Posts filed under ‘Infecciones nosocomiales’

Decolonization in Prevention of Health Care-Associated Infections.

Clin Microbiol Rev. April 2016 V.29 N.2 P.201-22.

Septimus EJ1, Schweizer ML2.

Author information

1 Hospital Corporation of America, Nashville, Tennessee, USA Texas A&M Health Science Center, College of Medicine, Houston, Texas, USA Edward.septimus@hcahealthcare.com.

2 University of Iowa Carver College of Medicine, Iowa City, Iowa, USA Iowa City VA Health Care System, Iowa City, Iowa, USA University of Iowa College of Public Health, Iowa City, Iowa, USA.

Abstract

Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection.

Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs).

This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant.

Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin.

Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin.

Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy.

Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida.

Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time.

There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms.

The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

PDF

http://cmr.asm.org/content/29/2/201.full.pdf+html

May 12, 2017 at 7:45 am

Real-Time Electronic Tracking of Diarrheal Episodes and Laxative Therapy Enables Verification of Clostridium difficile Clinical Testing Criteria and Reduction of Clostridium difficile Infection Rates

Journal of Clinical Microbiology May 2017 V.55 N.5 P.1276-1284

Cynthia Y. Truong, Saurabh Gombar, Richard Wilson, Gopalakrishnan Sundararajan, Natasa Tekic, Marisa Holubar, John Shepard, Alexandra Madison, Lucy Tompkins, Neil Shah, Stan Deresinski, Lee F. Schroeder, and Niaz Banaei

aDepartment of Pathology, Stanford University School of Medicine, Stanford, California, USA

bDigital Solutions, Stanford Health Care, Stanford, California, USA

cDivision of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA

dInfection Control and Prevention, Stanford Health Care, Stanford, California, USA

eStanford Antimicrobial Safety and Sustainability, Stanford Health Care, Stanford, California, USA

fDepartment of Pathology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA

gClinical Microbiology Laboratory, Stanford Health Care, Stanford, California, USA

Health care-onset health care facility-associated Clostridium difficile infection (HO-CDI) is overdiagnosed for several reasons, including the high prevalence of C. difficile colonization and the inability of hospitals to limit testing to patients with clinically significant diarrhea. We conducted a quasiexperimental study from 22 June 2015 to 30 June 2016 on consecutive inpatients with C. difficile test orders at an academic hospital. Real-time electronic patient data tracking was used by the laboratory to enforce testing criteria (defined as the presence of diarrhea [≥3 unformed stools in 24 h] and absence of laxative intake in the prior 48 h). Outcome measures included C. difficile test utilization, HO-CDI incidence, oral vancomycin utilization, and clinical complications. During the intervention, 7.1% (164) and 9.1% (211) of 2,321 C. difficile test orders were canceled due to absence of diarrhea and receipt of laxative therapy, respectively. C. difficile test utilization decreased upon implementation from an average of 208.8 tests to 143.0 tests per 10,000 patient-days (P < 0.001). HO-CDI incidence rate decreased from an average of 13.0 cases to 9.7 cases per 10,000 patient-days (P = 0.008). Oral vancomycin days of therapy decreased from an average of 13.8 days to 9.4 days per 1,000 patient-days (P = 0.009). Clinical complication rates were not significantly different in patients with 375 canceled orders compared with 869 episodes with diarrhea but negative C. difficile results. Real-time electronic clinical data tracking is an effective tool for verification of C. difficile clinical testing criteria and safe reduction of inflated HO-CDI rates.

PDF

http://jcm.asm.org/content/55/5/1276.full.pdf+html

May 9, 2017 at 8:23 am

Portación nasal de Staphylococcus aureus en trabajadores de la salud: primer reporte en un hospital público en Argentina

Revista Argentina de Microbiología Mayo 2017

Carina Andrea Boncompain (a), Cristian Alejandro Suáreza (a-b), Héctor Ricardo Morbidoni (a-c)

a Laboratorio de Microbiología Molecular, Cátedra de Microbiología, Facultad de Ciencias Médicas, Universidad Nacional de Rosario, Rosario, Argentina

b Consejo Nacional de Investigaciones Científicas y Tecnológicas, CONICET, Argentina

c Consejo de Investigaciones, Universidad Nacional de Rosario, Rosario, Argentina

Resumen

Staphylococcus aureus es agente causal de numerosas infecciones en humanos, que pueden ser desde leves hasta graves, y circula tanto en la comunidad como en las instalaciones de los centros de salud.

Los pacientes y los trabajadores de la salud pueden diseminar cepas durante los exámenes médicos de rutina o durante la hospitalización.

El foco de este estudio fue determinar la tasa de portación nasal de S. aureus sensible o resistente a meticilina en trabajadores de la salud del Hospital Provincial del Centenario, un hospital público de atención primaria en Argentina. Se llevó a cabo un estudio transversal en 320 trabajadores de la salud (TS).

Se tomaron hisopados nasales y se aislaron colonias presuntivas de S. aureus. La identidad de las bacterias y su resistencia a meticilina fueron confirmadas por amplificación de los genes nuc y mec. El análisis estadístico comprendió el test de la chi al cuadrado y el test de exactitud de Fisher.

De 320 TS, 96 (30%) fueron portadores nasales de S. aureus, de los cuales 20 (6,3% del total) llevaban cepas de S. aureus resistentes a meticilina (SAMR) y 76 (23,7% del total) eran portadores de cepas sensibles a meticilina (SAMS). La portación entre los médicos fue del 30% y estuvo dentro de los niveles publicados; dentro del subgrupo del personal técnico la portación fue superior: 57%.

Se detectaron resistencias acompañantes (64,6%; 62/96) a fluoroquinolonas (24%; 23/96), aminoglucósidos (13,5%; 13/96) o macrólidos (34,4%; 33/96). Todas las cepas fueron sensibles a vancomicina y solo el 3,1% (3/96), las 3 SAMS, fueron resistentes a mupirocina.

Este estudio, el primero en su tipo en Argentina y uno de los pocos hechos en América del Sur, remarca la relevancia de la portación nasal de SAMR y SAMS en el personal de atención de la salud y evidencia la necesidad de contar con recomendaciones consensuadas para el tamizaje regular de S. aureus, así como de estrategias de decolonización ….

PDF hacer CLIC en OPTIONS donde se lee “DOWNLOAD PDF”

http://www.elsevier.es/en-revista-revista-argentina-microbiologia-372-avance-resumen-staphylococcus-aureus-nasal-carriage-in-S032575411730010X

May 8, 2017 at 9:13 am

Complex Routes of Nosocomial Vancomycin-Resistant Enterococcus faecium Transmission Revealed by Genome Sequencing.

Clin Infect Dis. 2017 Apr 1;64(7):886-893.

Raven KE1, Gouliouris T1,2,3, Brodrick H1, Coll F4, Brown NM2,3, Reynolds R5,6, Reuter S1, Török ME1,2,3, Parkhill J7, Peacock SJ1,3,4,7.

Author information

1 Department of Medicine, University of Cambridge.

2 Public Health England, Clinical Microbiology and Public Health Laboratory, Addenbrooke’s Hospital, and.

3 Cambridge University Hospitals NHS Foundation Trust, Cambridge.

4 London School of Hygiene and Tropical Medicine.

5 British Society for Antimicrobial Chemotherapy, Birmingham.

6 North Bristol NHS Trust, Southmead Hospital, Bristol; and.

7 Wellcome Trust Sanger Institute, Hinxton, Cambridge, United Kingdom.

Abstract

BACKGROUND:

Vancomycin-resistant Enterococcus faecium (VREfm) is a leading cause of nosocomial infection. Here, we describe the utility of whole-genome sequencing in defining nosocomial VREfm transmission.

METHODS:

A retrospective study at a single hospital in the United Kingdom identified 342 patients with E. faecium bloodstream infection over 7 years. Of these, 293 patients had a stored isolate and formed the basis for the study. The first stored isolate from each case was sequenced (200 VREfm [197 vanA, 2 vanB, and 1 isolate containing both vanA and vanB], 93 vancomycin-susceptible E. faecium) and epidemiological data were collected. Genomes were also available for E. faecium associated with bloodstream infections in 15 patients in neighboring hospitals, and 456 patients across the United Kingdom and Ireland.

RESULTS:

The majority of infections in the 293 patients were hospital-acquired (n = 249) or healthcare-associated (n = 42). Phylogenetic analysis showed that 291 of 293 isolates resided in a hospital-associated clade that contained numerous discrete clusters of closely related isolates, indicative of multiple introductions into the hospital followed by clonal expansion associated with transmission. Fine-scale analysis of 6 exemplar phylogenetic clusters containing isolates from 93 patients (32%) identified complex transmission routes that spanned numerous wards and years, extending beyond the detection of conventional infection control. These contained both vancomycin-resistant and -susceptible isolates. We also identified closely related isolates from patients at Cambridge University Hospitals NHS Foundation Trust and regional and national hospitals, suggesting interhospital transmission.

CONCLUSIONS:

These findings provide important insights for infection control practice and signpost areas for interventions. We conclude that sequencing represents a powerful tool for the enhanced surveillance and control of nosocomial E. faecium transmission and infection

PDF

https://oup.silverchair-cdn.com/oup/backfile/Content_public/Journal/cid/64/7/10.1093_cid_ciw872/1/ciw872.pdf?Expires=1493989314&Signature=PWsoHk4ZslYHxHMhvNbpngwvfxGkVif–DIxIYk7GJ9EKlIKOeczfr1QNsV~Neh79GNdopZ4oYseQAFN5ZZevQ5wV26yFb3WlZrhe5XWWHK45XvTEZIRMnF~XT1IBzk2TWlG-8eWaVliA9lOwV6Ips8eFOS7zet~NxFrhqYm~egD6oqYG4VdqYQU6CfywYx58wdNsM5FNgQd~VGdFaTOsdgH-VF4LS6z~CvXiM50YcyE1A-RWeZLx34m6OHbN389~GKP2dk0TEa9IMP4yU51q7ZTYpzlzPyMWu-33JN5lVhywnHk0AREZfP8AIgHrFl0qgJWO47z8J8Ea8NTrfwe5A__&Key-Pair-Id=APKAIUCZBIA4LVPAVW3Q

 

May 4, 2017 at 8:51 am

ESCMID guideline for the diagnosis and treatment of biofilm infections 2014.

Clinical Microbiology and Infection May 2015 V.21 Suppl 1:S1-25.

Høiby N1, Bjarnsholt T2, Moser C3, Bassi GL4, Coenye T5, Donelli G6, Hall-Stoodley L7, Holá V8, Imbert C9, Kirketerp-Møller K10, Lebeaux D11, Oliver A12, Ullmann AJ13, Williams C14; ESCMID Study Group for Biofilms and Consulting External Expert Werner Zimmerli.

Author information

1 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark. Electronic address: hoiby@hoibyniels.dk

2 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark; Department of International Health, Immunology and Microbiology, University of Copenhagen, Denmark.

3 Department of Clinical Microbiology, Rigshospitalet, Copenhagen, Denmark.

4 Department of Pulmonary and Critical Care Medicine, Thorax Institute, Hospital Clinic, Barcelona; Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; Centro de Investigación Biomedica En Red- Enfermedades Respiratorias (CIBERES), Barcelona; and University of Barcelona, Barcelona, Spain.

5 Laboratory of Pharmaceutical Microbiology, Ghent University, Ghent, Belgium.

6 Microbial Biofilm Laboratory, IRCCS Fondazione Santa Lucia, Rome, Italy.

7 Department of Microbial Infection and Immunity, Center for Microbial Interface Biology, Ohio State University, Columbus, OH, USA.

8 Institute for Microbiology, Masaryk University and St Anne’s University Hospital, Brno, Czech Republic.

9 Laboratoire Ecologie et Biologie des Interactions, Université de Poitiers, Poitiers, France.

10 Department of Orthopaedic Surgery, Hvidovre University Hospital, Hvidovre, Denmark.

11 Institut Pasteur, Unité de Génétique des Biofilms, Paris; Université Paris Descartes, Sorbonne Paris Cité, Hôpital Necker Enfants Malades, Centre d’Infectiologie Necker-Pasteur; and Institut Imagine, Paris, France.

12 Servicio de Microbiología, Hospital Universitario Son Espases, Instituto de Investigación Sanitaria de Palma, Palma de Mallorca, Spain.

13 Department of Internal Medicine II, Julius-Maximilians-University, Würzburg, Germany.

14 Institute of Healthcare Associated Infection, University of the West of Scotland, Paisley, UK.

Abstract

Biofilms cause chronic infections in tissues or by developing on the surfaces of medical devices. Biofilm infections persist despite both antibiotic therapy and the innate and adaptive defence mechanisms of the patient. Biofilm infections are characterized by persisting and progressive pathology due primarily to the inflammatory response surrounding the biofilm. For this reason, many biofilm infections may be difficult to diagnose and treat efficiently. It is the purpose of the guideline to bring the current knowledge of biofilm diagnosis and therapy to the attention of clinical microbiologists and infectious disease specialists. Selected hallmark biofilm infections in tissues (e.g. cystic fibrosis with chronic lung infection, patients with chronic wound infections) or associated with devices (e.g. orthopaedic alloplastic devices, endotracheal tubes, intravenous catheters, indwelling urinary catheters, tissue fillers) are the main focus of the guideline, but experience gained from the biofilm infections included in the guideline may inspire similar work in other biofilm infections. The clinical and laboratory parameters for diagnosing biofilm infections are outlined based on the patient’s history, signs and symptoms, microscopic findings, culture-based or culture-independent diagnostic techniques and specific immune responses to identify microorganisms known to cause biofilm infections. First, recommendations are given for the collection of appropriate clinical samples, for reliable methods to specifically detect biofilms, for the evaluation of antibody responses to biofilms, for antibiotic susceptibility testing and for improvement of laboratory reports of biofilm findings in the clinical microbiology laboratory. Second, recommendations are given for the prevention and treatment of biofilm infections and for monitoring treatment effectiveness. Finally, suggestions for future research are given to improve diagnosis and treatment of biofilm infections

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)00090-1/pdf

April 22, 2017 at 9:00 am

Antimicrobial susceptibility testintg in biofilm-growing bacteria

Clinical Microbiology and Infection October 2014 V.20 N.10 P.981-990

M.D. Macia, E. Rojo-Molinero, A. Oliver

Biofilms are organized bacterial communities embedded in an extracellular polymeric matrix attached to living or abiotic surfaces. The development of biofilms is currently recognized as one of the most relevant drivers of persistent infections. Among them, chronic respiratory infection by Pseudomonas aeruginosa in cystic fibrosis patients is probably the most intensively studied. The lack of correlation between conventional susceptibility test results and therapeutic success in chronic infections is probably a consequence of the use of planktonically growing instead of biofilm-growing bacteria. Therefore, several in vitro models to evaluate antimicrobial activity on biofilms have been implemented over the last decade. Microtitre plate-based assays, the Calgary device, substratum suspending reactors and the flow cell system are some of the most used in vitro biofilm models for susceptibility studies. Likewise, new pharmacodynamic parameters, including minimal biofilm inhibitory concentration, minimal biofilm-eradication concentration, biofilm bactericidal concentration, and biofilm-prevention concentration, have been defined in recent years to quantify antibiotic activity in biofilms. Using these parameters, several studies have shown very significant quantitative and qualitative differences for the effects of most antibiotics when acting on planktonic or biofilm bacteria. Nevertheless, standardization of the procedures, parameters and breakpoints, by official agencies, is needed before they are implemented in clinical microbiology laboratories for routine susceptibility testing. Research efforts should also be directed to obtaining a deeper understanding of biofilm resistance mechanisms, the evaluation of optimal pharmacokinetic/pharmacodynamic models for biofilm growth, and correlation with clinical outcome.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(14)65364-7/pdf

April 22, 2017 at 8:59 am

European Society of Clinical Microbiology and Infectious Diseases: update of the diagnostic guidance document for Clostridium difficile infection

Clinical Microbiology & Infection August 2016

M.J.T. Crobach, T. Planche, C. Eckert, F. Barbut, E.M. Terveer, O.M. Dekkers, M.H. Wilcox, E.J. Kuijper

In 2009 the first European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline for diagnosing Clostridium difficile infection (CDI) was launched. Since then newer tests for diagnosing CDI have become available, especially nucleic acid amplification tests. The main objectives of this update of the guidance document are to summarize the currently available evidence concerning laboratory diagnosis of CDI and to formulate and revise recommendations to optimize CDI testing. This update is essential to improve the diagnosis of CDI and to improve uniformity in CDI diagnosis for surveillance purposes among Europe. An electronic search for literature concerning the laboratory diagnosis of CDI was performed. Studies evaluating a commercial laboratory test compared to a reference test were also included in a meta-analysis. The commercial tests that were evaluated included enzyme immunoassays (EIAs) detecting glutamate dehydrogenase, EIAs detecting toxins A and B and nucleic acid amplification tests. Recommendations were formulated by an executive committee, and the strength of recommendations and quality of evidence were graded using the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system. No single commercial test can be used as a stand-alone test for diagnosing CDI as a result of inadequate positive predictive values at low CDI prevalence. Therefore, the use of a two-step algorithm is recommended. Samples without free toxin detected by toxins A and B EIA but with positive glutamate dehydrogenase EIA, nucleic acid amplification test or toxigenic culture results need clinical evaluation to discern CDI from asymptomatic carriage.

PDF

http://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)30025-8/pdf

April 13, 2017 at 5:04 pm

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