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Borg MA, Suda D, Scicluna E, Brincat A, Zarb P. Universal admission screening: a potential game-changer in hospitals with high prevalence of MRSA. J Hosp Infect 2021; 113:77-84. [PMID: 33811962 DOI: 10.1016/j.jhin.2021.03.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 03/24/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Despite the perception that meticillin-resistant Staphylococcus aureus (MRSA) is now under control in high-income countries, global prevalence remains high, even increasing in some regions. Universal admission screening and decolonization has been instituted in some hospitals to attempt control but the practice remains controversial. METHODS In 2014, Mater Dei Hospital in Malta introduced a universal admission screening policy, utilizing a novel, centralized and customized approach to achieve high compliance and low cost. Admissions are screened nasally by designated staff using chromogenic media, irrespective of risk factors. Carriers are decolonized without concurrent isolation or contact precautions. In this study, longitudinal, quasi-experimental evaluation was undertaken using time series analysis to analyse the impact of the intervention on the proportion of MRSA among clinical S. aureus isolates (%MRSA) and incidence per 1000 bed-days. A cost-utility analysis was also attempted to identify approximate quality-adjusted life years (QALYs) gained. RESULTS A transfer function model approach concluded that the intervention had a significant effect on both %MRSA and incidence. Six years following its introduction, the screening programme had led to an overall 43% long-term reduction in %MRSA from pre-screening levels [R2=0.687; Bayesian information criterion (BIC)=4.063], translating to a decrease in incidence of approximately 0.56 cases/1000 bed-days (R2=0.633, BIC=-3.063). No correlation was identified with consumption of antibiotics or alcohol hand rub. The annual cost-benefit of the programme was calculated at €1058 per QALY gain per year. CONCLUSION The universal admission screening and decolonization intervention was successful and cost-effective in this high-endemicity setting. It facilitated improvement in the prevalence of MRSA, achieving reduction levels rarely reported by Mediterranean hospitals.
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Affiliation(s)
- M A Borg
- University of Malta, Msida, Malta; Mater Dei Hospital, Msida, Malta.
| | - D Suda
- University of Malta, Msida, Malta
| | | | | | - P Zarb
- University of Malta, Msida, Malta; Mater Dei Hospital, Msida, Malta
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Kaier K, Wilson C, Hulscher M, Wollersheim H, Huis A, Borg M, Scicluna E, Lambert ML, Palomar M, Tacconelli E, De Angelis G, Schumacher M, Wolkewitz M, Kleissle EM, Frank U. Implementing strategic bundles for infection prevention and management. Infection 2011; 40:225-8. [DOI: 10.1007/s15010-011-0186-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2011] [Accepted: 08/09/2011] [Indexed: 11/29/2022]
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Borg M, Tiemersma E, Scicluna E, van de Sande-Bruinsma N, de Kraker M, Monen J, Grundmann H. Prevalence of penicillin and erythromycin resistance among invasive Streptococcus pneumoniae isolates reported by laboratories in the southern and eastern Mediterranean region. Clin Microbiol Infect 2009; 15:232-7. [DOI: 10.1111/j.1469-0691.2008.02651.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Borg MA, van de Sande-Bruinsma N, Scicluna E, de Kraker M, Tiemersma E, Monen J, Grundmann H. Antimicrobial resistance in invasive strains of Escherichia coli from southern and eastern Mediterranean laboratories. Clin Microbiol Infect 2008; 14:789-96. [PMID: 18727803 DOI: 10.1111/j.1469-0691.2008.02037.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
From January 2003 to December 2005, 5091 susceptibility test results from invasive isolates of Escherichia coli, collected from blood cultures and cerebrospinal fluid routinely processed within 58 participating laboratories, were investigated. These laboratories in turn serviced 64 hospitals in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey. The median proportion of resistance to third-generation cephalosporins for the duration of the project was 18.9% (interquartile range (IQR): 12.5-30.8%), and for fluoroquinolones 21.0% (IQR: 7.7-32.6%). A substantial proportion of strains reported by laboratories in countries east of the Mediterranean exhibited evidence of multiresistance, the highest proportion being from Egypt (31%). There is clearly a need for further investigation of potential causes of the significant resistance identified, as well as for strengthening of national and international surveillance initiatives within this region.;
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Affiliation(s)
- M A Borg
- Infection Control Unit, Mater Dei Hospital, Msida, Malta
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Abstract
A structured questionnaire concerning hospital infection control (IC) organisation and initiatives was sent to 45 hospitals in Algeria, Cyprus, Egypt, Jordan, Lebanon, Libya, Malta, Morocco, Tunisia and Turkey. Hospitals bordering the eastern Mediterranean appeared to have more established IC infrastructures than southern Mediterranean hospitals. However, there were no significant differences among hospitals in the two regions in surveillance activities, the presence of an antibiotic policy or feedback of resistance data to prescribers, all of which were at a low level. Only a minority of hospitals had published antimicrobial treatment guidelines or gave feedback on antimicrobial resistance data to prescribers.
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Affiliation(s)
- M A Borg
- Infection Control Unit, St. Luke's Hospital, G'Mangia, Malta.
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Grigoryan L, Birkin J, Burgerhof J, Degener J, Deschepper R, Stålsby Lundborg C, Monnet D, Scicluna E, Haaijer-Ruskamp F, Di Matteo A, Tambi-Andrasevic A, Andrajati R, Edelstein H, Valinteliene R, Mechtler R, Deliens L, Van der Kelen G. O167 Attitudes, beliefs and knowledge concerning antibiotic use and self-medication:a comparative European study. Int J Antimicrob Agents 2007. [DOI: 10.1016/s0924-8579(07)70107-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Borg MA, Scicluna E, De Kraker M, Van de Sande-Bruinsma N, Tiemersma E, Gür D, Ben Redjeb S, Rasslan O, Elnassar Z, Benbachir M, Pieridou Bagatzouni D, Rahal K, Daoud Z, Grundmann H, Monen J. Antibiotic resistance in the southeastern Mediterranean - preliminary results from the ARMed project. ACTA ACUST UNITED AC 2006; 11:11-12. [PMID: 29208166 DOI: 10.2807/esm.11.07.00639-en] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sporadic reports from centres in the south and east of the Mediterranean have suggested that the prevalence of antibiotic resistance in this region appears to be considerable, yet pan-regional studies using comparable methodology have been lacking in the past. Susceptibility test results from invasive isolates of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Enterococcus faecium and faecalis routinely recovered from clinical samples of blood and cerebrospinal fluid within participating laboratories situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey were collected as part of the ARMed project. Preliminary data from the first two years of the project showed the prevalence of penicillin non-susceptibility in S. pneumoniae to range from 0% (Malta) to 36% (Algeria) [median: 29%] whilst methicillin resistance in Staphylococcus aureus varied from 10% in Lebanon to 65% in Jordan [median: 43%]. Significant country specific resistance in E. coli was also seen, with 72% of isolates from Egyptian hospitals reported to be resistant to third generation cephalosporins and 40% non-susceptible to fluoroquinolones in Turkey. Vancomycin non-susceptibility was only reported in 0.9% of E. faecalis isolates from Turkey and in 3.8% of E. faecium isolates from Cyprus. The preliminary results from the ARMed project appear to support previous sporadic reports suggesting high antibiotic resistance in the Mediterranean region. They suggest that this is particularly the case in the eastern Mediterranean region where resistance in S. aureus and E. coli seems to be higher than that reported in the other countries of the Mediterranean.
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Affiliation(s)
- M A Borg
- Infection Control Unit, St. Luke's Hospital, G'Mangia MSD08, Malta
| | - E Scicluna
- Infection Control Unit, St. Luke's Hospital, G'Mangia MSD08, Malta
| | - M De Kraker
- National Institute of Public Health and the Environment, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands
| | - N Van de Sande-Bruinsma
- National Institute of Public Health and the Environment, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands
| | - E Tiemersma
- National Institute of Public Health and the Environment, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands
| | - D Gür
- Clinical Microbiology Laboratory, Hacettepe University, Ankara, Turkey
| | - S Ben Redjeb
- Microbiology Laboratory, Hospital Charles Nicolle, Tunis, Tunisia
| | - O Rasslan
- Infectious Disease Research and Infection Control Unit, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Z Elnassar
- Pathology and Microbiology Department, Jordan University of Science and Technology, Irbid, Jordan
| | - M Benbachir
- Microbiology Laboratory, Faculty of Medicine, Casablanca, Morocco
| | | | - K Rahal
- Institute Pasteur, Alger, Algeria
| | - Z Daoud
- Microbiology Laboratory, St. George University Hospital, Beirut, Lebanon
| | - H Grundmann
- National Institute of Public Health and the Environment, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands
| | - J Monen
- National Institute of Public Health and the Environment, Department of Infectious Disease Epidemiology, Bilthoven, The Netherlands
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Borg MA, Scicluna E, de Kraker M, van de Sande-Bruinsma N, Tiemersma E, Gür D, Ben Redjeb S, Rasslan O, Elnassar Z, Benbachir M, Pieridou Bagatzouni D, Rahal K, Daoud Z, Grundmann H, Monen J. Antibiotic resistance in the southeastern Mediterranean--preliminary results from the ARMed project. Euro Surveill 2006; 11:164-7. [PMID: 16966796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023] Open
Abstract
Sporadic reports from centres in the south and east of the Mediterranean have suggested that the prevalence of antibiotic resistance in this region appears to be considerable, yet pan-regional studies using comparable methodology have been lacking in the past. Susceptibility test results from invasive isolates of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Enterococcus faecium and faecalis routinely recovered from clinical samples of blood and cerebrospinal fluid within participating laboratories situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey were collected as part of the ARMed project. Preliminary data from the first two years of the project showed the prevalence of penicillin non-susceptibility in S. pneumoniae to range from 0% (Malta) to 36% (Algeria) [median: 29%] whilst methicillin resistance in Staphylococcus aureus varied from 10% in Lebanon to 65% in Jordan [median: 43%]. Significant country specific resistance in E. coli was also seen, with 72% of isolates from Egyptian hospitals reported to be resistant to third generation cephalosporins and 40% non-susceptible to fluoroquinolones in Turkey. Vancomycin non-susceptibility was only reported in 0.9% of E. faecalis isolates from Turkey and in 3.8% of E. faecium isolates from Cyprus. The preliminary results from the ARMed project appear to support previous sporadic reports suggesting high antibiotic resistance in the Mediterranean region. They suggest that this is particularly the case in the eastern Mediterranean region where resistance in S. aureus and E. coli seems to be higher than that reported in the other countries of the Mediterranean.
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Affiliation(s)
- M A Borg
- Infection Control Unit, St. Luke's Hospital, G'Mangia MSD08, Malta
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Borg M, Scicluna E, Suda D. P4.01 Impact of Overcrowding on Methicillin Resistant Staphylococcus aureus (MRSA) Incidence in General Ward Settings - a Time Series Analysis. J Hosp Infect 2006. [DOI: 10.1016/s0195-6701(06)60063-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Charron M, Scicluna E. [From dream to reality]. Soins Psychiatr 1998:11-2. [PMID: 10095756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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