Correlation between meticillin-resistant Staphylococcus aureus prevalence and infection control initiatives within southern and eastern Mediterranean hospitals

Surveillance and Control of Antibiotic Resistance in the Mediterranean Region

Antibiotic resistance is one of the most relevant problems in the healthcare: the growth of resistant microorganisms in healthcare settings is a worrisome threat, raising length to stay (LOS), morbidity and mortality in those patients. The importance of the antibiotic resistance and its spread around the world, gave rise to the activation of several surveillance systems, based especially on the collection of laboratory data to local or national level. The objective of this work is to carry out a review of the scientific literature existing on the topic and scientific activities related to surveillance of antibiotic resistance in the countries bordering the Mediterranean Sea. Recent Data from European Centre for Disease Prevention and Control (November 2015) show, for different combinations bacterium-drug, an increase of resistance from North to South and from West to East of Europe. It is of particular concern the phenomenon of resistance carried out by some gram-negative, specifically Klebsiella pneumoniae and Escherichia coli to third-generation cephalosporin, often combined in opposition to fluoroquinolones and aminoglycosides. Is particularly high the incidence of resistance to carbapenems by strains of Enterobacteriaceae (Klebsiella included). The resistance exerted by MRSA (Methicillin-resistant Staphylococcus aureus) continues to be relevant, albeit showing some decline in recent years. The incidence of resistance carried on by Streptococcus pneumoniae is stable and is mainly relevant to macrolides. Finally, a significant increase in recording relatively exercised by Enterococcus faecium to Vancomycin. Detecting, preventing, and controlling antibiotic resistance requires strategic, coordinated, and sustained efforts. It also depends on the engagement of governments, academia, industry, healthcare providers, the general public, and the agricultural community, as well as international partners. Committing to combating antibiotic-resistant microbes does support patient care, economic growth, agriculture, and economic and national security.

Prevalence of colonization and infection with methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus and of Clostridium difficile infection in Canadian hospitals

OBJECTIVE

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile infection (CDI) in Canadian hospitals.

DESIGN

National point prevalence survey in November 2010.

SETTING

Canadian acute care hospitals with at least 50 beds.

PATIENTS

Adult inpatients colonized or infected with MRSA or VRE or with CDI.

METHODS

The prevalence (per 100 inpatients) of MRSA, VRE, and CDI was determined. Associations between prevalence and institutional characteristics and infection control policies were evaluated.

RESULTS

One hundred seventy-six hospitals (65% of those eligible) participated. The median (range) prevalence rates for MRSA and VRE colonization or infection and CDI were 4.2% (0%-22.1%), 0.5% (0%-13.1%), and 0.9% (0%-8.6%), respectively. Median MRSA and VRE infection rates were low (0.3% and 0%, respectively). MRSA, VRE, and CDI were thought to have been healthcare associated in 79%, 96%, and 84% of cases, respectively. In multivariable analysis, routine use of a private room for colonized/infected patients was associated with lower median MRSA infection rate (prevalence ratio [PR], 0.44 [95% confidence interval (CI), 0.22-0.88]) and VRE prevalence (PR, 0.26 [95% CI, 0.12-0.57]). Lower VRE rates were also associated with enhanced environmental cleaning (PR, 0.52 [95% CI, 0.36-0.75]). Higher bed occupancy rates were associated with higher rates of CDI (PR, 1.02 [95% CI, 1.01-1.03]).

CONCLUSIONS

These data provide the first national prevalence estimates for MRSA, VRE, and CDI in Canadian hospitals. Certain infection prevention and control policies were found to be associated with prevalence and deserve further investigation.

Isolation and antimicrobial susceptibility of bacteria from chronic suppurative otitis media patients in kerman, iran

BACKGROUND

Chronic supportive otitis media (CSOM) is one of the commonest illnesses in ENT practice. This study was conducted to find out the various aerobic microorganisms associated with CSOM and their current antimicrobial susceptibility patterns to commonly used antimicrobials.

METHODS

samples were collected from 117 clinically diagnosed cases of CSOM and processed according to standard protocols.

RESULTS

Out of 117 CSOM cases, 105 (86%) showed positive bacterial culture. The Staphylococcus aureus was the commonest aerobic isolate in CSOM. The sensitivity of Staphylococci spp. to commonly used antimicrobials varied from 27.2% for cefixime to 95.5% for gentamicin and coagulase positive. Pseudomonas isolates showed complete (100%) resistance to amoxicillin/clavulanate (co-amoxiclave), cloxacillin and cefixime, and high sensitivity to ciprofloxacin (95%) and cephalexin (90%).

CONCLUSION

An appropriate knowledge of antibacterial susceptibility of microorganisms would contribute to a rational antibiotic use and the success of treatment for chronic supportive otitis media.

Population biological principles of drug-resistance evolution in infectious diseases

The emergence of resistant pathogens in response to selection pressure by drugs and their possible disappearance when drug use is discontinued are evolutionary processes common to many pathogens. Population biological models have been used to study the dynamics of resistance in viruses, bacteria, and eukaryotic microparasites both at the level of the individual treated host and of the treated host population. Despite the existence of generic features that underlie such evolutionary dynamics, different conclusions have been reached about the key factors affecting the rate of resistance evolution and how to best use drugs to minimise the risk of generating high levels of resistance. Improved understanding of generic versus specific population biological aspects will help to translate results between different studies, and allow development of a more rational basis for sustainable drug use than exists at present.

Antibiotic consumption as a driver for resistance in Staphylococcus aureus and Escherichia coli within a developing region

BACKGROUND

This study aimed to provide insight into possible antibiotic drivers of methicillin-resistant Staphylococcus aureus (MRSA) and Escherichia coli resistant to third-generation cephalosporins (3GCREC) in southern and eastern Mediterranean institutions.

METHODS

MRSA and 3GCREC susceptibility proportions from 19 regional hospitals, previously published by the ARMed project, were correlated with antibiotic use data from the same institutions.

RESULTS

Hospitals reporting below-median MRSA proportions had significantly lower total antibiotic use. MRSA proportions increased with greater use of carbapenems (P=.04). In multivariate analysis, a positive correlation was identified with the use of carbapenems (P=.002), combination penicillins (P=.018), and aminoglycosides (P=.014). No difference was ascertained between 3GCREC proportions and total antibiotic use. In multivariate linear regression, a correlation was identified only for 3GCREC (P=.005), but a negative association was evident for beta-lactamase-resistant penicillins (P=.010) and first-generation cephalosporins (P=.012).

CONCLUSIONS

The results suggest an association between resistance and antibiotic use, especially for carbapenems and third-generation cephalosporins. These data support the urgent implementation of antibiotic stewardship initiatives in hospitals in developing countries that focus on more judicious use of broad-spectrum formulations.

Antimicrobial use: risk driver of multidrug resistant microorganisms in healthcare settings

PURPOSE OF REVIEW

This review explores recent evidence on the association between antibiotics usage and resistance.

RECENT FINDINGS

A meta-analysis showed that the risk of acquiring methicillin-resistant Staphylococcus aureus was increased by 1.8-fold in patients who had taken antibiotics. Such risk was almost three-times greater after using quinolones or glycopeptides. Significant heterogeneity between studies was mainly related to study designs. A Cochrane systematic review suggested that, although the quality of the evidence was poor, interventions to improve hospital antibiotic prescribing were associated with a reduction in the incidence of antimicrobial resistant pathogens. Against this evidence, mupirocin-resistant S. aureus and linezolid-resistant vancomycin-resistant enterococci (VRE) were detected in institutions where these drugs were not widely used. Studies assessing the impact of vancomycin prescribing restriction on VRE rates were heterogeneous and the effectiveness of such interventions remains poorly defined. Important confounders of studies, other than study design, are the lack of analysis of secular trends of infections, colonization pressure in the ward and duration of follow up.

SUMMARY

Available evidence, although not always of high quality, suggests that a link between antibiotics usage at individual and institutional levels and resistant bacteria does exist. Benchmark guidelines for empiric therapy in hospitalized patients, taking into consideration not only patients' needs but also ecological costs of resistance, should be rapidly developed.