A multi-center blinded study on the efficiency of phenotypic screening methods to detect glycopeptide intermediately susceptible Staphylococcus aureus (GISA) and heterogeneous GISA (h-GISA)

Contains fulltext : 52338.pdf (publisher's version ) (Open Access)BACKGROUNDS: To determine the true incidence of hGISA/GISA and its consequent clinical impact, methods must be defined that will reliably and reproducibly discriminate these resistant phenotypes from vancomycin susceptible S. aureus (VSSA). METHODS: This study assessed and compared the ability of eight Dutch laboratories under blinded conditions to discriminate VSSA from hGISA/GISA phenotypes and the intra- and inter-laboratory reproducibility of agar screening plates and the Etest method. A total of 25 blinded and unique strains (10 VSSA, 9 hGISA and 6 GISA) were categorized by the PAP-AUC method and PFGE typed to eliminate clonal duplication. All strains were deliberately added in quadruplets to evaluate intra-laboratory variability and reproducibility of the methods. Strains were tested using three agar screening methods, Brain Heart Infusion agar (BHI) + 6 microg/ml vancomycin, Mueller Hinton agar (MH) + 5 microg/ml vancomycin and MH + 5 microg/ml teicoplanin) and the Etest macromethod using a 2 McFarland inoculum. RESULTS AND DISCUSSION: The ability to detect the hGISA/GISA phenotypes varied significantly between methods and phenotypes. BHI vancomycin and MH vancomycin agar screens lacked the ability to detect hGISA. The MH teicoplanin agar screen was more sensitive but still inferior to Etest that had a sensitivity of 98.5% and 99.5%, for hGISA and GISA, respectively. Intra- and inter-laboratory reproducibility varied between methods with poorest performance seen with BHI vancomycin. CONCLUSION: This is the first multi-center blinded study to be undertaken evaluating various methods to detect GISA and hGISA. These data showed that the ability of clinical laboratories to detect GISA and hGISA varied considerably, and that screening plates with vancomycin have a poor performance in detecting hGISA

Türkiye’de bulunan yoğun bakımlarda sabun, kağıt havlu ve alkol bazlı el dezenfektanı yeterli mi?: Phokai çalışması sonuçları

Introduction: Hand hygiene is one of the most effective infection control measures to prevent the spread of healthcare-associated infections (HCAI). Water, soap, paper towel and hand disinfectant must be available and adequate in terms of effective hand hygiene. The adequacy of hand hygiene products or keeping water-soap and paper towel is still a problem for many developing countries like Turkey. In this multicenter study, we analyzed the adequacy in number and availability of hand hygiene products.Materials and Methods: This study was performed in all intensive care units (ICUs) of 41 hospitals (27 tertiary-care educational, 10 state and four private hospitals) from 22 cities located in seven geographical regions of Turkey. We analyzed water, soap, paper towel and alcohol-based hand disinfectant adequacy on four different days, two of which were in summer during the vacation time (August, 27th and 31st 2016) and two in autumn (October, 12th and 15th 2016).Results: The total number of ICUs and intensive care beds in 41 participating centers were 214 and 2357, respectively. Overall, there was no soap in 3-11% of sinks and no paper towel in 10-18% of sinks while there was no alcohol-based hand disinfectant in 1-4.7% of hand disinfectant units on the observation days. When we compared the number of sinks with soap and/or paper towel on weekdays vs. weekends, there was no significant difference in summer. However, on autumn weekdays, the number of sinks with soap and paper towel was significantly lower on weekend days (p<0.0001, p<0.0001) while the number of hand disinfectant units with alcohol-based disinfectant was significantly higher (p<0.0001).Conclusion: There should be adequate and accessible hand hygiene materials for effective hand hygiene. In this study, we found that soap and paper towels were inadequate on the observation days in 3-11% and 10-18% of units, respectively. Attention should be paid on soap and paper towel supply at weekends as well

Comparison of steam technology and a two-step cleaning (water/detergent) and disinfecting (1,000 resp. 5,000 ppm hypochlorite) method using microfiber cloth for environmental control of multidrug-resistant organisms in an intensive care unit.

Aim: The aim of this prospective observational study was to evaluate the impact of two cleaning and disinfecting methods and the use of steam against methicillin-resistant Staphyl ococcus aureus , vancomycin-resistant Enterococcus faecalis , carbapenem-resistant Pseudomonas aeruginosa and multidrug-resistant (MDR) Acinetobacter baumannii in a tertiary referral hospital. Methods: McFarland 0.5 suspensions (content 1.5 x 108 cfu/ml) of four challenge bacterial species were prepared and used to inoculate different sites in three ICU rooms. One of the following methods was used in each room: steam technology (Tecnovap Evo 304) resp. cleaning with microfiber cloths, soaked with detergent and water, thereafter disinfection with 1,000 ppm hypochlorite or the same procedure with 5,000 ppm hypochlorite. Qualitative microbiology and ATP bioluminescence were performed before and after cleaning with each method. The Wilcoxon test was used for paired samples to check for ordinal variables. The cost of each cleaning method was analyzed. Results: Environmental cleaning with steam technology was found to be as effective against MDR microorganisms as a two-step cleaning process (water/detergent and disinfecting with 1,000 resp. 5,000 ppm hypochlorite) in ICUs. No bacterial growth was detected after any of the three cleaning methods. Steam technology was 76% and 91% cheaper than using 5,000 ppm and 1,000 ppm hypochlorite, respectively.Conclusions: When compared to, steam technology was found to have an advantage over the 2-step procedure with cleaning and disinfection, because it avoids the use of chemicals, reduces water consumption, labor time and costs for cleaning.Zielsetzung: In einer prospektiven Beobachtungsstudie sollte die Wirksamkeit von zwei Verfahren der desinfizierenden Reinigung bzw. der Anwendung von Dampf gegen Methicillin-resistente Staphylococcus aureus (MRSA), Vancomycin-resistente Enterococcus faecalis (VRE), Carbapenem-resistente Pseudomonas aeruginosa und multiresistente (MDR) Acinetobacter baumannii in einem Krankenhaus der Tertiärversorgung verglichen werden.Methode: Von den vier Bakterienspecies wurden Suspensionen mit einem Gehalt von 1,5 x 108 KbE/ml hergestellt und zur Kontamination von drei Lokalisationen in drei Intensivstationen eingesetzt. In jedem Raum wurde eine der folgenden Reinigungsmethoden angewendet: Dampftechnologie (Tecnovap Evo 304) oder 2 Formen der desinfizierenden Reinigung in zwei Schritten: zuerst Reinigung mit Tensid getränktem Mikrofasertuch, anschließend Wischdesinfektion mit 1.000 ppm oder analoges Vorgehen nur mit 5.000 ppm Hypochlorit. Vor und nach der desinfizierenden Reinigung wurde ein qualitativer Erregernachweis geführt und die Reinigungswirkung mittels ATP-Biolumineszenz gemessen. Der Wilcoxon-Test wurde für gepaarte Stichproben zur Überprüfung ordinaler Variablen verwendet. Die Kosten für jede Reinigungsmethode wurden analysiert.Ergebnisse: Die drei Verfahren erwiesen sich als gleich wirksam. Nach keiner der drei Reinigungsmethoden war ein Bakterienwachstum nachweisbar. Die Dampftechnologie war 76% bzw. 91% preiswerter als die Verwendung von 5.000 ppm bzw. 1.000 ppm Hypochlorit.Schlussfolgerung: Im Vergleich zur zweistufigen desinfizierenden Reinigung mit Chlorlösungen erwies sich die Dampftechnologie als vorteilhafter, da auf den Einsatz von Chemikalien verzichtet und der Verbrauch von Wasser, benötigter Arbeitszeit und Reinigungskosten reduziert wird

Factors associated with catheter-associated urinary tract infections and the effects of other concomitant nosocomial infections in intensive care units

Background: Catheter-associated urinary tract infections (CAUTIs) are the most common nosocomial infections in intensive care units (ICUs). The objectives of this study were to describe the incidence, aetiology, and risk factors of CAUTIs in ICUs and to determine whether concomitant nosocomial infections alter risk factors. Methods: Between April and October 2008, all adult catheterized patients admitted to the ICUs of Zonguldak Karaelmas University Hospital were screened daily, and clinical and microbiological data were collected for each patient. Results: Two hundred and four patients were included and 85 developed a nosocomial infection. Among these patients, 22 developed a CAUTI alone, 38 developed a CAUTI with an additional nosocomial infection, either concomitantly or prior to the onset of the CAUTI, and 25 developed nosocomial infections at other sites. The CAUTI rate was 19.02 per 1000 catheter-days. A Cox proportional hazard model showed that in the presence of other site nosocomial infections, immune suppression (hazard ratio (HR) 3.73, 95% CI 1.47-9.46; p = 0.006), previous antibiotic usage (HR 2.06, 95% CI 1.11-3.83; p = 0.023), and the presence of a nosocomial infection at another site (HR 1.82, 95% CI 1.04-3.20; p = 0.037) were the factors associated with the acquisition of CAUTIs with or without a nosocomial infection at another site. When we excluded the other site nosocomial infections to determine if the risk factors differed depending on the presence of other nosocomial infections, female gender (HR 2.67, 95% CI 1.03-6.91; p = 0.043) and duration of urinary catheterization (HR 1.07 (per day), 95% CI 1.01-1.13; p = 0.019) were found to be the risk factors for the acquisition of CAUTIs alone. Conclusions: Our results showed that the presence of nosocomial infections at another site was an independent risk factor for the acquisition of a CAUTI and that their presence alters risk factors. © 2012 Informa Healthcare

Correction to: An interdisciplinary investigation of the seismic performance of a historic tower in Istanbul during the 1999 Kocaeli earthquake (Bulletin of Earthquake Engineering, (2023), 21, 5, (2921-2945), 10.1007/s10518-023-01638-6)

Correction: Bulletin of Earthquake Engineering 21, 233 (2023) Original article was published with incorrect references and should be read as: Somma F, Flora A, Bilotta E, Viggiani GM (2021b) Numerical analysis on shallow foundations lateral disconnection. In: 8th ECCOMAS thematic conference on computational methods in structural dynamics and earthquake engineering. Athens, Greece, pp 27–30. Original article has been corrected

An interdisciplinary investigation of the seismic performance of a historic tower in Istanbul during the 1999 Kocaeli earthquake

This paper investigates the effects of soil-structure interaction and site amplification on the seismic response of one of the towers of the Theodosian walls of Constantinople during the Kocaeli earthquake in 1999, that largely damaged it. The interacting system is first analysed in the frequency domain by the well-known replacement oscillator model, turning out that the effect of soil-structure interaction could be relevant. The complete system is then examined by the direct approach considering non linearity of the behaviour of both the structure and the soil. The failure mechanism detected from where stress and plasticization concentrate into the masonry panels is consistent with the out-of-plane mechanism of one of the tower facades triggered by the reference earthquake. The focus was then set on the effectiveness of some retrofitting interventions, including the lateral disconnection of the embedded sides of the tower from the surrounding soil, the soil treatment by grouted columns and the classical technique for masonry rehabilitation. Even though the latter choice is the most common one, retrofitting interventions concentrated into the soil could be effective as well. Their use should be properly considered when the scope of the intervention is the preservation of cultural heritage

A snapshot of geriatric infections in Turkey: ratio of geriatric inpatients in hospitals and evaluation of their infectious diseases: A multicenter point prevalence study.

INTRODUCTION: The human population is aging at an astonishing rate. The aim of this study is to capture a situation snapshot revealing the proportion of individuals aged 65 years and over among inpatients in healthcare institutions in Turkey and the prevalence and type of infections in this patient group in order to draw a road map. MATERIALS AND METHODS: Hospitalized patients over 65 years at any of the 62 hospitals in 29 cities across Turkey on February 9, 2017 were included in the study. Web-based SurveyMonkey was used for data recording and evaluation system. RESULTS: Of 17,351 patients 5871 (33.8%) were ≥65 years old. The mean age was 75.1±7.2 years; 3075 (52.4%) patients were male. Infection was reason for admission for 1556 (26.5%) patients. Pneumonia was the most common infection. The median length of hospital stay was 5 days (IQR: 2-11 days). The Antibiotic therapy was initiated for 2917 (49.7%) patients at the time of admission, and 23% of the antibiotics prescribed were inappropriate. Healthcare-associated infections developed in 1059 (18%) patients. Urinary catheters were placed in 2388 (40.7%) patients with 7.5% invalid indication. CONCLUSION: This study used real data to reveal the proportion of elderly patients in hospital admissions. The interventions done, infections developed during hospitalization, length of hospital stay, and excessive drug load emphasize the significant impact on health costs and illustrate the importance of preventive medicine in this group of patients