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Abuhammad S, Alwedyan D, Hamaideh S, AL-Jabri M. Knowledge, Attitude, and Practices of Mothers Working as Nurses Toward Multidrug-Resistant: Impact of an Educational Program in Neonatal Intensive Care Unit. Infect Drug Resist 2024; 17:1937-1950. [PMID: 38770367 PMCID: PMC11104437 DOI: 10.2147/idr.s461188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 05/10/2024] [Indexed: 05/22/2024] Open
Abstract
Objective This study seeks to assess the influence of an educational program on enhancing the knowledge, attitudes, and practices of NICU nurses regarding MDROs. Methodology Quasi-experimental design that investigated the efficacy of an educational intervention in shaping the knowledge, attitudes, and practices of mothers working as nurses in NICU toward MDROs was used. A total of 168 nurses participated, divided into 84 intervention groups and 84 non-educational groups. Results The analysis of overall knowledge scores before and after the educational interventions revealed a significant improvement in post-education knowledge scores (Mean = 16.94) compared to pre-education scores (Mean = 12.9929; t(83) = 40.119, p < 0.001). Attitude scores exhibited a notable improvement post-education, with mean scores increasing from 46.64 in the pretest to 58.45 in the posttest. The total attitude shift was statistically significant (t(83) = 104.23, p < 0.001 0). Regarding overall practice, the data suggests a positive impact of education on neonatal nurses' practices related to antibiotic usage (t(3) = 149.31, p < 0.001). A significant positive correlation was found between post-knowledge and post-attitude (r = 0.251, p = 0.021). Conclusion Based on the study findings, the MDROs educational program demonstrated its effectiveness in improving nurses' knowledge and attitudes toward MDROs, serving as a valuable educational resource for nurses. Given the increasing demand for nurses with MDROs knowledge, attitude, and practice in NICU, and considering the documented positive impact on protecting neonates from fatal infections, enhancing nurses' knowledge, attitudes, and practices toward MDROs has become imperative.
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Affiliation(s)
- Sawsan Abuhammad
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Dalya Alwedyan
- Department of Maternal and Child Health, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Shaher Hamaideh
- Department of Community and Mental Health Nursing, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Colaneri M, Genovese C, Lombardi A, Holmes D, Bandera A, Gori A. Carbapenem or new β-lactam-β-lactamase inhibitors? An Italian survey supported by SITA, SIMIT and SIAARTI to identify the factors affecting empiric antimicrobial therapy choice in real-life clinical practice. Eur J Clin Microbiol Infect Dis 2024; 43:1017-1023. [PMID: 38457097 DOI: 10.1007/s10096-024-04798-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
While a tailored antibiotic treatment plan is often straightforward, what we often observe in daily clinical practice is a highly variable approach when defining empirical therapy. Specifically, a debate exists on preference to spare the new β-lactams and β-lactamase inhibitors (BL-BLIs) or to apply a carbapenem-sparing strategy first. To investigate, we designed a web survey aimed at investigating the variables considered relevant to empirically choosing one antibiotic over the other. Submitted to Italian infectious diseases and intensive care physicians through the support of Società Italiana di Malattie Infettive e Tropicali (SIMIT), Società Italiana di Terapia Antinfettiva (SITA) and Società Italiana Anestesia, Analgesia, Rianimazione e Terapia Intensiva (SIAARTI). We found that demographic characteristics were irrelevant when deciding for empirical therapy. Clinical and anamnestic data were most meaningful. Significantly considered were underlying comorbidities and previous exposure to antimicrobial treatments. History of third-generation cephalosporin-resistant, carbapenem-resistant and/or metallo-β-lactamase-producing Enterobacterales rectal colonisation and/or infection were considered the most relevant by most physicians. Unexpectedly, clinicians considered less the source of infection. These results prompt the need of straightforward methods to retrieve medical histories and the magnitude of rectal colonisation data, often not routinely obtained.
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Affiliation(s)
- Marta Colaneri
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy.
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy.
| | - Camilla Genovese
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
| | - Andrea Lombardi
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Darcy Holmes
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Alessandra Bandera
- Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy
- Infectious Diseases Unit, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Andrea Gori
- Infectious Diseases and Immunopathology, Department of Clinical Sciences, Università di Milano, L. Sacco Hospital, Milan, Italy
- Centre for Multidisciplinary Research in Health Science (MACH), University of Milano, Milano, Italy
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Pantano D, Friedrich AW. Hub and Spoke: Next level in regional networks for infection prevention. Int J Med Microbiol 2024; 314:151605. [PMID: 38290401 DOI: 10.1016/j.ijmm.2024.151605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/14/2024] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
The threat of multidrug-resistant organisms (MDROs) and antimicrobial resistance (AMR) are real and increasing every day. They affect not only healthcare systems but also communities, causing economic and public health concerns. Governments must take action to tackle AMR and prevent the spread of MDROs and regional hubs have a critical role to play in achieving this outcome. Furthermore, bacteria have no borders, consequently, cooperation networks should be extended between countries as a crucial strategy for achieving the success of infection control. Euregions, which are a specific form of cooperation between local authorities of two or more bordering European countries, can help solve common problems and improve the lives of people living on both sides of the border. Regional collaboration strategies can enhance infection control and build resilience against antimicrobial resistance. This review identifies risk factors and the correct approaches to infection prevention and control, including education and awareness programs for healthcare professionals, appropriate prescribing practices, and infection prevention control measures. These measures can help reduce the incidence of antimicrobial resistance in the region and save lives. It is therefore essential to take concrete actions and foster the creation of more effective regional and cross-border centers to ensure the success of infection control policies and the management of healthcare-associated infections. This work sheds light on the issue of MDRO infections within healthcare settings, while also acknowledging the crucial role of the One Health concept in understanding the broader context of these infections. By recognizing the interdependence of human and animal health and the environment, we can take constructive steps toward mitigating the risks of these infections and promoting better health outcomes for all.
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Affiliation(s)
- Daniele Pantano
- University Hospital Münster, Institute of Hygiene, Münster, Germany.
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4
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Dalbeni A, Cattazzo F, De Marco L, Bevilacqua M, Zoncapè M, Lombardi R, Stupia R, Mantovani A, Sacerdoti D. Bacterial infections as a risk factor for non-neoplastic portal vein thrombosis development in cirrhotic patients. Dig Liver Dis 2024; 56:477-483. [PMID: 37778894 DOI: 10.1016/j.dld.2023.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND Portal vein thrombosis (PVT) and sepsis are common complications in patients with liver cirrhosis. Factors that lead to PVT are not completely understood. This study aimed to investigate the possible association between bacterial infections and the development of PVT in cirrhotic patients. PATIENTS AND METHODS 202 consecutive cirrhotic patients without previous infections, followed at the Liver Unit in Verona Hospital, were enrolled from 2017 to 2021 (median follow-up 3.3 years). During the follow-up period, PVT was diagnosed by ultrasound, CT and/or MRI, and episodes of bacterial infections requiring hospitalization were recorded. Malignant PVT was an exclusion criterion. RESULTS Of the 202 patients enrolled (68.3 % males, mean age 63.8 ± 11 years), 22 (10.8 %) developed PVT during the follow up. In patients with PVT, the prevalence of previous bacterial infections was significantly higher compared to patients without PVT (63.6% vs 31.1 %; p = 0.02). Cox regression analysis revealed that a history of bacterial infection was the only variable that demonstrated a significant association with the risk of de novo PVT occurrence (HR 4.04, 95 % CI: 1.68-9.65). CONCLUSION in patients with liver cirrhosis bacterial infections are a predisposing factor for the following development of PVT. Further studies are needed to confirm this evidence.
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Affiliation(s)
- Andrea Dalbeni
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy.
| | - Filippo Cattazzo
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Leonardo De Marco
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Michele Bevilacqua
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Mirko Zoncapè
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Rosa Lombardi
- Department of Pathophysiology and Transplantation, Unit of Metabolic and Internal Medicine, University of Milan, Italy
| | - Roberta Stupia
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
| | - Anna Mantovani
- Division of General Medicine C, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy; Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy.
| | - David Sacerdoti
- Liver Unit, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, University of Verona, Verona, Italy
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Babiker A, Karadkhele G, Bombin A, Watkins R, Robichaux C, Smith G, Beechar VB, Steed DB, Jacobs JT, Read TD, Satola S, Larsen CP, Kraft CS, Pouch SM, Woodworth MH. The Burden and Impact of Early Post-transplant Multidrug-Resistant Organism Detection Among Renal Transplant Recipients, 2005-2021. Open Forum Infect Dis 2024; 11:ofae060. [PMID: 38464488 PMCID: PMC10924447 DOI: 10.1093/ofid/ofae060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/06/2024] [Indexed: 03/12/2024] Open
Abstract
Background Reducing the burden of multidrug-resistant organism (MDRO) colonization and infection among renal transplant recipients (RTRs) may improve patient outcomes. We aimed to assess whether the detection of an MDRO or a comparable antibiotic-susceptible organism (CSO) during the early post-transplant (EPT) period was associated with graft loss and mortality among RTRs. Methods We conducted a retrospective cohort study of RTRs transplanted between 2005 and 2021. EPT positivity was defined as a positive bacterial culture within 30 days of transplant. The incidence and prevalence of EPT MDRO detection were calculated. The primary outcome was a composite of 1-year allograft loss or mortality following transplant. Multivariable Cox hazard regression, competing risk, propensity score-weighted sensitivity, and subgroup analyses were performed. Results Among 3507 RTRs, the prevalence of EPT MDRO detection was 1.3% (95% CI, 0.91%-1.69%) with an incidence rate per 1000 EPT-days at risk of 0.42 (95% CI, 0.31-0.57). Among RTRs who met survival analysis inclusion criteria (n = 3432), 91% (3138/3432) had no positive EPT cultures and were designated as negative controls, 8% (263/3432) had a CSO detected, and 1% (31/3432) had an MDRO detected in the EPT period. EPT MDRO detection was associated with the composite outcome (adjusted hazard ratio [aHR], 3.29; 95% CI, 1.21-8.92) and death-censored allograft loss (cause-specific aHR, 7.15; 95% CI, 0.92-55.5; subdistribution aHR, 7.15; 95% CI, 0.95-53.7). A similar trend was seen in the subgroup and sensitivity analyses. Conclusions MDRO detection during the EPT period was associated with allograft loss, suggesting the need for increased strategies to optimize prevention of MDRO colonization and infection.
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Affiliation(s)
- Ahmed Babiker
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Geeta Karadkhele
- Emory Transplant Center and Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Andrei Bombin
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Rockford Watkins
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Chad Robichaux
- Department of Biomedical Informatics, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Gillian Smith
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Georgia Emerging Infections Program, Atlanta, Georgia, USA
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia, USA
| | - Vivek B Beechar
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Danielle B Steed
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Jesse T Jacobs
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Timothy D Read
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sarah Satola
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Christian P Larsen
- Emory Transplant Center and Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Colleen S Kraft
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Stephanie M Pouch
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael H Woodworth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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6
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Monari C, Spagnuolo F, Pisaturo M, Ascione S, Donnarumma G, Calò F, Caredda E, Montella F, Maietta A, Montaldo P, Pugliese U, Galdiero M, Carpentieri M, Coppola N. Bloodstream Infection Due to a VIM-Metallo-β-Lactamase-Producing Klebsiella pneumoniae Treated with Cefiderocol in a Preterm Newborn. Infect Dis Ther 2023; 12:727-734. [PMID: 36522526 PMCID: PMC9925637 DOI: 10.1007/s40121-022-00735-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/21/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The prevalence of certain multidrug-resistant organisms (MDROs), especially Gram-negative bacteria, is dramatically increasing in patient care settings, including pediatric and neonatal units. However, most of the new drugs available for the treatment of MDROs have not yet been studied in children and newborns. CASE REPORT We report the clinical case of a preterm neonate, born at 31 weeks gestation + 1 day of age by emergency Cesarean Section (CS), with a bloodstream infection (BSI) due to a Verona integron-borne metallo-β-lactamase (VIM)-producing Klebsiella pneumoniae. We successfully treated the infection with cefiderocol in an off-label regimen at the following dose: loading dose 60 mg/kg and then 40 mg/kg every 8 h in extended infusion for 9 days. The baby showed a quick clinical and biochemical improvement and tolerated well the treatment. Follow-up blood cultures at 48 h after the start of cefiderocol were negative. CONCLUSIONS Antimicrobial-resistant pathogens are of increasing concern in neonatal settings. More studies in this unique population are necessary to better describe the pharmacokinetic and pharmacodynamic profile of the new drugs against MDROs, such as cefiderocol, and to define a proper effective dose.
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Affiliation(s)
- Caterina Monari
- Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Ferdinando Spagnuolo
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Mariantonietta Pisaturo
- Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Serena Ascione
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Giovanna Donnarumma
- Department of Experimental Medicine, Microbiology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Federica Calò
- Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy
| | - Elisabetta Caredda
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Fortunato Montella
- Department of Experimental Medicine, Microbiology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Anna Maietta
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Paolo Montaldo
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Umberto Pugliese
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Massimiliano Galdiero
- Department of Experimental Medicine, Microbiology Section, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mauro Carpentieri
- Neonatal Intensive Care Unit, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Nicola Coppola
- Department of Mental Health and Public Medicine - Infectious Diseases Unit, University of Campania Luigi Vanvitelli, Via L. Armanni 5, 80131, Naples, Italy.
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Meschiari M, Onorato L, Bacca E, Orlando G, Menozzi M, Franceschini E, Bedini A, Cervo A, Santoro A, Sarti M, Venturelli C, Biagioni E, Coloretti I, Busani S, Girardis M, Lòpez-Lozano JM, Mussini C. Long-Term Impact of the COVID-19 Pandemic on In-Hospital Antibiotic Consumption and Antibiotic Resistance: A Time Series Analysis (2015-2021). Antibiotics (Basel) 2022; 11:826. [PMID: 35740232 DOI: 10.3390/antibiotics11060826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/15/2022] [Accepted: 06/17/2022] [Indexed: 01/22/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19)-pandemic-related overload of health systems has compromised the application of antimicrobial stewardship (AS) models and infection prevention and control (IPC) programs. We aimed to evaluate the impact of COVID-19 on antimicrobial consumption (AC) and antimicrobial resistance (AMR) in the University Hospital of Modena. A time series analysis with an autoregressive integrated moving average model was conducted from January 2015 to October 2021 to evaluate the AC in the whole hospital and the intensive care unit (ICU), the incidence density (ID) of bloodstream infections (BSIs) due to the main multidrug-resistant organisms, and of C. difficile infections (CDIs). After an initial peak during the COVID-19 period, a decrease in the trend of AC was observed, both at the hospital (CT: -1.104, p = 0.025) and ICU levels (CT: -4.47, p = 0.047), with no significant difference in the single classes. Among the Gram-negative isolates, we observed a significant increase only in the level of BSIs due to carbapenem-susceptible Pseudomonas aeruginosa (CL: 1.477, 95% CI 0.130 to 2.824, p = 0.032). Considering Gram-positive bacteria, an increase in the level of BSIs due to methicillin-resistant Staphylococcus aureus and in the trend of CDIs were observed, though they did not reach statistical significance (CL: 0.72, 95% CI -0.039 to 1.48, p = 0.062; CT: 1.43, 95% CI -0.002 to 2.863, p = 0.051; respectively). Our findings demonstrated that the increases in AMR and AC that appeared in the first COVID-19 wave may be later controlled by restoring IPC and AS programs to pre-epidemic levels. A coordinated healthcare effort is necessary to address the longer-term impact of COVID-19 on AC to avoid irreversible consequences on AMR.
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Onorato L, Monari C, Capuano S, Grimaldi P, Coppola N. Prevalence and Therapeutic Management of Infections by Multi-Drug-Resistant Organisms ( MDROs) in Patients with Liver Cirrhosis: A Narrative Review. Antibiotics (Basel) 2022; 11:232. [PMID: 35203834 PMCID: PMC8868525 DOI: 10.3390/antibiotics11020232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 02/06/2022] [Accepted: 02/08/2022] [Indexed: 12/11/2022] Open
Abstract
Bacterial infections are common events that significantly impact the clinical course of patients with cirrhosis. As in the general population, infections caused by multi-drug-resistant organisms (MDROs) are progressively increasing in cirrhotic patients, accounting for up to 30-35% of all infections. Nosocomial acquisition and prior exposure to antimicrobial treatment or invasive procedures are well-known risk factors for MDRO infections. Several studies have demonstrated that infections due to MDROs have a poorer prognosis and higher rates of treatment failure, septic shock, and hospital mortality. Due to the increasing rate of antimicrobial resistance, the approach to empirical treatment in cirrhotic patients with life-threatening infections has become significantly more challenging. In order to ensure a prompt administration of effective antibiotic therapy while avoiding unnecessary antibiotic exposure at the same time, it is of utmost importance to choose the correct antimicrobial therapy and administration schedule based on individual clinical characteristics and risk factors and rapidly adopt de-escalation strategies as soon as microbiological data are available. In the present paper, we aimed to provide an overview of the most frequent infections diagnosed in cirrhotic patients, the prevalence and impact of antimicrobial resistance, and potential therapeutic options in this population.
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Affiliation(s)
| | | | | | | | - Nicola Coppola
- Department of Mental Health and Public Medicine, Section of Infectious Diseases, University of Campania Luigi Vanvitelli, 80138 Naples, Italy; (L.O.); (C.M.); (S.C.); (P.G.)
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9
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Chen X, Pan D, Chen Y. The drug resistance of multidrug-resistant bacterial organisms in pediatric pneumonia patients. Am J Transl Res 2021; 13:3309-3315. [PMID: 34017503 PMCID: PMC8129425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study aimed to investigate the distribution of multidrug-resistant organisms in pediatric patients with infectious pneumonia and to analyze their resistance and risk factors. METHODS Pediatric patients infected with five MDROs (MRSA, MDR-PA, MDRAB, ESBL KP, and ESBL E. coli) and five sensitive bacteria (MSSA, PA, AB, KP, and E. coli) were recruited as the study cohort. The distribution of the MDROs and the risk factors for MDRO-infected pneumonia were investigated. The two groups' treatment costs, hospitalization times, and prognoses were compared. RESULTS A total of 219 children were included, including 3 cases of mixed infections with MDRO and sensitive bacteria (1.37%), 110 cases of MDRO infections (50.23%), and 106 cases of sensitive bacterial infections (48.40%). Imipramine was sensitive to MDR-PA, MDRAB, ESBL KP, and ESBL E. coli, and vancomycin was sensitive to MRSA. A logistic regression model and a multifactorial analysis showed that ICU treatment, mechanical ventilation, arterial and venous intubation, fiberoptic bronchoscopy, concomitant chronic lung disease, and chronic cardiovascular disease were the independent risk factors for MDRO (P < 0.05). The hospitalization times, the treatment costs, and the 30-day mortality rate of the children in the MDRO group were significantly higher than they were in the children infected with sensitive bacteria (P < 0.05). CONCLUSION Vancomycin or imipenem may result in good clinical outcomes in children treated in the ICU subject to mechanical ventilation, arterial and venous intubation, fiberoptic bronchoscopy, the overuse of antimicrobial drugs, and children with concomitant chronic lung disease or chronic cardiovascular disease.
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Affiliation(s)
- Xianbo Chen
- Department of Pediatrics, Wenling Maternal and Child Health HospitalWenling City, Zhejiang Province, China
| | - Danfeng Pan
- Department of Pediatrics, The First People’s Hospital of WenlingWenling City, Zhejiang Province, China
| | - Yongzheng Chen
- Department of Pediatrics, Wenling Maternal and Child Health HospitalWenling City, Zhejiang Province, China
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Abstract
Purpose of review There is a continuing debate regarding contact precaution (CP) usage for endemic multidrug-resistant organisms (MDROs). In this review, we examine current recommendations for CP and highlight differences in CP use between endemic and non-endemic MDROs. Recent findings The discontinuation of CP had no effect on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. The evidence regarding CP for extended-spectrum beta-lactamase producing Enterobacteriaceae is inconclusive, highlighting the need for more research to determine best infection control strategies. Carbapenem-resistant Enterobacteriaceae maintains a sporadic pattern in the USA, supporting current recommendations to use CP for colonized and infected patients. MDR Acinetobacter baumannii (MDR-AB) is extremely virulent and responsible for outbreaks in healthcare settings, emphasizing the need for CP use with MDR-AB infected patients. Candida auris (C. auris) is often misdiagnosed; it is resistant to UV light and quaternary ammonium low-level disinfection. Because little is known about the transmission of C. auris, significant caution and CP use are necessitated. There is little research on vancomycin-resistant S. aureus (VRSA) control strategies due to its rarity; thus, CP is strongly recommended. Summary Contact precautions are frequently part of a bundled infection control approach that involves meticulous hand hygiene, patient decolonization, chlorhexidine gluconate bathing, and reducing the use of invasive devices. Healthcare facilities should continue to utilize CP for non-endemic MDROs and the presence of endemic MDROs; however, CP may not add benefit to the current infection prevention bundle approach.
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Greene LR. Non-ventilator health care associated pneumonia (NV-HAP): Oncology. Am J Infect Control 2020; 48:A20-2. [PMID: 32331560 DOI: 10.1016/j.ajic.2020.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/23/2022]
Abstract
Literature suggests that cancer patients can become colonized or infected with a variety of opportunistic and health care-associated pathogens, putting them at higher risk for nonventilator health care-associated pneumonia. This section will review the epidemiology of nonventilator health care-associated pneumonia and the importance of prevention strategies in this vulnerable population. Prevention strategies for cancer patients across the continuum of care are highlighted.
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12
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Al Mayahi Z, Kamel S, Amer H, Beatty M. Outbreak of colistin-resistant organisms at a tertiary hospital in Riyadh, Saudi Arabia, 2016. Pan Afr Med J 2020; 34:162. [PMID: 32153702 PMCID: PMC7046114 DOI: 10.11604/pamj.2019.34.162.19998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/05/2019] [Indexed: 11/29/2022] Open
Abstract
Introduction Multidrug-resistant organisms (MDROs) have been a major concern in King Saud Medical City (KSMC) recently. The number of cases with colistin resistance was growing rapidly in the first half of 2016, challenging the infection control practices and mandating a thorough outbreak investigation. The objective of this study was to determine the extent of the outbreak, identify potential risk factors and prevent further increase in the rates of MDROs. Methods Reviewing the medical records of the 22 admitted cases with colistin resistance using an abstraction form composed of demographical data, comorbidities, details of current admissions, and procedures. Also, tracking patients' movements in the hospital, reviewing all cultures isolates, and reviewing the surveillance and infection control strategies. Results Mean age was 49.71±17.824 (20-79 years), 90.9% were males, 63.6% cases admitted under medical unit. The average duration of stay in the ED was 1.23 day. Over 2/3 had hypertension and diabetes mellitus. Majority of patients staying between 20-40 days in the hospital & the average number of days until developing colistin resistance was 44.18. Resistance was solely related to two organisms that were Acinetobacter baumanni (59.1%) and Klebsiella pneumoniae (40. 9%). Ventilators and folly's catheters were equally (95.5%) used by 21 patients. The most common site of infection was respiratory (41.3%), of which most were sputum samples. Resistance of over 75% is recorded by antibiotics like tazocin, ciprofloxacin, imepenen and oxacillin. Conclusion The uncontrolled use of antibiotics, prolonged stay in the Intensive Care Unit (ICU), frequent uses of different devices, are the potential risk factors of developing colistin resistance.
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Affiliation(s)
- Zayid Al Mayahi
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia
| | - Shady Kamel
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, King Saud University, Riyadh, KSA
| | - Hala Amer
- Infection Control Administration, King Saud Medical City, Ministry of Health, Riyadh, KSA.,Department of Community Medicine, National Research Centre, Egypt
| | - Mark Beatty
- Field Epidemiology Training Program, Ministry of Health, Riyadh, Saudi Arabia
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13
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Gazzarata R, Monteverde ME, Ruggiero C, Maggi N, Palmieri D, Parruti G, Giacomini M. Healthcare Associated Infections: An Interoperable Infrastructure for Multidrug Resistant Organism Surveillance. Int J Environ Res Public Health 2020; 17:E465. [PMID: 31936787 PMCID: PMC7013448 DOI: 10.3390/ijerph17020465] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 12/25/2019] [Accepted: 12/30/2019] [Indexed: 01/26/2023]
Abstract
Prevention and surveillance of healthcare associated infections caused by multidrug resistant organisms (MDROs) has been given increasing attention in recent years and is nowadays a major priority for health care systems. The creation of automated regional, national and international surveillance networks plays a key role in this respect. A surveillance system has been designed for the Abruzzo region in Italy, focusing on the monitoring of the MDROs prevalence in patients, on the appropriateness of antibiotic prescription in hospitalized patients and on foreseeable interactions with other networks at national and international level. The system has been designed according to the Service Oriented Architecture (SOA) principles, and Healthcare Service Specification (HSSP) standards and Clinical Document Architecture Release 2 (CDAR2) have been adopted. A description is given with special reference to implementation state, specific design and implementation choices and next foreseeable steps. The first release will be delivered at the Complex Operating Unit of Infectious Diseases of the Local Health Authority of Pescara (Italy).
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Affiliation(s)
| | | | - Carmelina Ruggiero
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
| | - Norbert Maggi
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
| | - Dalia Palmieri
- Epidemiology Office, Azienda Unità Sanitaria Locale (AUSL) di Pescara, 65124 Pescara, Italy;
| | - Giustino Parruti
- Department of Infectious Disease, Azienda Sanitaria Locale (AUSL) di Pescara, 65124 Pescara, Italy;
| | - Mauro Giacomini
- Healthropy S.r.l., 17100 Savona, Italy (C.R.); (N.M.); (M.G.)
- Department of Informatics, Bioengineering, Robotics and Systems Engineering (DIBRIS), University of Genova, 16145 Genoa, Italy
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14
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Gentry EM, Kester S, Fischer K, Davidson LE, Passaretti CL. Bugs and Drugs: Collaboration Between Infection Prevention and Antibiotic Stewardship. Infect Dis Clin North Am 2019; 34:17-30. [PMID: 31836329 DOI: 10.1016/j.idc.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 12/18/2022]
Abstract
Overall goals of antibiotic stewardship and infection prevention programs are to improve patient safety as it pertains to risk of infection or multidrug-resistant organism (MDRO) acquisition. Although the focus of day-to-day activities may differ, the themes of surveillance, education, clinician engagement, and multidisciplinary interactions are prevalent in both programs. Synergistic work between programs has yielded benefits in prevention of MDROs, surgical site infections, Clostridioides difficile infection, and reducing inappropriate testing and treatment for asymptomatic bacteriuria. Collaboration between programs can help maximize resources and minimize redundant work to keep issues related to bugs and drugs at bay.
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Affiliation(s)
- Erin M Gentry
- Antimicrobial Support Network, Carolinas Medical Center, Department of Pharmacy Services, Atrium Health, 1000 Blythe Boulevard, Charlotte, NC 28203, USA.
| | - Shelley Kester
- Infection Prevention, Division of Quality, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
| | - Kristin Fischer
- Department of Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 209, Charlotte, NC 28203, USA
| | - Lisa E Davidson
- Antimicrobial Support Network, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1540 Garden Terrace, Suite 211, Charlotte, NC 28203, USA
| | - Catherine L Passaretti
- Health System Infection Prevention, Internal Medicine, Division of Infectious Diseases, Atrium Health, 1616 Scott Avenue, Charlotte, NC 28203, USA
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15
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Abstract
The definition of sepsis continues to be as dynamic as the management strategies used to treat this. Sepsis-3 has replaced the earlier systemic inflammatory response syndrome (SIRS)-based diagnoses with the rapid Sequential Organ Failure Assessment (SOFA) score assisting in predicting overall prognosis with regards to mortality. Surgeons have an important role in ensuring adequate source control while recognizing the threat of carbapenem-resistance in gram-negative organisms. Rapid diagnostic tests are being used increasingly for the early identification of multi-drug-resistant organisms (MDROs), with a key emphasis on the multidisciplinary alert of results. Novel, higher generation antibiotic agents have been developed for resistance in ESKCAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) organisms while surgeons have an important role in the prevention of spread. The Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial has challenged the previous paradigm of length of antibiotic treatment whereas biomarkers such as procalcitonin are playing a prominent role in individualizing therapy. Several novel therapies for refractory septic shock, while still investigational, are gaining prominence rapidly (such as vitamin C) whereas others await further clinical trials. Management strategies presented as care bundles continue to be updated by the Surviving Sepsis Campaign, yet still remain controversial in its global adoption. We have broadened our temporal and epidemiologic perspective of sepsis by understanding it both as an acute, time-sensitive, life-threatening illness to a chronic condition that increases the risk of mortality up to five years post-discharge. Artificial intelligence, machine learning, and bedside scoring systems can assist the clinician in predicting post-operative sepsis. The public health role of the surgeon is key. This includes collaboration and multi-disciplinary antibiotic stewardship at a hospital level. It also requires controlling pharmaceutical sales and the unregulated dispensing of antibiotic agents globally through policy initiatives to control emerging resistance through prevention.
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Affiliation(s)
- Vanessa P Ho
- Division of Trauma, Critical Care, Burns, and Acute Care Surgery, MetroHealth Medical Center, Cleveland, Ohio
| | - Haytham Kaafarani
- Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Boston, Massachusetts
| | - Rishi Rattan
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Nicholas Namias
- Division of Trauma and Surgical Critical Care, University of Miami Miller School of Medicine, Miami, Florida
| | - Heather Evans
- Division of General & Acute Care Surgery, Medical University of South Carolina, Charleston, South Carolina
| | - Tanya L Zakrison
- Section for Trauma and Acute Care Surgery, The University of Chicago Medicine, Chicago, Illinois
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16
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Dandachi I, Chaddad A, Hanna J, Matta J, Daoud Z. Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach. Front Microbiol 2019; 10:1941. [PMID: 31507558 PMCID: PMC6716069 DOI: 10.3389/fmicb.2019.01941] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022] Open
Abstract
In the last decade, extended-spectrum cephalosporin and carbapenem resistant Gram-negative bacilli (GNB) have been extensively reported in the literature as being disseminated in humans but also in animals and the environment. These resistant organisms often cause treatment challenges due to their wide spectrum of antibiotic resistance. With the emergence of colistin resistance in animals and its subsequent detection in humans, the situation has worsened. Several studies reported the transmission of resistant organisms from animals to humans. Studies from the middle east highlight the spread of resistant organisms in hospitals and to a lesser extent in livestock and the environment. In view of the recent socio-economical conflicts that these countries are facing in addition to the constant population mobilization; we attempt in this review to highlight the gaps of the prevalence of resistance, antibiotic consumption reports, infection control measures and other risk factors contributing in particular to the spread of resistance in these countries. In hospitals, carbapenemases producers appear to be dominant. In contrast, extended spectrum beta lactamases (ESBL) and colistin resistance are becoming a serious problem in animals. This is mainly due to the continuous use of colistin in veterinary medicine even though it is now abandoned in the human sphere. In the environment, despite the small number of reports, ESBL and carbapenemases producers were both detected. This highlights the importance of the latter as a bridge between humans and animals in the transmission chain. In this review, we note that in the majority of the Middle Eastern area, little is known about the level of antibiotic consumption especially in the community and animal farms. Furthermore, some countries are currently facing issues with immigrants, poverty and poor living conditions which has been imposed by the civil war crisis. This all greatly facilitates the dissemination of resistance in all environments. In the one health concept, this work re-emphasizes the need to have global intervention measures to avoid dissemination of antibiotic resistance in humans, animals and the environment in Middle Eastern countries.
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Affiliation(s)
- Iman Dandachi
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Amer Chaddad
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jason Hanna
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Jessika Matta
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
| | - Ziad Daoud
- Faculty of Medicine and Medical Sciences, Clinical Microbiology Laboratory, University of Balamand, Beirut, Lebanon
- Division of Clinical Microbiology, Saint George Hospital University Medical Center, Beirut, Lebanon
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17
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Hafza N, Challita C, Dandachi I, Bousaab M, Dahdouh E, Daoud Z. Competition assays between ESBL-producing E. coli and K. pneumoniae isolates collected from Lebanese elderly: An additional cost on fitness. J Infect Public Health 2017; 11:393-397. [PMID: 28988774 DOI: 10.1016/j.jiph.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 06/09/2017] [Revised: 08/13/2017] [Accepted: 09/09/2017] [Indexed: 11/15/2022] Open
Abstract
The dissemination of Multi Drug Resistant Organisms (MDROs) is one of the major public health problems addressed nowadays. High fecal carriage rates of MDR Enterobacteriaceae were reported from Lebanese nursing homes. Studies have shown that the acquisition of resistance genes by bacteria might confer a fitness cost detected as a decrease in the frequency of these bacteria as compared to sensitive isolates. In this study, the competitive growth of MDR Enterobacteriaceae isolated from elderly is assessed. Sensitive and ESBL-producing Escherichia coli and Klebsiella pneumoniae isolates were identified. Inter-species in-vitro competition assays were conducted in different combinations. ESBL-producing K. pneumoniae presented a fitness cost when competing against sensitive E. coli. On the other hand, resistant E. coli only showed a fitness cost when growing in presence of two sensitive K. pneumoniae isolates. These results suggest that ESBL-production genes in E. coli and K. pneumoniae may confer a fitness cost that leads to the decrease in frequency of these bacteria in interspecies competitions. Culturing bacteria in a medium with more diverse isolates can provide better insights into bacterial competition and resistance dynamics, which can be exploited in the search for alternative therapeutic approaches towards the colonization of resistant bacteria.
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Affiliation(s)
| | - Caren Challita
- Faculty of Medicine, Clinical Microbiology Lab, University of Balamand, Lebanon
| | - Iman Dandachi
- Faculty of Medicine, Clinical Microbiology Lab, University of Balamand, Lebanon
| | - Mounir Bousaab
- Faculty of Medicine, Clinical Microbiology Lab, University of Balamand, Lebanon
| | - Elias Dahdouh
- Faculty of Veterinary, Department of Animal Health, Universidad Complutense de Madrid, Madrid, Spain
| | - Ziad Daoud
- Faculty of Medicine, Clinical Microbiology Lab, University of Balamand, Lebanon.
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18
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Abstract
Antimicrobial resistance is a common iatrogenic complication of modern life and medical care. One of the most demonstrative examples is the exponential increase in the incidence of extended-spectrum β-lactamases (ESBLs) production among Enterobacteriaceae, which is the most common human pathogens outside of the hospital settings. Infections resulting from ESBL-producing bacteria are associated with devastating outcomes, now affecting even previously healthy individuals. This development poses an enormous burden and threat to public health. This paper aims to narrate the evolving epidemiology of ESBL infections, and highlight current challenges in terms of management and prevention of these common infections.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - David E Katz
- Department of Internal Medicine D, Shaare Zedek Medical Center, Hebrew University School of Medicine, Jerusalem, Israel
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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19
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Abstract
Antimicrobial resistance is a common iatrogenic complication of both modern life and medical care. Certain multidrug resistant and extensively drug resistant Gram-negative organisms pose the biggest challenges to health care today, predominantly owing to a lack of therapeutic options. Containing the spread of these organisms is challenging, and in reality, the application of multiple control measures during an evolving outbreak makes it difficult to measure the relative impact of each measure. This article reviews the usefulness of various infection control measures in containing the spread of multidrug-resistant Gram-negative bacilli.
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Affiliation(s)
- Amos Adler
- Clinical Microbiology Laboratory, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel; Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | | | - Dror Marchaim
- Department of Medicine, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel; Division of Infectious Diseases, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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20
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Huebner NO, Dittmann K, Henck V, Wegner C, Kramer A. Epidemiology of multidrug resistant bacterial organisms and Clostridium difficile in German hospitals in 2014: Results from a nationwide one-day point prevalence of 329 German hospitals. BMC Infect Dis 2016; 16:467. [PMID: 27590879 PMCID: PMC5010689 DOI: 10.1186/s12879-016-1756-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One important aspect in combatting resistance to antibiotics is to increase the awareness and knowledge by epidemiological studies. We therefore conducted a German-wide point-prevalence survey for multidrug resistant bacterial organisms (MDROs) and Clostridium difficile (CD) to assess the epidemiology and structure quality of infection control in German hospitals. METHOD 1550 hospitals were asked to participate and to report surveillance data on the prevalence of Methicillin-resistant and Vancomycin resistant Staphylococcus aureus (MRSA, VRSA/GRSA), Vancomycin resistant Enterococcus faecalis/faecium (VRE), multiresistant strains of Escherichia coli (EC), Klebsiella spp. (KS), Enterobacter spp. (ES), Acinetobacter spp. (AB) and Pseudomonas spp. (PS). as well as CD infections. RESULTS Surveys from 73,983 patients from 329 hospitals were eligible for analysis. MRSA was the most often reported pathogen (prevalence: 1.64 % [CI95: 1.46-1.82]), followed by 3 multidrug resistant EC (3MRGN-EC) (0.75 % [CI95: 0.60-0.89]), CD (0.74 % [CI95: 0.60-0.88]), VRE (0.25 % [CI95: 0.13-0.37]) und 3MRGN-KS (0.22 % [CI95: [0.15-0.29]). The majority of hospitals met the German recommendations for staffing with infection control personnel. CONCLUSION The continuing increase in participating hospitals in this third survey in a row indicates a growing awareness to MDROs and our pragmatic approach. Our results confirm that MRSA, 3MRGN-EC, VRE and 3MRGN-KS remain the most prevalent MDROs in German hospitals.
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Affiliation(s)
- Nils-Olaf Huebner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17475, Greifswald, Germany. .,IMD laboratory network, MVZ Greifswald GmbH, 17489, Greifswald, Germany.
| | - Kathleen Dittmann
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17475, Greifswald, Germany
| | - Vivien Henck
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17475, Greifswald, Germany
| | - Christian Wegner
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17475, Greifswald, Germany
| | - Axel Kramer
- Institute of Hygiene and Environmental Medicine, University Medicine Greifswald, Walther-Rathenau-Str. 49a, 17475, Greifswald, Germany
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21
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Cunha BA, Gran A, Raza M. Persistent extended-spectrum β-lactamase-positive Escherichia coli chronic prostatitis successfully treated with a combination of fosfomycin and doxycycline. Int J Antimicrob Agents 2015; 45:427-9. [PMID: 25662814 DOI: 10.1016/j.ijantimicag.2014.12.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 12/02/2014] [Accepted: 12/03/2014] [Indexed: 10/24/2022]
Abstract
For chronic bacterial prostatitis, there are few oral antibiotics available that are active against common uropathogens and are able to penetrate the non-inflamed prostate at therapeutic concentrations. Oral options to treat chronic prostatitis due to Gram-negative bacillary multidrug-resistant organisms are even more limited. We report a case of persistent extended-spectrum β-lactamase (ESBL)-positive Escherichia coli chronic prostatitis refractory to antibiotic therapy. Prolonged courses of fosfomycin failed to eradicate the infection. Re-treatment with high-dose fosfomycin again failed to clear the infection. After repeated courses of fosfomycin, the ESBL-positive E. coli remained susceptible to fosfomycin. Transrectal ultrasound revealed prostatic calcifications that were thought to be the reason for antibiotic failure. Following transurethral resection of the prostate (TURP) to remove the prostatic calcifications, the prostatic calcifications remained and the infection persisted. Although the patient's ESBL-positive E. coli was resistant to doxycycline, he was treated with a combination of fosfomycin plus doxycycline. Treatment with fosfomycin and doxycycline rapidly cured his chronic prostatitis.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
| | - Arthur Gran
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA
| | - Muhammad Raza
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA
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Chemaly RF, Simmons S, Dale C, Ghantoji SS, Rodriguez M, Gubb J, Stachowiak J, Stibich M. The role of the healthcare environment in the spread of multidrug-resistant organisms: update on current best practices for containment. Ther Adv Infect Dis 2014; 2:79-90. [PMID: 25469234 DOI: 10.1177/2049936114543287] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [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: 12/13/2022] Open
Abstract
The role of the environment in harboring and transmitting multidrug-resistant organisms has become clearer due to a series of publications linking environmental contamination with increased risk of hospital-associated infections. The incidence of antimicrobial resistance is also increasing, leading to higher morbidity and mortality associated with hospital-associated infections. The purpose of this review is to evaluate the evidence supporting the existing methods of environmental control of organisms: environmental disinfection, contact precautions, and hand hygiene. These methods have been routinely employed, but transmission of multidrug-resistant organisms continues to occur in healthcare facilities throughout the country and worldwide. Several new technologies have entered the healthcare market that have the potential to close this gap and enhance the containment of multidrug-resistant organisms: improved chemical disinfection, environmental monitoring, molecular epidemiology, self-cleaning surfaces, and automated disinfection systems. A review of the existing literature regarding these interventions is provided. Overall, the role of the environment is still underestimated and new techniques may be required to mitigate the role that environmental transmission plays in acquisition of multidrug-resistant organisms.
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Affiliation(s)
- Roy F Chemaly
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | | | - Shashank S Ghantoji
- Department of Infectious Diseases, Infection Control, and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Julie Gubb
- Xenex Healthcare Services, San Antonio, TX, USA
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Martin-Loeches I, Torres A, Rinaudo M, Terraneo S, de Rosa F, Ramirez P, Diaz E, Fernández-Barat L, Li Bassi GL, Ferrer M. Resistance patterns and outcomes in intensive care unit (ICU)-acquired pneumonia. Validation of European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification of multidrug resistant organisms. J Infect 2014; 70:213-22. [PMID: 25445887 DOI: 10.1016/j.jinf.2014.10.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 10/02/2014] [Accepted: 10/05/2014] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Bacterial resistance has become a major public health problem. OBJECTIVE To validate the definition of multidrug-resistant organisms (MDRO) based on the European Centre for Disease Prevention and Control (ECDC) and the Centers for Disease Control and Prevention (CDC) classification. MATERIAL Prospective, observational study in six medical and surgical Intensive-Care-Units (ICU) of a University hospital. RESULTS Three-hundred-and-forty-three patients with ICU-acquired pneumonia (ICUAP) were prospectively enrolled, 140 patients had no microbiological confirmation (41%), 82 patients (24%) developed ICUAP for non-MDRO, whereas 121 (35%) were MDROs. Non-MDRO, MDRO and no microbiological confirmation patients did not present either a significant different previous antibiotic use (p 0.18) or previous hospital admission (p 0.17). Appropriate antibiotic therapy was associated with better ICU survival (105 [92.9%] vs. 74 [82.2%]; p = 0.03). An adjusted multivariate regression logistic analysis identified that only MDRO had a higher ICU-mortality than non-MDRO and no microbiological confirmation patients (OR 2.89; p < 0.05; 95% CI for Exp [β]. 1.02-8.21); Patients with MDRO ICUAP remained in ICU for a longer period than MDRO and no microbiological confirmation respectively (p < 0.01) however no microbiological confirmation patients had more often antibiotic consumption than culture positive ones. CONCLUSIONS Patients who developed ICUAP due to MDRO showed a higher ICU-mortality than non-MDRO ones and use of ICU resources. No microbiological confirmation patients had more often antibiotic consumption than culture positive patients. Risk factors for MDRO may be important for the selection of initial antimicrobial therapy, in addition to local epidemiology.
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Affiliation(s)
- Ignacio Martin-Loeches
- St. James's Hospital, Multidisciplinary Intensive Care Research Organization (MICRO), Trinity Centre for Health Sciences, Dublin, Ireland; Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain
| | - Antonio Torres
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain.
| | - Mariano Rinaudo
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
| | - Silvia Terraneo
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
| | - Francesca de Rosa
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
| | - Paula Ramirez
- Intensive Care Medicine, Hospital Universitari i Politècnic la Fe, CIBER Enfermedades Respiratorias, Valencia, Spain
| | - Emili Diaz
- Critical Care Center, Corporacion Sanitaria Parc Taulí, CIBER Enfermedades Respiratorias, Parc Tauli, University Institute, Sabadell, Spain
| | - Laia Fernández-Barat
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
| | - Gian Luigi Li Bassi
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
| | - Miquel Ferrer
- Hospital Clinic, IDIBAPS, Universitat de Barcelona, CIBER Enfermedades Respiratorias, Servei de Pneumologia, Institut del Torax, Barcelona, Spain
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Abstract
The importance of the commensal microbiota that colonizes the skin, gut, and mucosal surfaces of the human body is being increasingly recognized through a rapidly expanding body of science studying the human microbiome. Although, at first glance, these discoveries may seem esoteric, the clinical implications of the microbiome in human health and disease are becoming clear. As such, it will soon be important for practicing clinicians to have an understanding of the basic concepts of the human microbiome and its relation to human health and disease. In this Concise Review, we provide a brief introduction to clinicians of the concepts underlying this burgeoning scientific field and briefly explore specific disease states for which the potential role of the human microbiome is becoming increasingly evident, including Clostridium difficile infection, inflammatory bowel disease, colonization with multidrug-resistant organisms, obesity, allergic diseases, autoimmune diseases, and neuropsychiatric illnesses, and we also discuss current and future roles of microbiome restorative therapies.
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Affiliation(s)
- Sahil Khanna
- Division of Gastroenterology, Mayo Clinic, Rochester, MN
| | - Pritish K Tosh
- Division of Hepatology and Infectious Diseases, Mayo Clinic, Rochester, MN.
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Pulia MS, Calderone M, Hansen B, Stake CE, Cichon M, Li Z, Safdar N. Feasibility of rapid polymerase chain reaction for detection of methicillin-resistant Staphylococcus aureus colonization among emergency department patients with abscesses. Open Access Emerg Med 2013; 5:17-22. [PMID: 27147869 PMCID: PMC4806814 DOI: 10.2147/oaem.s50226] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose In the era of community-associated methicillin-resistant Staphylococcus aureus (MRSA), clinicians face a difficult challenge when selecting antibiotics to treat abscesses. The lack of rapid diagnostics capable of identifying the causative organism often results in suboptimal antibiotic stewardship practices. Although not fully elucidated, the association between MRSA colonization and subsequent infection represents an opportunity to enhance antibiotic selectivity. Our primary objective was to examine the feasibility of utilizing a rapid polymerase chain reaction (PCR) system (Cepheid’s GeneXpert®) to detect MRSA colonization prior to patient discharge in the emergency department (ED). Methods This feasibility study was conducted at a tertiary care, urban, academic ED. Patients presenting with a chief complaint related to a potential abscess during daytime hours over an 18-week period were screened for eligibility. Subjects were enrolled into either the PCR swab protocol group (two-thirds) or traditional care group (one-third). PCR swabs were obtained from known MRSA carriage sites (nasal, pharyngeal) and the superficial aspect of the wound. Results The two groups were similar in terms of demographics, abscess location, and MRSA history. The PCR results were available prior to patient discharge in 100% of cases. The turnaround times in minutes for the PCR swabs were as follows: nasal 73 ± 7, pharyngeal 82 ± 14, and superficial wound 79 ± 17. No significant difference in length of stay was observed between the two groups. The observed ideal antibiotic selection rates improved by 45% in the PCR group, but this trend was not significant (P = 0.08). Conclusion When collected in triage, PCR swabs demonstrated turnaround times that were effective for use in the ED setting. Utilizing a rapid PCR MRSA colonization detection assay for ED patients with abscesses did not adversely impact the length of stay. Real-time determination of MRSA colonization may represent an opportunity to improve antibiotic selectivity in the treatment of abscesses.
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Affiliation(s)
- Michael S Pulia
- Division of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Mary Calderone
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Brad Hansen
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Christine E Stake
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mark Cichon
- Department of Emergency Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Zhanhai Li
- University of Wisconsin Department of Biostatistics and Medical Informatics, Madison, WI, USA
| | - Nasia Safdar
- William S Middleton Veterans Affairs Medical Center and the Department of Medicine, Division of Infectious Disease, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Cantey JB, Sreeramoju P, Jaleel M, Treviño S, Gander R, Hynan LS, Hill J, Brown C, Chung W, Siegel JD, Sánchez PJ. Prompt control of an outbreak caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. J Pediatr 2013; 163:672-9.e1-3. [PMID: 23582136 DOI: 10.1016/j.jpeds.2013.03.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Revised: 01/25/2013] [Accepted: 03/01/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To assess the effectiveness of a set of multidisciplinary interventions aimed at limiting patient-to-patient transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) during a neonatal intensive care unit (NICU) outbreak, and to identify risk factors associated with ESBL-KP colonization and disease in this setting. STUDY DESIGN A 61-infant cohort present in the NICU during an outbreak of ESBL-KP from April 26, 2011, to May 16, 2011, was studied. Clinical characteristics were compared in infected/colonized infants and unaffected infants. A multidisciplinary team formulated an outbreak control plan that included (1) staff reeducation on recommended infection prevention measures; (2) auditing of hand hygiene and environmental services practices; (3) contact precautions; (4) cohorting of infants and staff; (5) alleviation of overcrowding; and (6) frequent NICU-wide screening cultures. Neither closure of the NICU nor culturing of health care personnel was instituted. RESULTS Eleven infants in this level III NICU were infected/colonized with ESBL-KP. The index case was an 18-day-old infant born at 25 weeks' gestation who developed septicemia from ESBL-KP. Two other infants in the same room developed sepsis from ESBL-KP within 48 hours; both expired. Implementation of various infection prevention strategies resulted in prompt control of the outbreak within 3 weeks. The ESBL-KP isolates presented a single clone that was distinct from ESBL-KP identified previously in other units. Being housed in the same room as the index infant was the only risk factor identified by logistic regression analysis (P = .002). CONCLUSION This outbreak of ESBL-KP affected 11 infants and was associated with 2 deaths. Prompt control with eradication of the infecting strain from the NICU was achieved with multidisciplinary interventions based on standard infection prevention practices.
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Affiliation(s)
- Joseph B Cantey
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
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