[On the economic burden of MRSA in Germany]

Photodynamic Inactivation of Bacteria in Ionic Environments Using the Photosensitizer SAPYR and the Chelator Citrate

Many studies show that photodynamic inactivation (PDI) is a powerful tool for the fight against pathogenic, multi-resistant bacteria and the closing of hygiene gaps. However, PDI studies have been frequently performed under standardized in vitro conditions comprising artificial laboratory settings. Under real life conditions, however, PDI encounters substances like ions, proteins, amino acids, and fatty acids, potentially hampering the efficacy PDI to an unpredictable extent. Thus, we investigated PDI with the phenalene-1-one based photosensitizer SAPYR against Escherichia coli and Staphylococcus aureus in the presence of calcium or magnesium ions, which are ubiquitous in potential fields of PDI applications like in tap water or on tissue surfaces. The addition of citrate should elucidate the potential as a chelator. The results indicate that PDI is clearly affected by such ubiquitous ions depending on its concentration and the type of bacteria. The application of citrate enhanced PDI especially for Gram-negative bacteria at certain ionic concentrations (e.g. CaCl₂ or MgCl₂ : 7.5 to 75 mmol l^-1 ). Citrate also improved PDI efficacy in tap water (especially for Gram-negative bacteria) and synthetic sweat solution (especially for Gram-positive bacteria). In conclusion, the use of chelating agents like citrate may facilitate the application of PDI under real life conditions.

Airborne Staphylococcus aureus in different environments-a review

The aim of the literature review was to describe the environments where the presence of airborne Staphylococcus aureus was confirmed and to catalogue the most often used methods and conditions of bioaerosol sampling to identify the bacteria. The basis for searching of studies on S. aureus in the bioaerosol in different environments was PubMed database resources from the years 1990-2019 (May). The review included studies which were carried on in selected environments: hospitals and other health care facilities, large-scale animal breeding, wastewater treatment plants, residential areas, educational institutions, and other public places. The highest concentrations and genetic diversity of identified S. aureus strains, including MRSA (methicillin-resistant S. aureus), have been shown in large-scale animal breeding. The role of the airborne transmission in dissemination of infection caused by these pathogens is empirically confirmed in environmental studies. Commonly available, well-described, and relatively inexpensive methods of sampling, identification, and subtyping guarantee a high reliability of results and allow to obtain fast and verifiable outcomes in environmental studies on air transmission routes of S. aureus strains.

The effect of isolation precautions on care processes and medical outcomes in patients colonized with MRSA

Background: Isolation precautions used in methicillin-resistant Staph ylo coc cus aureus (MRSA) infection control are effective in inhibiting pathogen transmission, but may cause unintended consequences in medical care. In addition, while costs attributed to MRSA are known to be substantial, little is known about their reimbursement in the German Diagnosis Related Groups (G-DRG) payment system. The aim of our study was to examine the effect of isolation precautions used in MRSA infection control on care processes, patient outcomes and deliver reliable data on MRSA-attributed reimbursement. Methods: A retrospective, matched cohort study of inpatients admitted to a general care teaching hospital in Bad Neuenahr, Germany, between January 1st, 2016, and December 31st, 2017 was performed. Patients isolated for MRSA colonization were matched to non-isolated controls based on age, gender, MRSA-adjusted Patient Clinical Complexity Level (Ma-PCCL) and Major Diagnostic Category (MDC). Main outcome measures on care processes and patient outcomes included adverse events, patient complaints, 30-day readmission rates, length of stay, type of discharge, and performance of instrument-based diagnostics. MRSA-attributed reimbursement was measured by conducting two separate G-DRG groupings, one with inclusion of MRSA-related codes and one without. Results: A total of 26,059 patients were admitted to Maria Hilf Hospital in Bad Neuenahr, Germany, during the study period. We identified 304 patients isolated for MRSA colonization. Compared to non-isolated matched controls, those on isolation precautions for MRSA colonization acquired about 45% more pressure ulcers and experienced significant delays in the performance of radiological diagnostics and echocardiographs. Patients isolated for MRSA colonization received about 49% fewer echocardiographs and had about 38% fewer abdominal ultrasound exams performed compared to non-isolated matched controls. A non-significant tendency towards fewer discharges to rehabilitation clinics and higher mortality rates were observed in patients isolated for MRSA colonization. Reimbursements were negligibly affected when MRSA-related codes were integrated by the grouper. Conclusion: Isolation precautions are associated with adverse consequences for care processes. These consequences need to be mitigated in order to justify placing patients at risk.

Risk Factors And Clinical Outcomes Of Hospital-Acquired MRSA Infections In Chongqing, China

Background

Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of hospital infection with multi-drug resistant characteristics. Its spread and epidemic pose great challenges to nosocomial infection control. This study was aimed to identify risk factors for hospital-acquired MRSA (HA-MRSA) infections and investigate its clinical outcome, developing infection control strategies and improving patient outcomes.

Methods

A retrospective case-case-control study was conducted to compare patients in Southwest Hospital, Chongqing, People's Republic of China from January 2018 to December 2018 with control patients. In this study, 251 patients with MRSA nosocomial infection, 339 patients with methicillin-sensitive Staphylococcus aureus strains (MSSA) nosocomial infection, and 300 patients with non-Staphylococcus aureus infection were included.

Results

Multivariate analysis showed that presence of central venous catheters (odds ratio [OR], 1.932; 95% confidence interval [CI], 1.074–3.477; P=0.028), sputum suction (OR, 2.887; 95% CI, 1.591–5.240; p<0.001), and total hospital stays more than 30 days (OR, 3.067; 95% CI, 2.063–4.559; P<0.001) were independent risk factors for HA-MRSA. Renal insufficiency (OR, 2.744; 95% CI, 1.089–6.914; P=0.032) and receipt of immunosuppressors (OR, 3.140; 95% CI, 1.284–7.678; P=0.012) were independent predictors of poor prognosis of MRSA nosocomial infection. Moreover, empirical use of antibiotics (OR, 0.514; 95% CI, 0.282–0.935; P=0.029) was a protective factor for poor prognosis of MRSA nosocomial infection. In-hospital mortality in the MRSA group was not statistically significant compared with the other two groups; however, the rate of poor prognosis in the MRSA group was higher than that of the MSSA group (27.5% vs 17.1%, χ²=9.200, P=0.002) and the control group (27.5% vs 16.0%, χ²=19.190, P=0.001).

Conclusion

Our results have shown presence of central venous catheters, sputum suction, and total hospital stays more than 30 days were associated with nosocomial MRSA infection. Patients with renal insufficiency and immunosuppressive therapy were more likely to cause poor prognosis with MRSA infection, and the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by MRSA infection. Based on above findings, strategies to control MRSA infection should emphasize more attention to these patients and appropriate empirical use of antibiotics.

Knowledge on Antibiotic Use, Self-Reported Adherence to Antibiotic Intake, and Knowledge on Multi-Drug Resistant Pathogens - Results of a Population-Based Survey in Lower Saxony, Germany

Introduction

Assessment of public awareness on antibiotic use and resistance can identify key issues for campaigns addressing these problems. Our aim was to assess the knowledge, attitudes, and practice (KAP) related to antibiotic use and multi-drug resistant (MDR) pathogens in a general population in Germany.

Methods

We conducted a KAP survey on antibiotics and on MDR pathogens using an online panel recruited from the general population, which was established using stratified random sampling from the population registry in four districts in Lower Saxony, Germany.

Results

In the 12 months preceding the survey, 32.3% of the participants had received at least one prescription for antibiotics, 95.7% reported to follow the recommendations of prescribers, and 10.3% reported to stop taking antibiotics as soon as they feel better. Up to 94.9% of the participants had heard of MDR pathogens, 42.7% reported to know somebody who had been tested positive for it, 0.8% had an infection with it, and 37.2% were worried of contracting it. In case of contact with a carrier of MDR pathogens, over 90% would increase hand hygiene and 0.8% would avoid the carrier completely. Participants considered health care workers (75.1%) and everybody in society (87.8%) to be responsible for combating the spread of MDR pathogens.

Conclusion

There is a high reported exposure to antibiotics and awareness of the problem of MDR pathogens. Despite personal worries, most of the participants indicated a reasonable, non-stigmatizing behavior toward carriers of MDR pathogens, and that every individual was responsible to avoid their spread.