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Hughes CML, Jeffers A, Sethuraman A, Klum M, Tan M, Tan V. The detection and prediction of surgical site infections using multi-modal sensors and machine learning: Results in an animal model. FRONTIERS IN MEDICAL TECHNOLOGY 2023; 5:1111859. [PMID: 37138726 PMCID: PMC10150061 DOI: 10.3389/fmedt.2023.1111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 03/30/2023] [Indexed: 05/05/2023] Open
Abstract
Introduction Surgical Site Infection (SSI) is a common healthcare-associated infection that imposes a considerable clinical and economic burden on healthcare systems. Advances in wearable sensors and digital technologies have unlocked the potential for the early detection and diagnosis of SSI, which can help reduce this healthcare burden and lower SSI-associated mortality rates. Methods In this study, we evaluated the ability of a multi-modal bio-signal system to predict current and developing superficial incisional infection in a porcine model infected with Methicillin Susceptible Staphylococcus Aureus (MSSA) using a bagged, stacked, and balanced ensemble logistic regression machine learning model. Results Results demonstrated that the expression levels of individual biomarkers (i.e., peri-wound tissue oxygen saturation, temperature, and bioimpedance) differed between non-infected and infected wounds across the study period, with cross-correlation analysis indicating that a change in bio-signal expression occurred 24 to 31 hours before this change was reflected by clinical wound scoring methods employed by trained veterinarians. Moreover, the multi-modal ensemble model indicated acceptable discriminability to detect the presence of a current superficial incisional SSI (AUC = 0.77), to predict an SSI 24 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.80), and to predict an SSI 48 hours in advance of veterinarian-based SSI diagnosis (AUC = 0.74). Discussion In sum, the results of the current study indicate that non-invasive multi-modal sensor and signal analysis systems have the potential to detect and predict superficial incisional SSIs in porcine subjects under experimental conditions.
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Affiliation(s)
- Charmayne Mary Lee Hughes
- Health Equity Institute NeuroTech Laboratory, San Francisco State University, San Francisco, CA, United States
- Correspondence: Charmayne Mary Lee Hughes
| | | | | | - Michael Klum
- Crely Healthcare Pte. Limited, Singapore, Singapore
| | - Milly Tan
- Crely Healthcare Pte. Limited, Singapore, Singapore
| | - Valerie Tan
- Crely Healthcare Pte. Limited, Singapore, Singapore
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Nanayakkara AK, Boucher HW, Fowler VG, Jezek A, Outterson K, Greenberg DE. Antibiotic resistance in the patient with cancer: Escalating challenges and paths forward. CA Cancer J Clin 2021; 71:488-504. [PMID: 34546590 DOI: 10.3322/caac.21697] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/23/2021] [Accepted: 08/12/2021] [Indexed: 12/13/2022] Open
Abstract
Infection is the second leading cause of death in patients with cancer. Loss of efficacy in antibiotics due to antibiotic resistance in bacteria is an urgent threat against the continuing success of cancer therapy. In this review, the authors focus on recent updates on the impact of antibiotic resistance in the cancer setting, particularly on the ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.). This review highlights the health and financial impact of antibiotic resistance in patients with cancer. Furthermore, the authors recommend measures to control the emergence of antibiotic resistance, highlighting the risk factors associated with cancer care. A lack of data in the etiology of infections, specifically in oncology patients in United States, is identified as a concern, and the authors advocate for a centralized and specialized surveillance system for patients with cancer to predict and prevent the emergence of antibiotic resistance. Finding better ways to predict, prevent, and treat antibiotic-resistant infections will have a major positive impact on the care of those with cancer.
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Affiliation(s)
- Amila K Nanayakkara
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
| | - Helen W Boucher
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
| | - Vance G Fowler
- Division of Infectious Diseases, Department of Medicine, Duke University Medical Center, Durham, North Carolina
| | - Amanda Jezek
- Infectious Diseases Society of America, Arlington, Virginia
| | - Kevin Outterson
- CARB-X, Boston, Massachusetts
- Boston University School of Law, Boston, Massachusetts
| | - David E Greenberg
- Division of Infectious Diseases and Geographic Medicine, Department of Medicine, University of Texas Southwestern, Dallas, Texas
- Department of Microbiology, University of Texas Southwestern, Dallas, Texas
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Isgren CM. Improving clinical outcomes via responsible antimicrobial use in horses. EQUINE VET EDUC 2021. [DOI: 10.1111/eve.13502] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- C. M. Isgren
- Department of Equine Clinical Science Faculty of Health & Life Sciences Institute of Infection, Veterinary and Ecological Sciences University of Liverpool Leahurst UK
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Nagarkoti S, Sadaf S, Awasthi D, Chandra T, Jagavelu K, Kumar S, Dikshit M. L-Arginine and tetrahydrobiopterin supported nitric oxide production is crucial for the microbicidal activity of neutrophils. Free Radic Res 2019; 53:281-292. [PMID: 30621514 DOI: 10.1080/10715762.2019.1566605] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 12/30/2018] [Accepted: 12/31/2018] [Indexed: 01/27/2023]
Abstract
Recent report from this lab has shown role of Rac2 in the translocation of inducible nitric oxide synthase (iNOS) to the phagosomal compartment of polymorphonuclear leukocytes (PMNs) following phagocytosis of beads. This study was undertaken to further assess the status and role of tetrahydrobiopterin (BH4), a redox-sensitive cofactor, L-arginine, and the substrate of nitric oxide synthase (NOS) in sustained nitric oxide (˙NO) production in killing of phagocytosed microbes (Escherichia coli) by human PMNs. Time-dependent study revealed consistent NO and reactive oxygen species (ROS) production in the PMNs following phagocytosis of beads. In addition, levels of L-arginine and BH4 were maintained or increased simultaneously to support the enzymatic activity of NOS in the bead activated PMNs. Moreover, translocation of nicotinamide adenine dinucleotide phosphate (NADPH) oxidase (NOX) subunits along with iNOS was reconfirmed in the isolated phagosomes. We demonstrate that increase in the level of NO was supported by L-arginine and BH4 to kill E. coli, by using PMNs from NOS2-/- mice, human PMNs treated with biopterin inhibitor, N-acetyl serotonin (NAS), or by suspending human PMNs in L-arginine deficient medium. Altogether, this study demonstrates that following phagocytosis, sustained. NO production in the PMNs was well-maintained by redox sensitive cofactor, BH4 and substrate, and L-arginine to enable microbial killing. Further results suggest NO production in the human PMNs, along with ROS and myeloperoxidase (MPO) is important to execute antimicrobial activity.
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Affiliation(s)
- Sheela Nagarkoti
- a Pharmacology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - Samreen Sadaf
- a Pharmacology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - Deepika Awasthi
- a Pharmacology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | | | - Kumaravelu Jagavelu
- a Pharmacology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - Sachin Kumar
- a Pharmacology Division , CSIR-Central Drug Research Institute , Lucknow , India
| | - Madhu Dikshit
- c Translational Health Science and Technology, NCR Biotech Science Cluster , Faridabad , India
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Lin S, Melki S, Lisgaris MV, Ahadizadeh EN, Zender CA. Post-operative MRSA infections in head and neck surgery. Am J Otolaryngol 2017; 38:417-421. [PMID: 28478091 DOI: 10.1016/j.amjoto.2017.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 03/31/2017] [Indexed: 11/20/2022]
Abstract
PURPOSE Surgical site infection (SSI) with methicillin-resistant Staphylococcus aureus (MRSA) is a serious post-operative complication, with head and neck cancer patients at greater risk due to the nature of their disease. Infection with MRSA has been shown to be costly and impart worse outcomes on patients who are affected. This study investigates incidence and risks for MRSA SSIs at a tertiary medical institution. MATERIALS AND METHODS This study reviewed 577 head and neck procedures from 2008 to 2013. Twenty-one variables (i.e. tumor characteristics, patient demographics, operative course, cultures) were analyzed with SPSS to identify trends. A multivariate analysis controlled for confounders (age, BMI, ASA class, length of stay) was completed. RESULTS We identified 113 SSIs of 577 procedures, 24 (21.23%) of which were MRSA. Of all analyzed variables, hospital exposure within the preceding year was a significant risk factor for MRSA SSI development (OR 2.665, 95% CI: 1.06-6.69, z statistic 2.086, p=0.0369). Immunosuppressed patients were more prone to MRSA infections (OR 14.1250, 95%CI: 3.8133-52.3217, p<0.001), and patients with a history of chemotherapy (OR 3.0268, 95% CI: 1.1750-7.7968, p=0.0218). Furthermore, MRSA SSI resulted in extended post-operative hospital stays (20.8±4.72days, p=0.031). CONCLUSIONS Patients who have a history of chemotherapy, immunosuppression, or recent hospital exposure prior to their surgery are at higher risk of developing MRSA-specific SSI and may benefit from prophylactic antibiotic therapy with appropriate coverage. Additionally, patients who develop MRSA SSIs are likely to have an extended postoperative inpatient stay.
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Affiliation(s)
- Sharon Lin
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Sami Melki
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Michelle V Lisgaris
- Department of Medicine - Infectious Diseases, University Hospitals Cleveland Medical Center, Cleveland, OH, United States
| | - Emily N Ahadizadeh
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States; Case Western Reserve University, School of Medicine, 10900 Euclid Avenue, Cleveland, OH, United States
| | - Chad A Zender
- Ear, Nose, and Throat Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, United States.
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Wu X, Yan T, Liu Y, Wang J, Li Y, Wang S. Nosocomial infections among acute leukemia patients in China: An economic burden analysis. Am J Infect Control 2016; 44:1123-1127. [PMID: 27417209 DOI: 10.1016/j.ajic.2016.03.072] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 03/28/2016] [Accepted: 03/28/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND The economic burden associated nosocomial infections (NIs) in patients with acute leukemia (AL) in China was unclear. A prospective study was conducted to quantify the medical cost burden of NIs among AL patients. METHODS Nine hundred ninety-four patients diagnosed with AL between January 2011 and December 2013 were included. Relevant necessary information was extracted from the hospital information system and hospital infection surveillance system. The primary outcome was incidence of NIs and the secondary was economic burden results, including extra medical costs and prolonged length of stay (LOS). We estimated the total incremental cost of NIs by comparing all-cause health care costs in patients with versus without infections. Prolonged duration of stay was compared in patients with different infections. RESULTS Of 994 patients with AL, 277 (27.9%) experienced NIs. NI was associated with a total incremental cost of $3,092 per patient ($5,227 vs $2,135; P < .01) and infected patients experienced a longer LOS (21 vs 10 days; P < .01). Patients with multisite infection had the highest total medical cost ($8,474.90 vs $2,209.90; P < .01) and the longest LOS (25 vs 15 days; P < .01). Western medicine was the main contributor to the rise of total cost in all kinds of infections. CONCLUSIONS NI was associated with higher medical costs, which imposed an economic burden on patients with AL. The study highlights the influence of NIs on LOS and health care costs and appeal to the establishment of prophylactic measures for NIs to reduce the unnecessary waste of medical resources in the long run.
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Affiliation(s)
- Xiaohui Wu
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Tianyuan Yan
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Yunhong Liu
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China; School of Nursing, Shandong University, Jinan, Shandong Province, China
| | - Jingna Wang
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Yingxia Li
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
| | - Shuhui Wang
- Division of Hospital Infection Control, Qilu Hospital of Shandong University, Jinan, Shandong Province, China.
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Khanh NT, Iyer NG. Management of post-operative fistula in head and neck surgery: Sweeping it under the carpet? World J Otorhinolaryngol 2015; 5:93-104. [DOI: 10.5319/wjo.v5.i4.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Revised: 07/19/2015] [Accepted: 09/28/2015] [Indexed: 02/06/2023] Open
Abstract
The most dreaded complication in head and neck surgery is the development of fistula. Fistulas are common and devastating. The prevalence and the risk factors that contribute to fistula formation after head and neck procedures were discussed briefly. The main goal of this manuscript is to discuss current management of head and neck fistula. We believed that the best management strategy for head and neck fistulas is prevention. We recommend a holistic preventive approach during the perioperative period. The roles of different types of wound products and hyperbaric oxygen therapy were also discussed and highlighted. We also discussed the operative repair of fistulas, which relies on the tenet of providing well-vascularized tissue to an area of poor wound healing. Most often, the surgeon’s preference and range of operative skills dictate the timing and the type of repair. We highlighted the use of the pectoralis major, a well-known flap, as well as a novel technique in the surgical repair of complex, difficult-to-heal head and neck fistula.
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Mirabile A, Vismara C, Crippa F, Bossi P, Locati L, Bergamini C, Granata R, Resteghini C, Conte E, Morelli D, Scarpellini P, Licitra L. Health care-associated infections in patients with head and neck cancer treated with chemotherapy and/or radiotherapy. Head Neck 2015; 38 Suppl 1:E1009-13. [PMID: 26041138 DOI: 10.1002/hed.24147] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2015] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The incidence of health care-associated infections in patients with head and neck cancer receiving chemotherapy and/or radiotherapy (RT) is unknown. This retrospective study investigated the most common pathogens and their antibiotic sensitivity/resistance patterns in patients with head and neck cancer. METHODS Infection rates in patients with head and neck cancer were analyzed over 2 periods (January 2005 to December 2009 and January 2010 to November 2012). RESULTS In the first period, 140 health care-associated infections were observed among 2288 admissions, mostly because of gram-negative pathogens affecting the respiratory tract. In the second period, 212 health care-associated infections were observed. An increase in antibiotic resistance was reported. Health care-associated infections were more frequent with: male sex, age <65 years, important comorbidities, smoking, proton pump inhibitors (PPIs), prophylaxis, and/or central venous catheter (CVC), locally advanced disease, and chemotherapy/RT, especially after the third week of treatment. CONCLUSION Health care-associated infections increased over time, with corresponding increases in gram-negative pathogens and resistant strains. Prevention and treatment protocols should be implemented in institutions treating patients with head and neck cancer. © 2015 Wiley Periodicals, Inc. Head Neck 38: E1009-E1013, 2016.
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Affiliation(s)
- Aurora Mirabile
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Chiara Vismara
- Medicine Laboratory Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Fulvio Crippa
- Department of Health Sciences, Unit of Infectious and Tropical Diseases San Paolo Hospital, Milan, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Laura Locati
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Roberta Granata
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Carlo Resteghini
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Eutilia Conte
- Medicine Laboratory Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Daniele Morelli
- Medicine Laboratory Unit, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
| | - Paolo Scarpellini
- Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology Unit, Department of Medical Oncology, Fondazione IRCCS "Istituto Nazionale dei Tumori,", Milan, Italy
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Affiliation(s)
- Annemarie Brown
- Lecturer in nursing, School of Health and Human Science, University of Essex
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Antonanzas F, Lozano C, Torres C. Economic features of antibiotic resistance: the case of methicillin-resistant Staphylococcus aureus. PHARMACOECONOMICS 2015; 33:285-325. [PMID: 25447195 DOI: 10.1007/s40273-014-0242-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper analyses and updates the economic information regarding methicillin-resistant Staphylococcus aureus (MRSA), including information that has been previously reviewed by other authors, and new information, for the purpose of facilitating health management and clinical decisions. The analysed articles reveal great disparity in the economic burden on MRSA patients; this is mainly due to the diversity of the designs of the studies, as well as the variability of the patients and the differences in health care systems. Regarding prophylactic strategies, the studies do not provide conclusive results that could unambiguously orientate health management. The studies addressing treatments noted that linezolid seems to be a cost-effective treatment for MRSA, mostly because it is associated with a shorter length of stay (LOS) in hospital. However, important variables such as antimicrobial susceptibility, infection type and resistance emergence should be included in these analyses before a conclusion is reached regarding which treatment is the best (most efficient). The reviewed studies found that rapid MRSA detection, using molecular techniques, is an efficient technique to control MRSA. As a general conclusion, the management of MRSA infections implicates important economic costs for hospitals, as they result in higher direct costs and longer LOS than those related to methicillin-susceptible S. aureus (MSSA) patients or MRSA-free patients; there is wide variability in those increased costs, depending on different variables. Moreover, the research reveals a lack of studies on other related topics, such as the economic implications of changes in MRSA epidemiology (community patients and lineages associated with farm animals).
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Durand ML, Yarlagadda BB, Rich DL, Lin DT, Emerick KS, Rocco JW, Deschler DG. The time course and microbiology of surgical site infections after head and neck free flap surgery. Laryngoscope 2014; 125:1084-9. [PMID: 25425457 DOI: 10.1002/lary.25038] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 10/02/2014] [Accepted: 10/28/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES/HYPOTHESIS Determine the time of onset and microbiology of surgical site infections (SSIs) following head and neck free flap reconstructive surgeries. STUDY DESIGN Retrospective cohort study. METHODS All 504 free flap surgical cases (484 patients) performed April 1, 2009 to September 30, 2013 were reviewed; SSIs occurring ≤30 days postoperatively were evaluated. Admission screening for methicillin-resistant Staphylococcus aureus (MRSA) colonization was performed on all patients. RESULTS Flap-recipient site infections (flap SSIs) occurred in 67 cases (13.3%), one-third week 1 postoperatively, one-third week 2, one-third days 15 to 30; 45% occurred after hospital discharge. Wound cultures were polymicrobial, but 25% grew only normal oral flora, whereas 75% grew pathogens not part of normal oral flora, such as gram-negative bacilli (44% of cases), MRSA (20%), and methicillin-sensitive S aureus (MSSA) (16%). The frequency of these pathogens did not vary significantly by the time of SSI onset. In 67%, cultures included at least one pathogen resistant to the prophylactic antibiotic used. Clindamycin prophylaxis was a significant risk factor for flap SSI and for early partial or complete flap loss from infection. Donor SSIs occurred in 22 cases (4.4%), 95% >1 week postoperatively, and MRSA or MSSA were the primary pathogens in 89%. Of the 25 patients colonized with MRSA on admission, 40% developed a flap or donor SSI, a rate significantly higher than in non-colonized patients. CONCLUSIONS Gram-negative bacilli, MRSA, and MSSA were significant SSI pathogens, and late onset of infection was common. Better screening, decolonization, and prophylaxis may reduce SSI rates. LEVEL OF EVIDENCE 2b
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Affiliation(s)
- Marlene L Durand
- Infectious Disease Service, Massachusetts Eye and Ear Infirmary, Boston, Massachusetts; Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, U.S.A
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Wissinger E, Griebsch I, Lungershausen J, Foster T, Pashos CL. The economic burden of head and neck cancer: a systematic literature review. PHARMACOECONOMICS 2014; 32:865-82. [PMID: 24842794 PMCID: PMC4153967 DOI: 10.1007/s40273-014-0169-3] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
BACKGROUND This systematic literature review aimed to evaluate and summarize the existing evidence on resource use and costs associated with the diagnosis and treatment of head and neck cancer (HNC) in adult patients, to better understand the currently available data. The costs associated with HNC are complex, as the disease involves multiple sites, and treatment may require a multidisciplinary medical team and different treatment modalities. METHODS Databases (MEDLINE and Embase) were searched to identify studies published in English between October 2003 and October 2013 analyzing the economics of HNC in adult patients. Additional relevant publications were identified through manual searches of abstracts from recent conference proceedings. RESULTS Of 606 studies initially identified, 77 met the inclusion criteria and were evaluated in the assessment. Most included studies were conducted in the USA. The vast majority of studies assessed direct costs of HNC, such as those associated with diagnosis and screening, radiotherapy, chemotherapy, surgery, side effects of treatment, and follow-up care. The costs of treatment far exceeded those for other aspects of care. There was considerable heterogeneity in the reporting of economic outcomes in the included studies; truly comparable cost data were sparse in the literature. Based on these limited data, in the US costs associated with systemic therapy were greater than costs for surgery or radiotherapy. However, this trend was not seen in Europe, where surgery incurred a higher cost than radiotherapy with or without chemotherapy. CONCLUSIONS Most studies investigating the direct healthcare costs of HNC have utilized US databases of claims to public and private payers. Data from these studies suggested that costs generally are higher for HNC patients with recurrent and/or metastatic disease, for patients undergoing surgery, and for those patients insured by private payers. Further work is needed, particularly in Europe and other regions outside the USA; prospective studies assessing the cost associated with HNC would allow for more systematic comparison of costs, and would provide valuable economic information to payers, providers, and patients.
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Affiliation(s)
| | | | | | | | - Chris L. Pashos
- UBC: An Express Scripts Company, 430 Bedford Street, Suite 100, Lexington, MA 02420 USA
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Avery C. A perspective on the role of the pectoralis major flap in oral and maxillofacial oncology surgery. ACTA ACUST UNITED AC 2014. [DOI: 10.1111/ors.12080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- C. Avery
- University Hospitals of Leicester; Leicester UK
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Abstract
Although major advances in the care of cancer patients over the past several decades have resulted in improved survival, infectious complications remain a significant cause of morbidity and mortality. To successfully identify, treat, and prevent infections, a comprehensive understanding of risk factors that predispose to infection and of commonly encountered pathogens is necessary. In addition, clinicians must keep abreast of the changing epidemiology of infections in this population. As therapeutic modalities continue to evolve, as established pathogens become increasingly drug resistant, and as new pathogens are discovered, successful management of infections will continue to present challenges in the years to come.
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Affiliation(s)
- Valentina Stosor
- Div. Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
| | - Teresa R. Zembower
- Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois USA
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Préaud E, Largeron N. Economic burden of non-cervical cancers attributable to human papillomavirus: a European scoping review. J Med Econ 2013; 16:763-76. [PMID: 23565814 DOI: 10.3111/13696998.2013.793691] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Human papillomavirus (HPV) has an important role in the aetiology of a range of diseases, including cervical, other anogenital, and head and neck cancers, genital warts and recurrent respiratory papillomatosis. This literature review was conducted to identify the available cost data for non-cervical HPV-related cancers (anal, penile, vulvar, vaginal, head and neck) in Europe and to inform discussion of methodological challenges for future economic research. METHODS The literature search was conducted using Medline and key words to identify papers published in English or French between 1 January 2000 and 31 December 2011. Abstracts of major conferences were searched to identify relevant information. Structured methods were used to select references that focused on overall disease management for inclusion in the review. RESULTS A total of 21 references from seven countries (Denmark, France, Germany, Greece, The Netherlands, Portugal, and the UK) were selected, including 11 references relating to head and neck cancers, five to anogenital cancers, and five to more than one HPV-related disease. Non-cervical cancers accounted for a substantial proportion of the economic burden of HPV-related cancers, and this burden was mainly driven by men (∼70%). A wide range of costs were reported for each disease, particularly head and neck cancers, predominantly due to disease complexity and variation in study design. LIMITATIONS The main limitation of this study was in the search strategy, which was constrained by the key words, the database searched, and the restriction on language (English/French). CONCLUSIONS Non-cervical cancers attributable to HPV impose a substantial economic burden in Europe, and the burden is greater in men than in women. This review provides useful information for future health-economic studies assessing the impact of HPV vaccination on all HPV-related diseases.
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Mittmann N, Koo M, Daneman N, McDonald A, Baker M, Matlow A, Krahn M, Shojania KG, Etchells E. The economic burden of patient safety targets in acute care: a systematic review. Drug Healthc Patient Saf 2012; 4:141-65. [PMID: 23097615 PMCID: PMC3476359 DOI: 10.2147/dhps.s33288] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Our objective was to determine the quality of literature in costing of the economic burden of patient safety. METHODS We selected 15 types of patient safety targets for our systematic review. We searched the literature published between 2000 and 2010 using the following terms: "costs and cost analysis," "cost-effectiveness," "cost," and "financial management, hospital." We appraised the methodologic quality of potentially relevant studies using standard economic methods. We recorded results in the original currency, adjusted for inflation, and then converted to 2010 US dollars for comparative purposes (2010 US$1.00 = 2010 €0.76). The quality of each costing study per patient safety target was also evaluated. RESULTS We screened 1948 abstracts, and identified 158 potentially eligible studies, of which only 61 (39%) reported any costing methodology. In these 61 studies, we found wide estimates of the attributable costs of patient safety events ranging from $2830 to $10,074. In general hospital populations, the cost per case of hospital-acquired infection ranged from $2132 to $15,018. Nosocomial bloodstream infection was associated with costs ranging from $2604 to $22,414. CONCLUSION There are wide variations in the estimates of economic burden due to differences in study methods and methodologic quality. Greater attention to methodologic standards for economic evaluations in patient safety is needed.
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Affiliation(s)
- Nicole Mittmann
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Marika Koo
- Health Outcomes and Pharmaco Economics (HOPE) Research Centre, Division of Clinical Pharmacology, Toronto, ON, Canada
| | - Nick Daneman
- Division of Infectious Diseases, Toronto, ON, Canada
| | - Andrew McDonald
- Quality and Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Michael Baker
- Patient Safety in Ontario, University Health Network, Toronto, ON, Canada
| | - Anne Matlow
- Infection Prevention and Control and Patient Safety, Hospital for Sick Children, Toronto, ON, Canada
| | - Murray Krahn
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, ON, Canada
| | - Kaveh G Shojania
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Edward Etchells
- University of Toronto Centre for Patient Safety, Sunnybrook Health Sciences Centre, Toronto, ON, Canada
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Shuman AG, Shuman EK, Hauff SJ, Fernandes LL, Light E, Chenoweth CE, Bradford CR. Preoperative topical antimicrobial decolonization in head and neck surgery. Laryngoscope 2012; 122:2454-60. [PMID: 22865589 DOI: 10.1002/lary.23487] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/30/2012] [Accepted: 05/11/2012] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Surgical site infections (SSIs) are an important cause of morbidity and mortality after head and neck surgery. Our primary objective was to determine the efficacy of preoperative topical antimicrobial decolonization before head and neck surgery. STUDY DESIGN Prospective, randomized controlled trial. METHODS This study was conducted among 84 patients presenting for head and neck surgery requiring admission to an academic medical center. Preoperative cultures were performed to identify Staphylococcus aureus carriers. Patients were randomized to preoperative topical antimicrobial decolonization with a 5-day regimen of chlorhexidine skin rinses and intranasal mupirocin coupled with standard perioperative systemic antimicrobial prophylaxis, versus standard prophylaxis alone. The main outcome was the incidence of SSIs. RESULTS Despite a trend suggesting a decrease in SSIs with perioperative topical antimicrobial decolonization (24% vs. 10%), there was no significant difference (odds ratio, 0.34; 95% confidence interval, 0.10-1.18; P = .079). Patients with a higher American Society of Anesthesiologists score (3 vs. 1; P = .02), with more operative blood loss (P = .05), and who required operative takeback (P = .04) had a higher rate of SSIs; there was a trend suggesting a higher rate of SSIs among patients undergoing clean-contaminated surgery compared to clean cases (P = .08) and among those having received prior radiation (P = .07) or chemotherapy (P = .06). CONCLUSIONS Preoperative antimicrobial decolonization did not significantly decrease the incidence of SSIs after head and neck surgery, but might be considered for high-risk groups despite the lack of conclusive evidence confirming efficacy. Risk factors for SSIs after head and neck surgery are identified for the first time in a prospective study.
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Affiliation(s)
- Andrew G Shuman
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospitals, Ann Arbor, Michigan 48109, USA.
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Robson V, Yorke J, Sen RA, Lowe D, Rogers SN. Randomised controlled feasibility trial on the use of medical grade honey following microvascular free tissue transfer to reduce the incidence of wound infection. Br J Oral Maxillofac Surg 2012; 50:321-7. [DOI: 10.1016/j.bjoms.2011.07.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2011] [Accepted: 07/17/2011] [Indexed: 11/29/2022]
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Costs of hospital-acquired infection and transferability of the estimates: a systematic review. Infection 2011; 39:185-99. [PMID: 21424853 DOI: 10.1007/s15010-011-0095-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/28/2011] [Indexed: 12/24/2022]
Abstract
Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAI (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced. The aims of this study were to conduct a systematic review of published studies that have produced COHAI estimates from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From a total of 89 publications, only eight papers (9.0%) had a high level of transferability in which all components of costs were described, data for costs in each component were reported, and unit costs were estimated with actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We feel that, in order to ensure an appropriate contribution to the infection control program decision-making process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-making, as well as relevant journal reviewers and editors to recognize the importance of a transferability paradigm.
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Downie F, Egdell S, Bielby A, Searle R. Barrier dressings in surgical site infection prevention strategies. ACTA ACUST UNITED AC 2011; 19:S42-6. [PMID: 21072011 DOI: 10.12968/bjon.2010.19.sup10.79693] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Healthcare-associated infections (HCAIs) are a matter of priority for the NHS. They are associated with significant morbidity, and frequently lead to increased length of hospital stay, pain and discomfort for the patient, and in some cases even permanent disability. It is estimated that surgical site infections (SSIs) constitute around 14% of all HCAIs. Any break in the skin affords a portal of entry for microbial pathogens, and hence places the patient at an increased risk of infection. To address the issue, a multi-factorial strategy for the prevention of SSIs is essential, with postoperative dressings playing a key part alongside universal precautions such as hand hygiene and aseptic technique. The available guidance specifies the need for a postoperative dressing which provides an effective physical barrier and a moist environment for optimal wound healing. Vapour-permeable barrier dressings appear to be effective in meeting both of these criteria and also offer additional advantages both to patients and practitioners, such as patient comfort and the ability to stay in place whilst the patient showers. However, regular wound assessment must be carried out to ensure the vapour-permeable postoperative dressing is the right choice for a specific patient at a given time.
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Srinivasan A, Seifried SE, Zhu L, Srivastava DK, Perkins R, Shenep JL, Bankowski MJ, Hayden RT. Increasing prevalence of nasal and rectal colonization with methicillin-resistant Staphylococcus aureus in children with cancer. Pediatr Blood Cancer 2010; 55:1317-22. [PMID: 20830777 PMCID: PMC2965815 DOI: 10.1002/pbc.22815] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Accepted: 08/03/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Infections with methicillin-resistant Staphylococcus aureus (MRSA), in community-settings, especially with strains carrying the Panton-Valentine Leukocidin (PVL) genes, have increased markedly in recent years. Colonization with S. aureus is a risk factor for infection. However, there are few studies that examine colonization and infection with PVL-positive strains of MRSA in cancer patients. PROCEDURE The epidemiology of colonization and infection with MRSA was studied in children with cancer during two time periods: 2000/2001 and 2006/2007. PVL genes were screened and spa typing performed on the isolates. RESULTS The prevalence of colonization with MRSA increased from 0.6% in 2000/2001 to 2.9% in 2006/2007 (P = 0.0003). MRSA colonization at admission was associated with infection (P < 0.0001; RR 38.32; 95% CI: 23.36-62.84). The prevalence of infection increased from 0.99% in 2000/2001 to 3.78% in 2006-2007 (P = 0.0002). Of the 32 colonized patients, 18 (56%) had infection. None of the 14 colonized but non-infected patients had dual colonization of nares and rectum, while 8 of the 18 infected patients had colonization of both of these sites (P = 0.004). Ten patients (31%) were colonized with PVL-positive strains. Patients colonized with PVL-positive strains were more likely to be colonized both in the nares and rectum (P = 0.005), and more likely to have infection (P = 0.001). Recurrent MRSA infections were seen in 22% of patients. CONCLUSION An increasing prevalence of colonization with MRSA was observed in children with cancer at our institution. Colonization with MRSA especially with PVL-positive strains was associated with infection.
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Affiliation(s)
- Ashok Srinivasan
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee 38105-3678, USA.
| | - Steven E. Seifried
- Department of Cell and Molecular Microbiology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI
| | - Liang Zhu
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Deo K. Srivastava
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN
| | - Rosalie Perkins
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
| | - Jerry L. Shenep
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, TN
| | - Matthew J. Bankowski
- Department of Pathology, John A. Burns School of Medicine, University of Hawaii, Honolulu, HI,Diagnostic Laboratory Services, Inc, Honolulu, HI
| | - Randall T. Hayden
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN
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Impact of methicillin-resistant Staphylococcus Aureus (MRSA) infection on patient outcome after pancreatoduodenectomy (PD)--a cause for concern? Pancreas 2010; 39:1211-4. [PMID: 20944489 DOI: 10.1097/mpa.0b013e3181e00cad] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study evaluated the impact of methicillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infection on postoperative complications and patient outcome after pancreatoduodenectomy (PD). METHODS Seventy-nine patients who underwent PD were monitored for hospital-acquired MRSA. The patients were grouped as (1) no MRSA infection, (2) skin colonization with MRSA, and (3) systemic MRSA infection. RESULTS Forty (51%) of the 79 patients were MRSA positive during hospital admission. Fourteen of the 40 patients swabbed for MRSA were found positive (skin colonization), and 26 patients (33%) developed systemic MRSA infection after PD. The sites of MRSA infection included (1) abdominal drain fluid (16/26; 42%), (2) sputum (4/26; 15%), (3) blood cultures (2/26; 8%), and (4) combination of sites (9/26; 35%). The patients with systemic MRSA infection had a longer postoperative stay (31 vs 22 days; P = 0.005) and increased incidence of chest infections compared with MRSA-negative patients (14 vs 4; P = 0.02). Four of the 16 patients with MRSA-positive drain fluid had a postpancreatectomy hemorrhage compared with 3 of the 63 patients with no MRSA infection in drain fluid (P = 0.02). CONCLUSION Of the 79 patients admitted for PD, 51% became colonized with MRSA infection. Systemic hospital-acquired MRSA infection in 33% was associated with prolonged postoperative stay, increased wound and chest infections, and increased risk of postoperative hemorrhage.
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Abstract
BACKGROUND Existing estimates of the costs of antimicrobial resistance exhibit broad variability, and the contributing factors are not well understood. This study examines factors that contribute to variation in these estimates. METHODS Studies of the costs of resistant infections (1995-2009) were identified, abstracted, and stated in comparable terms (eg, converted to 2007 U.S. dollars). Linear regressions were conducted to assess how costs incurred by patients with resistant infections versus those incurred by uninfected or susceptible-organism-infected controls varied according to (1) costs incurred by control subjects; (2) study population characteristics; (3) methodological factors (eg, matching); and (4) length of stay. RESULTS Estimates of difference in costs incurred by patients with resistant infections versus patients without resistant infections varied between $-27,609 (control costs exceeded case costs) and $126,856. Differences were greater when the costs incurred by control subjects were higher (ie, when the underlying cost of care was high). Study-adjusted cost differences were greater for bloodstream infections (vs. any other infection site), for studies that reported median (vs. mean) costs, for studies that reported total (vs. postinfection or infection-associated) costs, for studies that used uninfected (vs. susceptible-organism-infected) controls, and for studies that did not match or adjust for length of stay before infection. CONCLUSION The cost of antimicrobial resistance seems to vary with the underlying cost of care. Increased costs of resistance are partially explained by longer length of stay for patients with resistant infections. Further research is needed to assess whether interventions should be differentially targeted at the highest cost cases.
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Jeannon JP, Orabi A, Manganaris A, Simo R. Methicillin Resistant Staphylococcus Aureus Infection as a causative agent of fistula formation following total laryngectomy for advanced head & neck cancer. HEAD & NECK ONCOLOGY 2010; 2:14. [PMID: 20584326 PMCID: PMC2907379 DOI: 10.1186/1758-3284-2-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 06/28/2010] [Indexed: 02/08/2023]
Abstract
Aims The purpose of this paper was to investigate the impact of Methicillin Resistant Staphylococcus Aureus (MRSA) infection in the aetiology of pharyngo-cutaneous fistula (PCF) formation following total laryngectomy for advanced laryngeal cancer. Methods This was a retrospective uncontrolled case study series of 31 consecutive patients based in a single institution tertiary referral head and neck oncology centre. Results Pharyngo-cutaneous fistulas (PCF) following total laryngectomy occurred in 10 (32%) patients. MRSA was identified in 80% of patients with a PCF compared to 9% of patients that did not develop a fistula (p = 0.0001255 Fisher exact test). MRSA infection (p = 0.00012) and previous radiotherapy (p = 0.00025) were the only significant factors found to be important in fistula formation on multivariate analysis. Post-operative infections such as cellulitis, chest infection and carotid fistula were also associated with MRSA infections. Conclusion MRSA infection following total laryngectomy for laryngeal cancer can lead to potential serious complications such as PCF. Patients who underwent total laryngectomy following radiotherapy failure are at a higher risk of acquiring MRSA.
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Affiliation(s)
- Jean-Pierre Jeannon
- Department of Ear Nose & Throat - Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
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Fraser S, Brady RR, Graham C, Paterson-Brown S, Gibb AP. Methicillin-resistant Staphylococcus aureus in surgical patients: identification of high-risk populations for the development of targeted screening programmes. Ann R Coll Surg Engl 2010; 92:311-5. [PMID: 20385046 DOI: 10.1308/003588410x12628812459698] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Methicillin-resistant Staphylococcus aureus (MRSA)-related hospital-acquired infection (HAI) in surgical patients is associated with high morbidity, mortality and financial cost. The identification and characterisation of populations of patients who are at high risk of developing MRSA infection or colonisation could inform the design of more effective strategies to prevent HAIs and reduce transmission of MRSA. PATIENTS AND METHODS An analysis of historical discharge data for the whole of 2005 (7145 surgical in-patients) was performed, for all patients admitted to general surgery at the Royal Infirmary of Edinburgh. Analysis specifically focused on MRSA laboratory data and coding data for patient demographics, medical co-morbidities, and progress of in-patient stay. RESULTS A total of 134 (1.88%) individual patients with colonisation or infection by MRSA were identified from indicated laboratory testing. Univariate analysis identified a significant association of concurrent MRSA-positive status with patients aged over 60 years (P < 0.01), a duration of inpatient stay > 7 days (P < 0.01), presence of a malignant neoplasm (P < 0.01), circulatory disease (P < 0.01), respiratory disease (P < 0.01), central nervous system disease (P < 0.01), renal failure (P < 0.01), and concurrent admission to ITU/HDU (P < 0.01). Multivariate analysis suggested MRSA colonisation or infection was strongest in those with co-morbid malignancy (P < 0.0001) or admission to ITU/HDU (P < 0.0001). CONCLUSIONS This large observational study has identified cancer patients as a UK surgical patient subpopulation which is at significantly higher risk of colonisation by MRSA. These data could inform the development of focused hospital in-patient screening protocols and provide a means to stratify patient risk.
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Affiliation(s)
- Stephanie Fraser
- Department of General Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
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A staff questionnaire study of MRSA infection on ENT and general surgical wards. Eur Arch Otorhinolaryngol 2010; 267:1455-9. [DOI: 10.1007/s00405-010-1221-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2009] [Accepted: 02/16/2010] [Indexed: 11/26/2022]
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Nkenke E, Vairaktaris E, Stelzle F, Neukam FW, St Pierre M. No reduction in complication rate by stay in the intensive care unit for patients undergoing surgery for head and neck cancer and microvascular reconstruction. Head Neck 2010; 31:1461-9. [PMID: 19384935 DOI: 10.1002/hed.21117] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this prospective cohort study was to determine whether an immediate postoperative period of deep sedation and artificial respiration in an intensive care unit (ICU) leads to fewer complications and a reduced failure rate of microvascular flaps compared with a situation in which patients are allowed to breathe spontaneously without sedation in a recovery room. METHODS Each group comprised 50 patients. General medical complications and flap donor and recipient site complications were documented. RESULTS Significantly, more patients had problems with weaning from ventilation in the ICU group (p = .022). More cases of respiratory insufficiency (p = .240) and pneumonia (p = .081) occurred in the ICU group compared with the recovery room group without statistically significant differences. The number of flaps lost was comparable in both groups (p = .646). CONCLUSIONS Admission to an ICU did not reduce complications after microvascular reconstruction and, therefore, has only to be considered for selected cases.
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Affiliation(s)
- Emeka Nkenke
- Department of Oral and Maxillofacial Surgery, University of Erlangen-Nuremberg, Erlangen, Germany.
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Health economic issues in the treatment of drug-resistant serious Gram-positive infections. J Infect 2009; 59 Suppl 1:S40-50. [PMID: 19766889 DOI: 10.1016/s0163-4453(09)60007-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Escalating health care costs have stimulated a paradigm change in the way health care is delivered, reimbursed, and evaluated. Reducing the length of hospital stay and controlling the cost of new technologies and therapies are major factors driving health care decisions. Economic evaluations have had variable success in the decision-making process, partly due to the overall quality, interpretation, and reporting of published analyses. Compared with other Gram-positive pathogens, the economic impact of methicillin-resistant Staphylococcus aureus (MRSA) infections remains the most studied. MRSA infections clearly represent a significant clinical and fiscal burden and future studies analyzing cost-effective strategies that encompass their prevention and optimal management would be beneficial. These studies would need to be carefully designed with clear objectives and explicit perspectives at the onset. Use of an appropriate reference group is key in the design process to measure the true impact of MRSA infections. Health-economic outcome data of the impact of linezolid compared with glycopeptides remain the most robust data available in this therapeutic area.
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Richer SL, Wenig BL. The efficacy of preoperative screening and the treatment of methicillin-resistant Staphylococcus aureus in an otolaryngology surgical practice. Otolaryngol Head Neck Surg 2009; 140:29-32. [PMID: 19130957 DOI: 10.1016/j.otohns.2008.10.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2008] [Revised: 10/13/2008] [Accepted: 10/16/2008] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To examine the efficacy of preoperative Staphylococcus aureus screening on postoperative methicillin-resistant S aureus (MRSA) infection rates in otolaryngology. STUDY DESIGN Chart review. SUBJECTS AND METHODS Postoperative MRSA infection rates in unscreened patients during a 1-year period were compared with infection rates in patients after preoperative S aureus screening was initiated. Colonized patients were treated with mupirocin and chlorhexidine preoperatively. RESULTS Records of 420 patients were reviewed. In the 241 patients without screening, nine patients had S aureus infections, and there were two (0.8%) postoperative MRSA surgical-site infections. Of 179 patients after screening was initiated, 24 patients (13.4%) were colonized with S aureus and underwent preoperative treatment. There were no MRSA infections in the postoperative period. CONCLUSION Early results show the potential benefit of preoperative S aureus screening in MRSA infection rate reduction. Although larger studies are needed, screening and treatment of MRSA colonized patients preoperatively may reduce infectious complications in otolaryngology.
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Wierzbicka M, Tomczak H, Witold S, Bartochowska A, Rogozińska A, Judka K. [MRSA and MSSA infections in patients operated on for head and neck cancers]. Otolaryngol Pol 2008; 62:375-9. [PMID: 18837207 DOI: 10.1016/s0030-6657(08)70275-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION The MRSA and MSSA infections are essential clinical problem. Both of the strains have high virulence (as a result of enzyme and toxin production), what disturbs wound healing as well as a general condition of the patient. AIM The purpose of this work was an estimation of the role of MRSA infections among patients operated on for head and neck cancers. MATERIAL AND METHODS From 1155 patients treated for head and neck cancers in The Department of Otolaryngology in Poznan in 2006-2007 189 biological samples were taken to carry out a bacteriological examination. The indications for this procedure were symptoms of infection in the operated area, wound healing per secundam and a hectic fever after the surgery. Biological specimens came from: 57 postoperative wounds, 36 tracheotomy areas, 24 tracheoesophageal fistulas, 9 salivary fistulas, 21 oral cavities and pharynxes, 2 noses, 4 ears, 6 central venous catheter areas, 2 gastrostomies, 2 cerebrospinal fluid (CSF) samples, 1 fluid from pleural cavity, 11 blood samples, 12 urine samples, 2 bronchoalveolar lavages (BAL). RESULTS 37 biological samples were aseptic, in 11 samples there were no pathological cultures, in 141 samples pathological bacterial flora was found. MRSA was found in 6 cultures and MSSA was found in 18 cultures. CONCLUSIONS In order to prevent the MRSA infection the Hospital Infections Department was formed. The results of commissioned bacteriological examinations are analyzed by the Department, what enables bacteriological flora observation in the hospital, fast identification of MRSA infected patients, and, what is more, MRSA infections prevention. It also helps to select proper medicaments in empiric antibiotic therapy.
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Dryden M. Complicated Skin and Soft Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus: Epidemiology, Risk Factors, and Presentation. Surg Infect (Larchmt) 2008; 9 Suppl 1:s3-10. [DOI: 10.1089/sur.2008.066.supp] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Matthew Dryden
- Microbiology and Communicable Disease, Royal Hampshire County Hospital, Winchester, Hampshire, United Kingdom
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Edmiston CE, Krepel CJ, Seabrook GR, Lewis BD, Brown KR, Towne JB. Preoperative Shower Revisited: Can High Topical Antiseptic Levels Be Achieved on the Skin Surface Before Surgical Admission? J Am Coll Surg 2008; 207:233-9. [DOI: 10.1016/j.jamcollsurg.2007.12.054] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2007] [Revised: 11/30/2007] [Accepted: 12/14/2007] [Indexed: 10/22/2022]
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Which patients are most at risk of methicillin resistant Staphylococcus aureus: a review of admissions to a regional maxillofacial ward between 2001 and 2005. Br J Oral Maxillofac Surg 2008; 46:439-44. [PMID: 18554758 DOI: 10.1016/j.bjoms.2007.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/31/2007] [Indexed: 11/23/2022]
Abstract
This study aimed to identify all Staphylococcus aureus (MRSA) cases on a Regional Maxillofacial ward, to estimate incidence and to ascertain who were most at risk. The study also explored clinical and demographic factors associated with MRSA in a subset of consecutive patients managed by primary surgery for previously untreated oral and oropharyngeal squamous cell carcinoma (OOSCC) over the same time period. Patients admitted from 1st April 2001 to 31st March 2006 to the Regional Maxillofacial Unit ward, Liverpool were identified by a retrospective review of the hospital MRSA database and there were 10109 patient admissions. MRSA (1.1%) occurred in 115 patient episodes involving 97 patients. There were 84 patients having a single episode and 13 more than one. There were no cases of mortality due to MRSA. Of the MFU patients 73 were oncology and 7 trauma. In the oncology group the commonest primary sites were wound (41) and sputum (11). Of new patients admitted for definitive treatment for OOSCC, 14% had MRSA and the two main risk factors were stage of cancer (P<0.001) and free flap (P<0.001). The risk of MRSA infection on our maxillofacial ward is low though MRSA infection is more prevalent among oncology patients particularly those requiring free tissue transfer. Careful adherence to infection prevention and control precautions is essential and practical methods to reduce MRSA need further evaluation.
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Penel N, Lefebvre JL, Cazin J, Clisant S, Neu JC, Dervaux B, Yazdanpanah Y. Additional direct medical costs associated with nosocomial infections after head and neck cancer surgery: a hospital-perspective analysis. Int J Oral Maxillofac Surg 2008; 37:135-9. [DOI: 10.1016/j.ijom.2007.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Revised: 05/30/2007] [Accepted: 08/13/2007] [Indexed: 01/18/2023]
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Abstract
The objective of this study is to estimate the cost of wound care in a local population of approximately 590 000 using results from a wound care audit carried out in Hull and the East Riding of Yorkshire as a basis. Full results of the audit will be published separately. An audit in June 2005 provided information on patients with wounds and on their treatment. This was combined with representative National Health Service unit costs to produce an estimate of the total cost of wound care in 2005-2006. In all, 1644 patients had a total of 2300 wounds (1.44 per patient). Most (74.1%) were treated in the community by district nurses, 21.2% were treated in hospital and 4.8% were treated in residential or hospice care. More than one in four hospital inpatients (26.8%) had a wound. Median duration was 6-12 weeks. Twenty-four per cent had their wound for 6 months or more, and almost 16% of patients had remained unhealed for a year or longer. One in eight wounds (12.8%) were reported as showing signs of infection. The estimated cost of wound care in 2005-2006 was pound15 million to pound18 million ( pound2.5 million to pound3.1 million per 100 000 population). Caring for patients with wounds required the equivalent of 88.5 full-time nurses and up to 87 hospital beds. Wounds are a significant source of cost to patients as well as the health care system. The most important determinant of cost appears to be wound complications which require hospitalisation or which delay hospital discharge. Reducing costs requires a systematic focus on effective and timely diagnosis, on ensuring treatment is appropriate to the cause and condition of the wound and on active measures to prevent complications and wound-related hospitalisation. These results should be generalisable to other similar populations in the UK and elsewhere.
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Affiliation(s)
- Philip Drew
- Hull and East Yorkshire Hospitals NHS Trust, Anlaby Road, Hull, HU 3 2J2, UK
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36
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Advantages of not using the intensive care unit after operations for oropharyngeal cancer: An audit at Worcester Royal Hospital. Br J Oral Maxillofac Surg 2007; 45:648-51. [DOI: 10.1016/j.bjoms.2007.05.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2007] [Indexed: 11/22/2022]
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Bowrey DJ, Evans MD, Clark GWB. Impact of methicillin-resistant Staphylococcus aureus infection on outcome after esophagectomy. World J Surg 2007; 31:326-31. [PMID: 17171479 DOI: 10.1007/s00268-006-0077-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Infection with methicillin-resistant Staphylococcus aureus (MRSA) has reached endemic proportions in the United Kingdom. The aim of the present study was to determine the frequency of MRSA infection in patients undergoing esophagectomy and to report its impact on patient outcome. PATIENTS AND METHODS The study population was 98 patients undergoing esophagectomy for carcinoma during the years 1998-2004. Patient information was collected prospectively and entered into a computerized database and analyzed retrospectively by univariate and multivariate analysis. RESULTS Overall, 20 of the 98 patients (20%) developed infection with MRSA after esophagectomy. Patients who developed MRSA infection had greater levels of postoperative morbidity, longer intensive care unit (ICU) stays (median 2 days versus 1 day, P = 0.005) and hospital stays (21 days versus 16 days, P < 0.001) compared to those who did not develop infection. Multivariate analysis identified preoperative chemotherapy (P = 0.006) and readmission to the ICU (P = 0.007) as significant risk factors with MRSA infection. Overall, 17 of 46 patients (37%) who received neoadjuvant chemotherapy developed MRSA infection, compared to 3 of 52 (6%) who did not receive this treatment (P = 0.0001). CONCLUSIONS Overall, one in five patients undergoing esophagectomy developed MRSA infection, with those patients who received neoadjuvant chemotherapy identified as being at greatest risk of this complication. This is an alarming finding, as neoadjuvant chemotherapy is the standard of care for patients with esophageal carcinoma in the United Kingdom.
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Affiliation(s)
- David J Bowrey
- Department of Surgery, University Hospital of Wales, Heath Park, Cardiff, CF14 4X, United Kingdom.
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Shiomori T, Miyamoto H, Udaka T, Okochi J, Hiraki N, Hohchi N, Hashida K, Fujimura T, Kitamura T, Nagatani G, Ohbuchi T, Suzuki H. Clinical features of head and neck cancer patients with methicillin-resistant Staphylococcus aureus. Acta Otolaryngol 2007; 127:180-5. [PMID: 17364350 DOI: 10.1080/00016480600750018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
CONCLUSIONS The risk factors for methicillin-resistant Staphylococcus aureus (MRSA) detection in head and neck cancer patients are the duration of hospitalization, intravenous hyperalimentation, prior antibiotic use, and the coexistence of other pathogens. OBJECTIVES To shed light on the clinical characteristics of MRSA-positive inpatients with head and neck cancers. The secondary goal was to evaluate risk factors for MRSA detection in comparison with methicillin-sensitive S. aureus (MSSA). PATIENTS AND METHODS Sixty-one consecutive inpatients with head and neck cancers with S. aureus detection were analyzed based on their medical records. The antimicrobial susceptibility of isolated S. aureus was tested by the broth microdilution method. RESULTS MRSA and MSSA were detected in 46 (75.4%) and 15 (24.6%) of the 61 patients, respectively. There was no significant difference in the male/female ratio, age, primary site, comorbidity, cancer stage, cancer treatment, or 5-year survival rate between the MRSA and MSSA groups. Compared with the MSSA group, the MRSA group had significantly longer hospitalization periods and intervals between admission and MRSA detection, as well as significantly greater likelihood of intravenous hyperalimentation, prior antibiotic use, and co-isolation of other pathogens. Isolated strains of MRSA were thoroughly sensitive to vancomycin and arbekacin and moderately sensitive to minocycline.
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Affiliation(s)
- Teruo Shiomori
- Department of Otorhinolaryngology, University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan.
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Simo R, French G. The use of prophylactic antibiotics in head and neck oncological surgery. Curr Opin Otolaryngol Head Neck Surg 2006; 14:55-61. [PMID: 16552259 DOI: 10.1097/01.moo.0000193183.30687.d5] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW An overview of best evidence-based current practice in the use of prophylactic antibiotics in elective oncological head and neck surgery is presented. RECENT FINDINGS Patients undergoing head and neck oncological surgery are at great risk of developing complications following surgery. The incidence of wound infection has been reported to be as high as 87%, often with devastating effects. Prophylactic antibiotics have helped to reduce significantly the risk of infection; however, clinicians managing these patients should also have a thorough understanding of the risk factors leading to postoperative infections and should apply the most basic surgical principles at all times, to minimize infection rates. SUMMARY Prophylactic antibiotics usage in clean-contaminated major oncological head and neck surgery is mandatory to reduce the risk of infection. In clean major oncological head and neck surgery their use is also advisable but there is no evidence that in clean surgery for benign disease it offers any advantage. Short antibiotic regimes of four doses per 24 h are as effective as prolonged courses regardless of the complexity of the procedure. A combination of antibiotic agents covering aerobic, anaerobic and Gram-negative bacteria is superior to single agents. High-risk patients should be also given short regimes, as there is no evidence that prolonged courses are of more benefit in these patients. Methicillin-resistant Staphylococcus aureus infection can have devastating consequences for patients undergoing major head and neck surgery. Protocols of prevention and treatment should be in place in all institutions treating patients with head and neck cancer. Close collaboration between surgical, microbiology and infection-control teams is essential.
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Affiliation(s)
- Ricard Simo
- Department of Otorhinolaryngology & Head and Neck Surgery, Guy's and St Thomas' Hospital, London, UK.
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Abstract
Antibiotic resistance continues to plague antimicrobial chemotherapy of infectious disease. And while true biocide resistance is as yet unrealized, in vitro and in vivo episodes of reduced biocide susceptibility are common and the history of antibiotic resistance should not be ignored in the development and use of biocidal agents. Efflux mechanisms of resistance, both drug specific and multidrug, are important determinants of intrinsic and/or acquired resistance to these antimicrobials, with some accommodating both antibiotics and biocides. This latter raises the spectre (as yet generally unrealized) of biocide selection of multiple antibiotic-resistant organisms. Multidrug efflux mechanisms are broadly conserved in bacteria, are almost invariably chromosome-encoded and their expression in many instances results from mutations in regulatory genes. In contrast, drug-specific efflux mechanisms are generally encoded by plasmids and/or other mobile genetic elements (transposons, integrons) that carry additional resistance genes, and so their ready acquisition is compounded by their association with multidrug resistance. While there is some support for the latter efflux systems arising from efflux determinants of self-protection in antibiotic-producing Streptomyces spp. and, thus, intended as drug exporters, increasingly, chromosomal multidrug efflux determinants, at least in Gram-negative bacteria, appear not to be intended as drug exporters but as exporters with, perhaps, a variety of other roles in bacterial cells. Still, given the clinical significance of multidrug (and drug-specific) exporters, efflux must be considered in formulating strategies/approaches to treating drug-resistant infections, both in the development of new agents, for example, less impacted by efflux and in targeting efflux directly with efflux inhibitors.
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Affiliation(s)
- Keith Poole
- Department of Microbiology & Immunology, Queen's University, Kingston, ON, Canada.
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