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Doyev R, Ben-Shalom E, Megged O. The predictive utility of prior positive urine culture in children with recurrent urinary tract infections. Eur J Pediatr 2020; 179:415-421. [PMID: 31768637 DOI: 10.1007/s00431-019-03522-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 11/25/2022]
Abstract
Urinary tract infections can cause renal damage if not treated promptly. The aim of this study was to examine if prior urine cultures can predict antibiotic susceptibility profile in a subsequent culture, in children with recurrent urinary tract infections. The medical records of all children with at least two episodes of urinary tract infection between 1999-2015 that occurred 2 weeks to 1 year apart were reviewed. Pathogen identity and antibiogram were compared between the two cultures for every patient. One hundred sixty-one cases of recurrent urinary tract infections were identified. Seventy-seven (48%) pairs of cultures grew the same pathogen. However, of these, 31 had an altered biogram. In 53% of the culture pairs, the pathogen in the second culture had a similar or better antibiotic susceptibility profile. We found no statistically significant correlation between the elapsed time between the two cultures and the probability of similar susceptibility profile between them. There was no correlation between antibiogram change and any of the demographic characteristics, including a history of renal transplantation and taking antibiotic prophylactic treatment.Conclusions: Antibiotic susceptibility profile of the pathogen in a prior urinary tract infection did not predict antibiotic susceptibility profile in a subsequent urinary tract infection in our study.What is Known:• Children with urinary tract infections often have recurrent infections.• Clinicians often use prior urine cultures to choose empirical antibiotic treatment in subsequent infections.What is New:• In only 50% of the cases, a subsequent urinary tract infection grows the same pathogen as the 1st urinary tract infection.• Even in cultures with the same pathogen growth, antibiogram is often different.
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Affiliation(s)
- Reut Doyev
- The Hebrew University Hadassah Medical School, Jerusalem, Israel
| | - Efrat Ben-Shalom
- Pediatric Department, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel.,Pediatric Nephrology Unit, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Orli Megged
- The Hebrew University Hadassah Medical School, Jerusalem, Israel. .,Pediatric Department, Shaare Zedek Medical Center, P.O.B. 3235, Jerusalem, Israel. .,Infectious Diseases Unit, Shaare Zedek Medical Center, Jerusalem, Israel.
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2
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Hand R, Manning L, Ritter JC, Norman P, Lamb L, Makepeace A, Sankhesara D, Hamilton E, Ingram P. Antimicrobial stewardship opportunities among inpatients with diabetic foot infections: microbiology results from a tertiary hospital multidisciplinary unit. Intern Med J 2020; 49:533-536. [PMID: 30957374 DOI: 10.1111/imj.14251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/22/2018] [Accepted: 08/22/2018] [Indexed: 01/01/2023]
Abstract
Among 125 inpatients with diabetic foot infections managed by a multidisciplinary foot ulcer unit, knowledge of methicillin-resistant Staphylococcus aureus colonisation status assisted decision-making to prescribe appropriately or with-hold empiric anti-methicillin-resistant Staphylococcus aureus therapy. Despite adherence to national guidelines, apparent overuse of anti-pseudomonal therapy was frequent, providing potential antimicrobial stewardship opportunities.
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Affiliation(s)
- Robert Hand
- Department of General Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Laurens Manning
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.,Faculty of Medicine and Health Sciences, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Jens C Ritter
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Paul Norman
- Department of Vascular Surgery, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Lydia Lamb
- Department of Endocrinology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Ashley Makepeace
- Department of Endocrinology, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Dipen Sankhesara
- Department of General Medicine, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Emma Hamilton
- Department of Endocrinology, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Medicine and Pharmacology, University of Western Australia, Harry Perkins Research Institute, Fiona Stanley Hospital, Perth, Western Australia, Australia
| | - Paul Ingram
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, Western Australia, Australia.,School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, Perth, Western Australia, Australia
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Yoshioka N, Deguchi M, Hagiya H, Yoshida H, Yamamoto N, Hashimoto S, Akeda Y, Tomono K. Available, Bed-sided, Comprehensive (ABC) score to a diagnosis of Methicillin-resistant Staphylococcus aureus infection: a derivation and validation study. BMC Infect Dis 2018; 18:19. [PMID: 29310586 PMCID: PMC5759200 DOI: 10.1186/s12879-017-2919-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 12/14/2017] [Indexed: 12/18/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) infections continue to be a leading problem in health care facilities worldwide. Methods This single-center retrospective cohort study consisted of a derivation phase and a validation phase. The derivation phase included all patients admitted to Osaka University Hospital between May 2010 and April 2011. We proposed a provisional available, bed-sided, comprehensive (ABC) score, and evaluated its accuracy using the clinical diagnosis as a reference. We subsequently revised ABC scores based on k coefficient scores of each variable; this revision was validated by applying it to another patient population. Results A total of 172 patients and 154 cases were enrolled in the derivation and validation studies, respectively. The revised ABC score consisted of four simple variables: type of clinical specimen (1 to 3 points), Gram-staining result (1 point), presence of local inflammation (2 points), and a systemic inflammatory response (2 points). A revised score of ≥5 points was sensitive (93.8%) and specific (90.6%), and the area under the receiver-operating curve was 0.969 (95% CI; 0.957–1). Conclusions We developed a simple and comprehensive scoring system for diagnosis of nosocomial MRSA infections; this system is applicable in a wide variety of situations. Electronic supplementary material The online version of this article (10.1186/s12879-017-2919-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nori Yoshioka
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Matsuo Deguchi
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hideharu Hagiya
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hisao Yoshida
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Norihisa Yamamoto
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Shoji Hashimoto
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yukihiro Akeda
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kazunori Tomono
- Division of Infection Control and Prevention, Osaka University Hospital, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan
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You JHS, Choi KW, Wong TY, Ip M, Ming WK, Wong RYK, Chan SN, Tse HT, Chau CTS, Lee NLS. Disease Burden, Characteristics, and Outcomes of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection in Hong Kong. Asia Pac J Public Health 2017; 29:451-461. [PMID: 28719790 DOI: 10.1177/1010539517717365] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to describe disease burden, characteristics, and outcomes of methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infection (BSI) in Hong Kong. A retrospective, observational study was conducted in 26 Hong Kong public hospitals between January 2010 and December 2012. The primary outcome measures were 30-day mortality rate and infection-related hospital cost. Of 1133 patients reviewed, 727 (64.17%) were male, 1075 (94.88%) had health care-associated community-onset and 44 (3.88%) had hospital-onset MRSA infection. The mean age of patients was 76 (SD = 15) years, including 172 (15.18%) aged 20 to 59 years and 961 (84.8%) aged ≥60 years. The annual incidence rates in age groups of 20 to 59 years and ≥60 years were 0.96 to 1.148 per 100 000 and 22.7 to 24.8 per 100 000, respectively. The 30-day mortality was 367 (32.39%). Older patients (>79 years), chronic lung disease, and prior hospitalization were associated with increased mortality. The mean cost was US$10 565 (SD = 11 649; US$1 = HK$7.8). MRSA BSI was a significant burden in Hong Kong.
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Affiliation(s)
- Joyce H S You
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kin-Wing Choi
- 2 Centre for Health Protection, Department of Health, the Government of Hong Kong SAR
| | - Tin-Yau Wong
- 2 Centre for Health Protection, Department of Health, the Government of Hong Kong SAR
| | - Margaret Ip
- 3 Department of Microbiology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Wai-Kit Ming
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Rity Yee-Kwan Wong
- 4 Divison of Infectious Diseases, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Sze-Ngai Chan
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Hoi-Tung Tse
- 1 The Chinese University of Hong Kong, Shatin, Hong Kong
| | | | - Nelson L S Lee
- 4 Divison of Infectious Diseases, Department of Medicine & Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong
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Complete adherence to evidence-based quality-of-care indicators for Staphylococcus aureus bacteremia resulted in better prognosis. Infection 2016; 45:83-91. [DOI: 10.1007/s15010-016-0946-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 09/17/2016] [Indexed: 12/31/2022]
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MiBAlert-a new information tool to fight multidrug-resistant bacteria in the hospital setting. Int J Med Inform 2016; 95:43-48. [PMID: 27697231 DOI: 10.1016/j.ijmedinf.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 05/15/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND Although the timely isolation of patients is an essential intervention to limit spread of drug-resistant bacteria, information about the colonization status is often unavailable or lost when patients are readmitted or transferred between hospitals. Therefore, carriers of drug resistant bacteria are not recognized sufficiently early, and proper and timely isolation precautions are not taken. Consequently, resistant bacteria of public health concerns including vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) can spread epidemically. To ensure timely identification and proper isolation of such patients we developed an automatic real-time alert of carriers of drug resistant bacteria. OBJECTIVES The aim of this paper is to describe the system, called MiBAlert, and share the initial experiences in connection with an outbreak of VRE in the greater Copenhagen area (the Capital region), Denmark. METHODS We obtained data on cases of VRE from hospitals in Copenhagen during the period when the first version of MiBAlert was implemented and log-data on the use of MiBAlert. Furthermore, a survey was conducted among 88 staff members to investigate their experiences of MiBAlert. RESULTS The alert is a tool directed toward healthcare personnel accessing the electronic health record (EHR) and those further involved in the care and treatment of the patient. It is based on a web service using data from the national microbiological database, MiBa. MiBAlert is a real-time electronic non-intrusive alert generated automatically in the header of the EHR each time record is accessed. On February 15, 2015 a pilot version of MiBAlert was launched. All positive tests for VRE throughout 1year were shown with alert status by MiBAlert visible to all medical staff with access to EHR. The alert system was automatically updated directly in the EHR across the five hospitals in the Capital region. We found that the system performed satisfactorily, being operational 24/7 all 135 trial days, apart from 72min, for all the hospitals. Of the staff who responded to the survey, 82% considered that MiBAlert overall improved compliance with isolation precautions regarding VRE-positive patients. We found a marked decline of new patients infected or colonized with VRE concomitant with the implementation of MiBAlert and the survey results. CONCLUSION We found that MiBAlert was a valuable tool in a bundle approach to counter a multiple hospital outbreak of VRE, and that it has a great potential to improve the control of other drug-resistant bacteria.
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Nillius D, von Müller L, Wagenpfeil S, Klein R, Herrmann M. Methicillin-Resistant Staphylococcus aureus in Saarland, Germany: The Long-Term Care Facility Study. PLoS One 2016; 11:e0153030. [PMID: 27073899 PMCID: PMC4830541 DOI: 10.1371/journal.pone.0153030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Accepted: 03/22/2016] [Indexed: 11/21/2022] Open
Abstract
Background Multiresistant organisms pose a threat for patients and care recipients. Control interventions need to be tailored to region, the type of institution considered, and risk factors. The German state of Saarland is ideally suited to study colonisation epidemiology throughout its various health and care institutions. After conclusion of a large admission prevalence study in acute care hospitals, we now performed a methicillin-resistant Staphylococcus aureus (MRSA) point prevalence study in Saarland long term care facilities (LTCF), allowing for a direct comparison with respect of MRSA prevalence and associated risk factors between these two institutional types located within a confined region. Methodology and Principal Findings Of all LTCF of the region, 65/136 participated in the study performed between 09/2013 and 07/2014. Overall, complete microbiological specimen and questionnaires of 2,858 of 4,275 (66.8%) LTCF residents were obtained. 136/2,858 (4.8%) screened residents revealed MRSA carrier status. Multivariate risk factor analysis yielded ulcer/deep soft tissue infection, urinary tract catheter, and MRSA history with multiple MRSA decolonisation cycles to be independently associated with MRSA carrier status. Conclusion As already known from previous studies, colonisation with MRSA is common in LTCF residents even in an area with relatively low MRSA prevalence. This found prevalence can now be related to the acute care admission prevalence (2.2%) as well as to the admission prevalence in acute care geriatric departments (7.6%). The common clonal attribution (spa type) of MRSA isolates prevalent in the LTCF population as well as in the acute care admission population points towards a close relationship between both types of institutions. However, the ostensible absence of risk factors such as “previous hospitalisation” in conjunction with newly identified factors such as “multiple decolonisation cycles” refers to MRSA colonisation risks independent of contact with acute care facilities. Overall, this large LTCF point prevalence study allows data-based, region-tailored decisions on MRSA screening policies and provides a basis for additional preventative measures.
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Affiliation(s)
- Dorothea Nillius
- Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany
- * E-mail:
| | - Lutz von Müller
- Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany
| | - Stefan Wagenpfeil
- Institute of Medical Biometry, Epidemiology, and Medical Informatics, Saarland University, Homburg, Germany
| | - Renate Klein
- Saarland Ministry of Social Affairs, Health, Women, and Family, Saarbrücken, Germany
| | - Mathias Herrmann
- Institute and State Laboratory of Medical Microbiology and Hygiene, Saarland University and Saarland University Medical Centre, Homburg, Germany
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Determinants of Outcome in Hospitalized Patients With Methicillin-Resistant Staphylococcus aureus Bloodstream Infection: Results From National Surveillance in Canada, 2008-2012. Infect Control Hosp Epidemiol 2016; 37:390-7. [PMID: 26782274 DOI: 10.1017/ice.2015.323] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Bloodstream infection (BSI) due to methicillin-resistant Staphylococcus aureus (MRSA) is associated with considerable morbidity and mortality. OBJECTIVE To determine the incidence of MRSA BSI in Canadian hospitals and to identify variables associated with increased mortality. METHODS Prospective surveillance for MRSA BSI conducted in 53 Canadian hospitals from January 1, 2008, through December 31, 2012. Thirty-day all-cause mortality was determined, and logistic regression analysis was used to identify variables associated with mortality. RESULTS A total of 1,753 patients with MRSA BSI were identified (incidence, 0.45 per 1,000 admissions). The most common sites presumed to be the source of infection were skin/soft tissue (26.6%) and an intravascular catheter (22.0%). The most common spa types causing MRSA BSI were t002 (USA100/800; 55%) and t008 (USA300; 29%). Thirty-day all-cause mortality was 23.8%. Mortality was associated with increasing age (odds ratio, 1.03 per year [95% CI, 1.02-1.04]), the presence of pleuropulmonary infection (2.3 [1.4-3.7]), transfer to an intensive care unit (3.2 [2.1-5.0]), and failure to receive appropriate antimicrobial therapy within 24 hours of MRSA identification (3.2 [2.1-5.0]); a skin/soft-tissue source of BSI was associated with decreased mortality (0.5 [0.3-0.9]). MRSA genotype and reduced susceptibility to vancomycin were not associated with risk of death. CONCLUSIONS This study provides additional insight into the relative impact of various host and microbial factors associated with mortality in patients with MRSA BSI. The results emphasize the importance of ensuring timely receipt of appropriate antimicrobial agents to reduce the risk of an adverse outcome.
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