Posts filed under ‘Health Care-Associated Infections’

Early-onset prosthetic valve endocarditis definition revisited: Prospective study and literature review

International Journal of Infectious Diseases February 2018 V.67 P.3–6

Rinaldo Focaccia Siciliano, Bruno Azevedo Randi, Danielle Menosi Gualandro, Roney Orismar Sampaio, Márcio Sommer Bittencourt, Christian Emmanuel da Silva Pelaes, Alfredo José Mansur, Pablo Maria Alberto Pomerantzeff, Flávio Tarasoutchi, Tânia Mara Varejão Strabelli

Highlights

  • Studies reporting the etiology of prosthetic valve endocarditis (PVE) are an unmet clinical need.
  • A prospective cohort study was performed along with a literature review to describe the distribution of the etiology of PVE.
  • At >120 days after valve surgery, there is a decrease in the incidence of resistant microorganisms.
  • PVE occurring at >120 days after surgery may be treated with the same empirical treatment as for late PVE.
  • This approach could lead to higher antibiotic efficacy and less damage to the patient’s natural flora.

Objective

To determine the annual incidence of prosthetic valve endocarditis (PVE) and to evaluate its current classification based on the epidemiological distribution of agents identified and their sensitivity profiles.

Methods

Consecutive cases of PVE occurring within the first year of valve surgery during the period 1997–2014 were included in this prospective cohort study. Incidence, demographic, clinical, microbiological, and in-hospital mortality data of these PVE patients were recorded.

Results

One hundred and seventy-two cases of PVE were included, and the global annual incidence of PVE was 1.7%. Most PVE cases occurred within 120 days after surgery (76.7%). After this period, there was a reduction in resistant microorganisms (64.4% vs. 32.3%, respectively; p = 0.007) and an increase in the incidence of Streptococcus spp (1.9% vs. 23.5%; p = 0.007). A literature review revealed 646 cases of PVE with an identified etiology, of which 264 (41%) were caused by coagulase-negative staphylococci and 43 (7%) by Streptococcus spp. This is in agreement with the current study findings.

Conclusions

Most PVE cases occurred within 120 days after valve surgery, and the same etiological agents were identified in this period. The current cut-off level of 365 days for the classification of early-onset PVE should be revisited.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30228-X/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30228-X/pdf

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February 18, 2018 at 4:03 pm

REVIEW – Environmental cleaning and disinfection of patient areas

International Journal of Infectious Diseases Ferbuary 2018 V.67 P.52–57

Michelle Doll, Michael Stevens, Gonzalo Bearman

Abstract

The healthcare setting is predisposed to harbor potential pathogens, which in turn can pose a great risk to patients.

Routine cleaning of the patient environment is critical to reduce the risk of hospital-acquired infections.

While many approaches to environmental cleaning exist, manual cleaning supplemented with ongoing assessment and feedback may be the most feasible for healthcare facilities with limited resources.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30270-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30270-9/pdf

February 10, 2018 at 9:18 am

Review – Approaches to hand hygiene monitoring: From low to high technology approaches

International Journal of Infectious Diseases December 2017 V.65 N. P.101–104

Nadia Masroor, Michelle Doll, Michael Stevens, Gonzalo Bearman

Highlights

  • Hand hygiene is a critical infection prevention practice in all healthcare settings.
  • Direct observation and product usage are appropriate methods to measure compliance in resource-limited facilities.
  • Advanced electronic hand hygiene monitoring systems are currently being assessed for accuracy and feasibility.
  • Current literature suggests a multimodal approach supplemented with ongoing education to enhance hand hygiene performance.

Abstract

Hand hygiene is a global and critical infection prevention practice across all healthcare settings. Approaches to monitoring hand hygiene compliance vary from simple methods such as direct observation and product usage to more advanced methods such as automated electronic monitoring systems. Current literature supports a multimodal approach, supplemented by education, to enhance hand hygiene performance.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30258-8/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30258-8/pdf

February 9, 2018 at 1:24 pm

 Clinical evaluation of early acquisition of Staphylococcus aureus carriage by newborns

International Journal of Infectious Diseases November 2017 V.64 N. P.9–14

Ayala Maayan-Metzger, Tzipora Strauss, Carmit Rubin, Hanaa Jaber, Mordechai Dulitzky,

Aylana Reiss-Mandel, Eyal Leshem, Galia Rahav, Gili Regev-Yochay

Abstract

Background

Little is known about neonatal Staphylococcus aureus carriage. Sites and clinical outcomes of S. aureus colonization during the first month of life were evaluated in this study.

Methods

A cohort of 279 infants born at term to 277 mothers was included. Maternal S. aureus colonization status was examined before labor. Newborns were screened for nasal, auricular, umbilical, and rectal colonization, one to three times within 100 h after birth, and infants of carrier mothers were re-screened at 1 month. Medical data were recorded from the medical charts at discharge and at the 1-month follow-up interview.

Results

Overall 43 out of 279 (15.4%) infants acquired S. aureus within the first days of life. The only two predictors of S. aureus carriage in the postnatal period were maternal S. aureus carriage (odds ratio 7.905, 95% confidence interval 3.182–19.638) and maternal antibiotic treatment during labor (odds ratio 0.121, 95% confidence interval 0.016–0.949). Among colonized children, the nose (56%) and rectum (40%) were more frequently colonized, while ear (26%) and umbilicus (16%) colonization were less common. Co-colonization at two sites was rare (4%), but always predicted carriage at 1 month of age. Maternal and neonatal characteristics, including neonatal outcomes, were similar between S. aureus carrier and non-carrier infants during the first month of life.

Conclusions

Maternal carriage is the major predictor of neonatal S. aureus carriage. The nose and rectum are the main sites of neonatal carriage. S. aureus carriage was not associated with neonatal complications throughout the first month of life. The long-term significance of early S. aureus carriage is yet to be determined.

abstract

http://www.ijidonline.com/article/S1201-9712(17)30219-9/fulltext

PDF

http://www.ijidonline.com/article/S1201-9712(17)30219-9/pdf

February 9, 2018 at 1:20 pm

Gentamicin synergises with azoles against drug-resistant Candida albicans

International Journal of Antimicrobial Agents January 2018 V.51 N.1 P.107–114

Mengjiao Lu, Cuixiang Yu, Xueyan Cui, Jinyi Shi, Lei Yuan, Shujuan Sun

Highlights

  • Gentamicin (GM) synergises with azoles against planktonic cells of resistant Candida albicans.
  • GM synergises with fluconazole (FLC) against pre-formed biofilms of C. albicans.
  • GM enhanced the in vivo efficacy of FLC against resistant C. albicans.
  • GM suppresses the efflux pump of resistant C. albicans.
  • GM?+?FLC reduces phospholipase activity of resistant C. albicans.

Candida spp. are the primary opportunistic pathogens of nosocomial fungal infections, causing both superficial and life-threatening systemic infections. Combination therapy for fungal infections has attracted considerable attention, especially for those caused by drug-resistant fungi. Gentamicin (GM), an aminoglycoside antibiotic, has weak antifungal activity against Fusarium spp. The aim of this study was to investigate the interactions of GM with azoles against Candida spp. and the underlying mechanisms. In a chequerboard assay, GM was found not only to work synergistically with azoles against planktonic cells of drug-resistant Candida albicans with a fractional inhibitory concentration index (FICI) of 0.13–0.14, but also synergised with fluconazole (FLC) against C. albicans biofilms pre-formed in <12?h. Synergism of GM with FLC was also confirmed in vivo in a Galleria mellonella infection model. In addition, mechanism studies showed that GM not only suppressed the efflux pump of resistant C. albicans in a dose-dependent manner but also inhibited extracellular phospholipase activity of resistant C. albicans when combined with FLC. These findings suggest that GM enhances the efficacy of azoles against resistant C. albicans via efflux inhibition and decreased activity of extracellular phospholipase.

abstract

http://www.ijaaonline.com/article/S0924-8579(17)30352-7/fulltext

PDF

http://www.ijaaonline.com/article/S0924-8579(17)30352-7/pdf

February 5, 2018 at 6:10 pm

Hospital sewage water: a reservoir for variants of New Delhi metallo-ß-lactamase (NDM)- and extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae

International Journal of Antimicrobial Agents January 2018 V.51 N.1 P.82–88

Shadab Parvez, Asad U. Khan

Highlights

  • In Escherichia coli, coexistence of NDM-1 with CMY-6 and CMY-139 was observed.
  • In E. coli, coexistence of NDM-4 with CMY-6, CMY-42 and CMY-86 was observed.
  • In E. coli, coexistence of NDM-5 with CMY-6 and CMY-42 and of NDM-7 with CMY-6 was observed.
  • Detection of NDM-5-producing Shigella boydii and NDM-7-producing Citrobacter freundii.
  • Identification of association of NDM-4 and OXA-48 in Citrobacter braakii and Citrobacter farmeri.

Abstract

New Delhi metallo-ß-lactamase (NDM)-producing Enterobacteriaceae have become a threat to public health.

Hospital sewage is generally unexplored, having the potential to harbour bacteria causing healthcare-associated infections. Hence, this study was initiated to monitor NDM-producing Enterobacteriaceae in hospital sewage water. A total of 32 isolates with blaNDM variants were detected in hospital sewage water, including 17 Escherichia coli, 8 Citrobacter freundii, 4 Shigella boydii, 2 Citrobacter braakii and 1 Citrobacter farmeri,  showing resistance to all antibiotics except colistin. All 32 isolates carried blaNDM (9 blaNDM-1, 11 blaNDM-4, 10 blaNDM-5 and 2 blaNDM-7), 24 isolates carried blaCMY variants (1 blaCMY-2, 3 blaCMY-4, 5 blaCMY-6, 11 blaCMY-42, 2 blaCMY-86 and 2 blaCMY-139), 20 isolates carried blaOXA-type (17 blaOXA-1 and 3 blaOXA-48), 19 isolates carried blaCTX-M and 9 isolates carried ampC on conjugative plasmids of IncFIA, IncFIB, IncFIC, IncP, IncY, IncHI1 and IncI1 types. In E. coli, coexistence of blaNDM-1 with blaCMY-6 and blaCMY-139, of blaNDM-4 with blaCMY-6, blaCMY-42 and blaCMY-86, of blaNDM-5 with blaCMY-6 and blaCMY-42, and of blaNDM-7 with blaCMY-6 was observed. NDM-5-producing S. boydii and NDM-7-producing C. freundii were identified as well as detection of  an association of blaNDM-4 and blaOXA-48 in C. braakii and C. farmeri. A class 1 integron was also found on a plasmid. ISAba125 and bleomycin genes were found surrounding all blaNDM variants. The emergence and dissemination of blaNDM variants in hospital sewage water is a matter of concern, creating an endemic scenario leading to the level of an outbreak.

abstract

http://www.ijaaonline.com/article/S0924-8579(17)30331-X/fulltext

PDF

http://www.ijaaonline.com/article/S0924-8579(17)30331-X/pdf

February 5, 2018 at 6:08 pm

Moxifloxacin plus rifampin as an alternative for levofloxacin plus rifampin in the treatment of a prosthetic joint infection with Staphylococcus aureus

International Journal of Antimicrobial Agents January 2018 V.51 N.1 P.38–42

Marjan Wouthuyzen-Bakker, Eduard Tornero, Laura Morata, Prashant V. Nannan Panday, Paul C. Jutte, Guillem Bori, Greetje A. Kampinga, Alex Soriano

Highlights

  • Excellent outcome with moxifloxacin/rifampin combination therapy in the treatment of early PJI caused by MSSA.
  • Moxifloxacin is an attractive agent in treatment of PJI.
  • Dose adjustments are not required in patients with renal insufficiency.
  • Moxifloxacin exhibits a high genetic barrier for resistance.
  • Moxifloxacin/rifampin may be used as an alternative for levofloxacin/rifampin in the treatment of early PJI caused by MSSA.

Objectives

The combination of a fluoroquinolone with rifampin is one of the cornerstones in the treatment of prosthetic joint infections (PJI) caused by staphylococci. Moxifloxacin is highly active against methicillin–susceptible Staphylococcus aureus (MSSA) and, therefore, is an attractive agent to use. However, several studies reported a lowering in serum moxifloxacin levels when combined with rifampin. The clinical relevance remains unclear. We determined the outcome of patients with early acute PJI caused by MSSA treated with either moxifloxacin/rifampin or levofloxacin/rifampin.

Methods

Medical files of patients treated with moxifloxacin/rifampin (University Medical Centre Groningen) or levofloxacin/rifampin (Hospital Clinic Barcelona) were retrospectively reviewed (2005–2015). Treatment failure was defined as the need for revision surgery and/or suppressive therapy, death by infection or a relapse of infection during follow-up.

Results

Differences in baseline characteristics between the two cohorts were observed, but prognostic parameters for failure, as defined by the KLIC-score (Kidney failure, Liver cirrhosis, Index surgery, C–reactive protein and Cemented prosthesis), were similar in the two groups (2.9 [1.5 SD] for the moxifloxacin group vs. 2.2 [1.2 SD] for the levofloxacin group [P?=?0.16]). With a mean follow-up of 50 months (36 SD) in the moxifloxacin group, and 67 months (50 SD) in the levofloxacin group (P?=?0.36), treatment was successful in 89% vs. 87.5%, respectively (P?=?0.89). None of the failures in the moxifloxacin group were due to rifampin– or moxifloxacin–resistant S. aureus strains.

Conclusion

Our data indicate that moxifloxacin combined with rifampin is as clinically effective as levofloxacin/rifampin for early acute PJI caused by MSSA.

abstract

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/fulltext

PDF

http://www.ijaaonline.com/article/S0924-8579(17)30210-8/pdf

February 5, 2018 at 6:05 pm

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