resistant strains could form biofilms, with the majority in moderate and strong levels, but 2.9% sensitive isolates had no such ability. However, the sensitive strains that could produce biofilms showed stronger biofilm formation capacity in the early stage before 24 h compared to the resistant isolates, though they became weaker afterwards. 24 biofilm-related genes and two blaOXA genes were found in both biofilm-forming and non-biofilm-forming strains, but with higher prevalence in the strains that could produce biofilms. No correlation was detected between twitching motility with antibiotic susceptibility or biofilm formation. These results raised a viewpoint that examining timepoint is a key factor for determining the biofilm formation ability, and further highlighted the importance of the appropriate surveillance and control measures in preventing the emergence and transmission of MDR and XDR A. baumannii.
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de Mello MS, Oliveira AC. Overview of the actions to combat bacterial resistance in large hospitals. Rev Lat Am Enfermagem 2021; 29:e3407. [PMID: 33852679 PMCID: PMC8040782 DOI: 10.1590/1518-8345.3952.3407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/01/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE to analyze, in the clinical practice of large hospitals, how the adoption of measures to prevent and control the spread of bacterial resistance has occurred, and to propose a score for the institutions' adherence. METHOD a cross-sectional study carried out in 30 large hospitals of Minas Gerais, from February 2018 to April 2019, after approval by the Ethics and Research Committee. Interviews were conducted with hospital managers, with Hospital Infection Control Services coordinators, and with the care coordinators of the Inpatient Units and Intensive Care Center. In addition, observations were made of the adoption of preventive measures by the multidisciplinary team in the care units. RESULTS in the 30 participating hospitals, 93.3% (N=28) had protocols for prophylactic antibiotics, and 86.7% (N=26) performed their audit, 86.7% (N=26) for therapeutic antibiotics and 83.3% (N=25) their audit; 93.3% (N=56) used gloves and cloaks for patients in contact precautions, and 78.3% (N=47) of the professionals were unaware of or answered incompletely on the five moments for hand hygiene. In the score to identify the adoption of measures to control bacterial resistance, 83.3% (N=25) of the hospitals were classified as partially compliant, 13.3% (N=04) as deficient, and 3.4% (N=01) as non-adoption. CONCLUSION it was found that the recommended measures to contain bacterial resistance are not consolidated in the clinical practice of the hospitals.
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Affiliation(s)
- Mariana Sanches de Mello
- Universidade Federal de Minas Gerais, Escola de Enfermagem, Belo Horizonte, MG, Brazil
- Hospital Socor, Belo Horizonte, Minas Gerais, Brazil
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Microbial Predominance and Antimicrobial Resistance in a Tertiary Hospital in Northwest China: A Six-Year Retrospective Study of Outpatients and Patients Visiting the Emergency Department. ACTA ACUST UNITED AC 2020; 2020:8838447. [PMID: 33312315 PMCID: PMC7719506 DOI: 10.1155/2020/8838447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 10/28/2020] [Indexed: 11/18/2022]
Abstract
Background With the wide use of antibiotics, antimicrobial resistance becomes a serious issue. Timely understanding of microbial pathogen profiles and the change of antimicrobial resistance provide an important guidance for effective and optimized use of antibiotics in local healthcare systems. The aim was to investigate the characteristics of microbial species and their antimicrobial resistances in a tertiary hospital with an Emergency Department and outpatient clinics for a period of six years. Methodology. A retrospective study was conducted using the HIS database of a tertiary hospital between 2013 and 2018. Antimicrobial susceptibility was tested by automated systems and/or the Kirby-Bauer disc diffusion method. The data were analyzed using the WHONET 5.6 software. The Cochran-Armitage test was used to study the trends over the period of research. Results In a total of 19,028 specimens submitted for microbial tests during the period from 49 units of the hospital, only the samples from the Emergency Department and Kidney Transplantation Clinic showed an annually significant increase (P < 0.001). More than 200 species with 46.4% gram-positive cocci and 45.3% gram-negative bacilli were identified in the 3,849 nonrepetitive isolates. The methicillin-resistant S. aureus and S. epidermidis rates were 25.1% and 74.6%, respectively. 60.9% E. coli and 33.5% K. pneumonia samples carried extended-spectrum-β-lactamase. All Staphylococci and Enterococci samples were not resistant to linezolid, vancomycin, and tigecycline. In addition, only 0.01% E. coli, 1.1% K. pneumonia, and 18.7% P. aeruginosa isolates showed resistance to carbapenems. Conclusions Vancomycin, linezolid and tigecycline were the most effective antibiotics for outpatients with gram-positive infection. Carbapenems were the most effective antibiotics for gram-negative infection. There was no significant annual increase of common multidrug resistances.
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5
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Lorenzin G, Scaltriti E, Gargiulo F, Caccuri F, Piccinelli G, Gurrieri F, Caruso A, De Francesco MA. Extensively drug-resistant Acinetobacter baumannii isolated from intensive care units in northern Italy: a genomic approach to characterize new sequence types. Future Microbiol 2019; 14:1281-1292. [PMID: 31638422 DOI: 10.2217/fmb-2019-0083] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Aim: This study aims to characterize clinical strains of Acinetobacter baumannii with an extensively drug-resistant phenotype. Methods: VITEK® 2, Etest® method and broth microdilution method for colistin were used. PCR analysis and multilocus sequence typing Pasteur scheme were performed to identify bla-OXA genes and genetic relatedness, respectively. Whole-genome sequencing analysis was used to characterize three isolates. Results: All the isolates were susceptible only to polymyxins. blaOXA-23-like gene was the only acquired carbapenemase gene in 88.2% of the isolates. Multilocus sequence typing identified various sequence types: ST2, ST19, ST195, ST577 and ST632. Two new sequence types, namely, ST1279 and ST1280, were detected by whole-genome sequencing. Conclusion: This study showed that carbapenem-resistant A. baumannii isolates causing infections in intensive care units almost exclusively produce OXA-23, underlining their frequent spread in Italy.
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Affiliation(s)
- Giovanni Lorenzin
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy.,Institute of Microbiology & Virology, Department of Biomedical, Surgical & Dental Sciences, University of Milan, Italy
| | - Erika Scaltriti
- Risk Analysis & Genomic Epidemiology Unit, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia Romagna, Parma, Italy
| | - Franco Gargiulo
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
| | - Francesca Caccuri
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
| | - Giorgio Piccinelli
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
| | - Francesca Gurrieri
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
| | - Maria Antonia De Francesco
- Institute of Microbiology, Department of Molecular & Translational Medicine, University of Brescia-Spedali Civili, Brescia, Italy
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Ahmad S, Shaker B, Ahmad F, Raza S, Azam SS. Moleculer dynamics simulaiton revealed reciever domain of Acinetobacter baumannii BfmR enzyme as the hot spot for future antibiotics designing. J Biomol Struct Dyn 2018; 37:2897-2912. [DOI: 10.1080/07391102.2018.1498805] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sajjad Ahmad
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Bilal Shaker
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Faisal Ahmad
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Saad Raza
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
| | - Syed Sikander Azam
- Computational Biology Lab, National Center for Bioinformatics, Quaid-i-Azam University, Islamabad, Pakistan
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7
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Chin CY, Tipton KA, Farokhyfar M, Burd EM, Weiss DS, Rather PN. A high-frequency phenotypic switch links bacterial virulence and environmental survival in Acinetobacter baumannii. Nat Microbiol 2018; 3:563-569. [PMID: 29693659 PMCID: PMC5921939 DOI: 10.1038/s41564-018-0151-5] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2017] [Accepted: 03/22/2018] [Indexed: 12/30/2022]
Abstract
Antibiotic resistant infections lead to 700,000 deaths per year worldwide1. The roles of phenotypically diverse subpopulations of clonal bacteria in the progression of diseases are unclear. We found that the increasingly pathogenic and antibiotic resistant pathogen, Acinetobacter baumannii, harbors a highly virulent subpopulation of cells responsible for disease. This virulent subpopulation possesses a thicker capsule and is resistant to host antimicrobials, which drive its enrichment during infection. Importantly, bacteria harvested from the bloodstream of human patients belong exclusively to this virulent subpopulation. Furthermore, the virulent form exhibits increased resistance to hospital disinfectants and desiccation, indicating a role in environmental persistence and the epidemic spread of disease. We identified a transcriptional “master regulator” of the switch between avirulent and virulent cells, and whose overexpression abrogated virulence. Further, the overexpression strain vaccinated mice against lethal challenge. This work highlights a phenotypic subpopulation of bacteria that drastically alters the outcome of infection, and illustrates how knowledge of the regulatory mechanisms controlling such phenotypic switches can be harnessed to attenuate bacteria and develop translational interventions.
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Affiliation(s)
- Chui Yoke Chin
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA.,Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA, USA.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA
| | - Kyle A Tipton
- Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Eileen M Burd
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA.,Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA.,Department of Pathology and Laboratory Medicine, Emory University, Atlanta, GA, USA
| | - David S Weiss
- Emory Vaccine Center, Emory University School of Medicine, Atlanta, GA, USA. .,Yerkes National Primate Research Center, Emory University School of Medicine, Atlanta, GA, USA. .,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA. .,Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA. .,Research Service, Atlanta VA Medical Center, Decatur, GA, USA.
| | - Philip N Rather
- Emory Antibiotic Resistance Center, Emory University School of Medicine, Atlanta, GA, USA. .,Department of Microbiology and Immunology, Emory University School of Medicine, Atlanta, GA, USA. .,Research Service, Atlanta VA Medical Center, Decatur, GA, USA.
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Skariyachan S, Manjunath M, Bachappanavar N. Screening of potential lead molecules against prioritised targets of multi-drug-resistant-Acinetobacter baumannii - insights from molecular docking, molecular dynamic simulations and in vitro assays. J Biomol Struct Dyn 2018. [PMID: 29529934 DOI: 10.1080/07391102.2018.1451387] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Acinetobacter baumannii, an opportunistic pathogen, has become multi-drug resistant (MDR) to major classes of antibacterial and poses grave threat to public health. The current study focused to screen novel phytotherapeutics against prioritised targets of Acinetobacter baumannii by computational investigation. Fourteen potential drug targets were screened based on their functional role in various biosynthetic pathways and the 3D structures of 9 targets were retrieved from Protein Data Bank and others were computationally predicted. By extensive literature survey, 104 molecules from 48 herbal sources were screened and subjected to virtual screening. Ten clinical isolates of A. baumannii were tested for antibiotic susceptibility towards clinafloxacin, imipenem and polymyxin-E. Computational screening suggested that Ajmalicine ((19α)-16, 17-didehydro-19-methyloxayohimban-16-carboxylic acid methyl ester from Rauwolfia serpentina), Strictamin (Akuammilan-17-oic acid methyl ester from Alstonia scholaris) and Limonin (7, 16-dioxo-7, 16-dideoxylimondiol from Citrus sps) exhibited promising binding towards multiple drug targets of A. baumannii in comparison with the binding between standard drugs and their targets. Limonin displayed promising binding potential (binding energy -9.8 kcal/mol) towards diaminopimelate epimerase (DapF) and UDP-N-acetylglucosamine 1-carboxyvinyltransferase (MurA). Ajmalicine and Strictamin demonstrated good binding potential (-9.5, -8.5 kcal/mol, respectively) towards MurA and shikimate dehydrogenase (-7.8 kcal/mol). Molecular dynamic simulations further validated the docking results. In vitro assay suggested that the tested isolates exhibited resistance to clinafloxacin, imipenem and polymyxin-E and the herbal preparations (crude extract) demonstrated a significant antibacterial potential (p ≤ .05). The study suggests that the aforementioned lead candidates and targets can be used for structure-based drug screening towards MDR A. baumannii.
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Affiliation(s)
- Sinosh Skariyachan
- a Department of Biotechnology Engineering , Dayananda Sagar Institutions , Bengaluru 560 078 , Karnataka , India.,b Visvesvaraya Technological University , Belagavi , India
| | - Meghna Manjunath
- a Department of Biotechnology Engineering , Dayananda Sagar Institutions , Bengaluru 560 078 , Karnataka , India.,b Visvesvaraya Technological University , Belagavi , India
| | - Nikhil Bachappanavar
- a Department of Biotechnology Engineering , Dayananda Sagar Institutions , Bengaluru 560 078 , Karnataka , India.,b Visvesvaraya Technological University , Belagavi , India
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9
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Salehi B, Goudarzi H, Nikmanesh B, Houri H, Alavi-Moghaddam M, Ghalavand Z. Emergence and characterization of nosocomial multidrug-resistant and extensively drug-resistant Acinetobacter baumannii isolates in Tehran, Iran. J Infect Chemother 2018; 24:515-523. [PMID: 29555392 DOI: 10.1016/j.jiac.2018.02.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 02/01/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
RATIONALE Acinetobacter baumannii is one of the antibiotic-resistant superbugs that threatens hospitalized patients. Emergence and spread of the multidrug-resistant (MDR) and extensively drug-resistant (XDR) clones cause erratic outbreaks following environmental contamination of hospital settings. OBJECTIVE The present study intended to characterize the antimicrobial resistant profiles and the genotypes of clinical and environmental isolates of A. baumannii as a result of dissemination of resistant strains. METHODS Clinical and environmental isolates of A. baumannii were obtained from patients, staff, and environment of an educational hospital in Tehran. Antimicrobial susceptibility testing was carried out using the disk diffusion and E-test methods. Multiplex PCR was performed for detection of OXA-type genes (blaOXA-23-like, blaOXA-24-like, blaOXA-58-like, and blaOXA-51-like). Genotypic relatedness of the isolates was achieved using repetitive extragenic palindromic element PCR (Rep-PCR) technique. RESULTS All the isolates were found to be susceptible to colistin and most of them (77%) were non-susceptible to tigecycline. A majority of the clinical and environmental isolates (97%) were considered as MDR strains and 41% as XDR. In multiplex detection, blaOXA-23-like was found in 54% of the isolates, which was the most frequent OXA-type gene. In addition, the frequency of the carbapenem-resistant A. baumannii (CRAB) was observed to be high (96%). In addition, molecular typing showed different Rep patterns of clinical isolates and clonal spread of environmental isolates. CONCLUSION The present study highlights the circulation of drug-resistant A. baumannii strains in different wards of hospitals principally in intensive care unit (ICU) as a nosocomial pathogen due to unwise managements.
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Affiliation(s)
- Bahare Salehi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hossein Goudarzi
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahram Nikmanesh
- Department of Medical Laboratory Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamidreza Houri
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Zohreh Ghalavand
- Department of Microbiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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10
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Zhang YY, Liang ZX, Li CS, Chang Y, Ma XQ, Yu L, Chen LA. Whole-Genome Analysis of an Extensively Drug-Resistant Acinetobacter baumannii Strain XDR-BJ83: Insights into the Mechanisms of Resistance of an ST368 Strain from a Tertiary Care Hospital in China. Microb Drug Resist 2018; 24:1259-1270. [PMID: 29489445 DOI: 10.1089/mdr.2017.0246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Acinetobacter baumannii is an important pathogen of nosocomial infections. Nosocomial outbreaks caused by antibiotic-resistant A. baumannii remain a significant challenge. Understanding the antibiotic resistance mechanism of A. baumannii is critical for clinical treatment. The purpose of this study was to determine the whole-genome sequence (WGS) of an extensively drug-resistant (XDR) A. baumannii strain, XDR-BJ83, which was associated with a nosocomial outbreak in a tertiary care hospital of China, and to investigate the antibiotic resistance mechanism of this strain. The WGS of XDR-BJ83 was performed using single-molecule real-time sequencing. The complete genome of XDR-BJ83 consisted of a 4,011,552-bp chromosome and a 69,069-bp plasmid. The sequence type of XDR-BJ83 was ST368, which belongs to clonal complex 92 (CC92). The chromosome of XDR-BJ83 carried multiple antibiotic resistance genes, antibiotic efflux pump genes, and mobile genetic elements, including insertion sequences, transposons, integrons, and resistance islands. The plasmid of XDR-BJ83 (pBJ83) was a conjugative plasmid carrying type IV secretion system. These results indicate that the presence of multiple antibiotic resistance genes, efflux pumps, and mobile genetic elements is likely associated with resistance to various antibiotics in XDR-BJ83.
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Affiliation(s)
- Yang-Yang Zhang
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China .,2 Department of Respiratory Medicine, Affiliated Hospital of Chengde Medical University , Chengde, China
| | - Zhi-Xin Liang
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China
| | - Chun-Sun Li
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China
| | - Yan Chang
- 3 Department of Respiratory Medicine, The General Hospital of the PLA Rocket Force , Beijing, China
| | - Xiu-Qing Ma
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China
| | - Ling Yu
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China
| | - Liang-An Chen
- 1 Department of Respiratory Medicine, Chinese PLA General Hospital , Beijing, China
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11
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Abstract
PURPOSE OF REVIEW Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. RECENT FINDINGS Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. SUMMARY Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.
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12
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Cheng VCC, Wong SC, Chen JHK, So SYC, Wong SCY, Ho PL, Yuen KY. Control of multidrug-resistant Acinetobacter baumannii in Hong Kong: Role of environmental surveillance in communal areas after a hospital outbreak. Am J Infect Control 2018; 46:60-66. [PMID: 28893447 DOI: 10.1016/j.ajic.2017.07.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/14/2017] [Accepted: 07/14/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Environmental reservoir is an important source of multidrug-resistant Acinetobacter baumannii (MRAB) outbreaks. The role of postoutbreak environmental surveillance for guiding sustained infection control effort has not been examined. METHODS Enhanced environmental disinfection and regular environmental surveillance of ward communal areas after an outbreak were performed in a university-affiliated hospital. To assess the usefulness of environmental culture in predicting patients with MRAB, weekly surveillance of communal areas was continued for 3 months after the outbreak in intervention wards. The incidence of MRAB in intervention and nonintervention wards (control) was compared, whereas the other infection control measures remained identical. RESULTS Postoutbreak weekly surveillance of communal areas showed that identification of newly diagnosed MRAB patients was significantly correlated with preceding environmental contamination with MRAB (P = .001). The incidence of nosocomial MRAB infection was significantly lower in the intervention compared with nonintervention wards (0.55 vs 2.28 per 1,000 patient days, respectively; P = .04). All MRAB isolated from the environmental and patients' samples belonged to multilocus sequence typing ST457 and were blaOXA23-like positive. CONCLUSIONS Environmental surveillance may serve as a surrogate marker for the presence of MRAB carriers. Implementation of timely infection control measures should be guided by environmental culture for MRAB to minimize the risk of MRAB outbreak.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China; Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China; Infection Control Team, Tung Wah Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Jonathan H K Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Simon Y C So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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13
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Han L, Lei J, Xu J, Han S. blaOXA-23-like and blaTEM rather than blaOXA-51-like contributed to a high level of carbapenem resistance in Acinetobacter baumannii strains from a teaching hospital in Xi'an, China. Medicine (Baltimore) 2017; 96:e8965. [PMID: 29310399 PMCID: PMC5728800 DOI: 10.1097/md.0000000000008965] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acinetobacter baumannii is one of the major threats in clinical infections due to its antibiotic resistance ability. It shows increasing resistance to carbapenems, mainly due to β-lactamase mediated mechanisms. The aim of this study was to investigate carbapenem resistance (CR) profiles and analyze β-lactamases genes composition of clinical A. baumannii strains from a teaching hospital in Xi'an. The resistance patterns to imipenem and meropenem were checked for 51 clinical A. baumannii strains. The existence of 15 β-lactamases genes was detected by polymerase chain reaction (PCR), and the positive genes were sequenced. The correlation between PCR-positive genes and CR phenotype was analyzed using Chi-square test and contingency coefficient. The expressions of PCR-positive genes were investigated. Forty-five out of 51 strains were resistant to imipenem and meropenem. blaTEM, blaOXA-23-like, and blaOXA-51-like were positive among 15 β-lactamases genes, and TEM-1, OXA-23, and OXA-66/69 were their subtypes. TEM and OXA-23-like only showed up in CR isolates, with the occurrence rate of 91.1% and 97.8%, respectively, whereas OXA-51-like appeared in all strains. ISAba1 was present in the upstream of OXA-23-like, but absent from that of OXA-51-like in our strains. OXA-23-like had highest relationship with CR, followed by TEM, but OXA-51-like had no correlation. This was verified by RT-qPCR that the expression was positive for OXA-23 and TEM-1, but negative for OXA-66/-69. A high rate of CR A. baumannii was detected in this study. Coexistence of TEM, OXA-23-like, and OXA-51-like was the primary resistance profile. The expressions of OXA-23-like and TEM genes were closely related with CR, while OXA-51-like had no contribution to the CR phenotype.
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Affiliation(s)
- Lei Han
- Department of Microbiology and Immunology, School of Basic Medical Science, Xi’an Jiaotong University Health Science Center
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education
| | - Jine Lei
- Department of Microbiology and Immunology, School of Basic Medical Science, Xi’an Jiaotong University Health Science Center
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education
- Department of Laboratory Medicine
| | - Jiru Xu
- Department of Microbiology and Immunology, School of Basic Medical Science, Xi’an Jiaotong University Health Science Center
- Key Laboratory of Environment and Genes Related to Diseases (Xi’an Jiaotong University), Ministry of Education
| | - Shaoshan Han
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
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Emergence of Extensively Drug Resistant Acinetobacter baumannii-Encoding Integrons and Extended-Spectrum Beta-Lactamase Genes Isolated from Ventilator-Associated Pneumonia Patients. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14377] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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15
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Lee S, Razqan GSA, Kwon DH. Antibacterial activity of epigallocatechin-3-gallate (EGCG) and its synergism with β-lactam antibiotics sensitizing carbapenem-associated multidrug resistant clinical isolates of Acinetobacter baumannii. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2017; 24:49-55. [PMID: 28160861 DOI: 10.1016/j.phymed.2016.11.007] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 11/02/2016] [Accepted: 11/10/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Infections caused by Acinetobacter baumannii were responsive to conventional antibiotic therapy. However, recently, carbapenem-associated multidrug resistant isolates have been reported worldwide and present a major therapeutic challenge. Epigallocatechin-3-Gallate (EGCG) extracted from green tea exhibits antibacterial activity. PURPOSE We evaluated the antibacterial activity of EGCG and possible synergism with antibiotics in carbapenem-associated multidrug resistant A. baumannii. A potential mechanism for synergism was also explored. MATERIALS AND METHODS Seventy clinical isolates of A. baumannii collected from geographically different areas were analyzed by minimal inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of EGCG. Checkerboard and time-killing assays were performed to exam the synergism between EGCG and antibiotics. The effects of EGCG on a multidrug efflux pump inhibitor (1-[1-naphthylmethyl] piperazine; NMP) and β-lactamase production were also examined in A. baumannii. RESULTS Sixty-three of 70 clinical isolates of A. baumannii carried carbapenemase-encoding genes with carbapenem-associated multidrug resistance. Levels of MIC and MBC of EGCG ranged from 64 to 512µg/ml and from 128 to ≥1024µg/ml, respectively among the clinical isolates. MIC90 and MBC86 levels were 256µg/ml and 512µg/ml of EGCG, respectively. Subinhibitory concentration of EGCG in combination with all antibiotics tested, including carbapenem, sensitized (MICs fall≤1.0µg/ml) all carbapenem-associated multidrug resistant isolates. Checkerboard and time-killing assays showed synergism between EGCG and meropenem (or carbenicillin) counted as fractional inhibitory concentration of < 0.5 and cell numbers' decrease per ml of >2log10 within 12h, respectively. EGCG significantly increased the effect of NMP but was unrelated to β-lactamase production in A. baumannii, suggesting EGCG may be associated with inhibition of efflux pumps. CONCLUSION Overall we suggest that EGCG-antibiotic combinations might provide an alternative approach to treat infections with A. baumannii regardless of antibiotic resistance.
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Affiliation(s)
- Spencer Lee
- Jericho Senior High School, Jericho, New York 11753, United States
| | | | - Dong H Kwon
- Department of Biology, Long Island University, Brooklyn, New York, 11201, United States ; Department of Medicine, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, Texas, 77030, United States.
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