Staphylococcus aureus infections; Lead by the nose

An overview and the latest insights regarding S. aureus nasal carriage, associated risks of developing infections and possible preventive measures, will be given in Chapter 2. Since mupirocin efficacy studies in preventing nosocomial infections have only been performed in surgical and dialysis patients, we decided to design and perform a mupirocin efficacy study in non-surgical patients. These patients are also responsible for a great burden in S. aureus hospital infections. This randomized, placebo-controlled trial is described in Chapter 3. This trial lead to four new research questions: 1. What is the risk of nosocomial S. aureus bacteremia for S. aureus carriers versus noncarriers? 2. Is there a difference in risk of mortality for carriers versus non-carriers once bacteremic with S. aureus? 3. What is the efficacy of mupirocin on reducin

What is the evidence base of used aggregated antibiotic resistance percentages to change empirical antibiotic treatment? A scoping review

Contains fulltext : 251404.pdf (Publisher’s version ) (Open Access)OBJECTIVES: Antibiotic resistance requires continuous monitoring by experts to decide whether empirical antibiotic therapies (EATs) should be replaced by alternative antibiotics. The exact moment and criteria for this change are unclear and generally based on consensus between experts. This scoping review aims to identify from the literature the resistance thresholds used for a change in EAT and the criteria on which they are based. METHODS: Scoping review for which a comprehensive structured literature search was conducted. Rayyan, software for systematic reviews, was used for the screening of abstracts and titles. Data sources were Pubmed and a hand-search of reference lists and grey literature. Papers were eligible if they concerned any type of bacterial infectious disease and mentioned or defined antibiotic resistance thresholds for decision-making purposes for EAT. The inclusion and analysis of articles was done by two researchers; any conflicts were resolved through discussion or by consulting a third reviewer. RESULTS: We identified 3146 unique papers. Following title/abstract screening, 125 papers were comprehensively read, and 16 papers were included. The included papers gave thresholds for urinary tract infections, respiratory tract infections, meningitis, skin and soft tissue infections, gonorrhoea, and bone and joint infections. Six criteria were found that were commonly used to base the thresholds on. These were: disease severity, efficacy of treatment, adverse drug events, risk of Clostridioides difficile infection, costs, and increased resistance. The number of criteria used to define each threshold varied from one to six between papers. CONCLUSIONS: The thresholds used for EATs are few, commonly based on expert opinion estimates, and can therefore have broad ranges. Used criteria underlying reported thresholds are heterogenous and require standardization. Considering the rising trend in resistance, there is a clear need for rigid tools to determine thresholds in order to support guideline development with the best and timely evidence

Burden of disease and economic impact of human Streptococcus suis infection in Viet Nam

Contains fulltext : 206045.pdf (publisher's version ) (Open Access

Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study

BACKGROUND: Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients. OBJECTIVE: To assess the efficacy of mupirocin prophylaxis in preventing nosocomial S. aureus infections in nonsurgical patients. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: 3 tertiary care academic hospitals and 1 nonacademic hospital. PATIENTS: 1602 culture-proven S. aureus carriers hospitalized in nonsurgical departments. INTERVENTION: Therapy with mupirocin 2% nasal ointment (n = 793) or placebo ointment (n = 809), twice daily for 5 days, started 1 to 3 days after admission. MEASUREMENTS: Nosocomial S. aureus infections according to defined criteria, in-hospital mortality, duration of hospitalization, and time to nosocomial S. aureus infection. Staphylococcus aureus isolates were genotyped to assess whether infection was caused by endogenous strains. RESULTS: The mupirocin and placebo groups did not statistically differ in the rates of nosocomial S. aureus infections (mupirocin, 2.6%; placebo, 2.8%; risk difference, 0.2 percentage point [95% CI, -1.5 to 1.9 percentage points]), mortality (mupirocin, 3.0%; placebo, 2.8%; risk difference, -0.2 percentage point [CI, -1.9 to 1.5 percentage points]), or duration of hospitalization (median for both, 8 days). However, time to nosocomial S. aureus infection was decreased in the mupirocin group from 12 to 25 days (P > 0.2). A total of 77% of S. aureus nosocomial infections were endogenous. LIMITATIONS: A few infections in both groups may have been missed because investigators assessed a patient for infection only if microbiology culture results were positive for S. aureus. CONCLUSION: Routine culture for S. aureus nasal carriage at admission and subsequent mupirocin application does not provide effective prophylaxis against nosocomial S. aureus infections in nonsurgical patients

Интеллектуальная радиосеть с нечеткой конфигурацией

В статье обсуждаются возможности применения одноранговой радиосети стандарта IEEE 802.15.4 (ZigBee) диапазона 2,4 ГГц для работы системы, состоящей из группы малогабаритных мобильных роботов и одного командного пункта. Основная задача группы роботов – проведение разведки во время спасательных операций после техногенных и природных катастроф и аварий. Для сохранения управляемости отдельными роботами и системой в целом предлагается повысить «интеллект» системы связи за счет гибкой маршрутизации каналов между командным пунктом и конкретным мобильным роботом с тем, чтобы иметь систему с автоматическим, интеллектуальным восстановлением канала обмена данных.У статті обговорюються можливості застосування однорангової радіомережі стандарту ІЕЕ 802.15.4 (ZigBee) діапазону 2,4 Ггу для роботи системи, що складається з групи малогабаритних мобільних роботів та одного командного пункту. Основна задача групи роботів – проведення розвідки під час рятувальних операцій після техногенних та природних катастроф і аварій. Для збереження керованості окремими ротами та системою в цілому пропонується підвищити інтелект системи зв’язку за рахунок гнучкої маршрутитизації каналів між командним пунктом та конкретним мобільним роботом з тим, щоб мати систему з автоматичним, інтелектуальним відновлюванням каналу обміну даних.In the article the possibilities of application peer-to-peer radio networks of standard IEEE 802.15.4 (ZigBee) a range of 2,4 GHz for work of the system consisting of small-sized mobile robots group and one command point are discussed. The primary goal of group of robots – is carrying out of investigation during rescue operations after technogenic and natural accidents and failures. For controllability preservation by separate robots and system as a whole, it is offered to raise “intelligence” of a communication system at the expense of flexible routeing of channels between command point and the concrete mobile robot to have system with automatic, intellectual restoration of the channel of data exchange

Surveillance-embedded genomic outbreak resolution of methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit

We observed an increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections at a Dutch neonatal intensive care unit. Weekly neonatal MSSA carriage surveillance and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. Traditional clustering of MSSA isolates by spa typing and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections. We investigated whether whole-genome sequencing (WGS) of MSSA surveillance would provide additional evidence for transmission. MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to WGS and bioinformatic analysis for identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. By measuring the genetic diversity in background surveillance, we defined transmission-level relatedness and identified isolates that had been unjustly assigned to clusters based on MLVA, while spa typing was concordant but of insufficient resolution. Detailing particular subsets of isolates provided evidence that HCWs were involved in multiple outbreaks, yet it alleviated concerns about one particular HCW. The improved resolution and accuracy of genomic outbreak analyses substantially altered the view on outbreaks, along with apposite measures. Therefore, inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference

Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa

__Importance:__ Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients. __Objective:__ To assess risk after the identification of an unexpected, severe, and lethal hospital-acquired infection caused by carbapenemase-producing Pseudomonas aeruginosa in a carbapenemase-low endemic setting. __Design, Settings, and Participants:__ A case series study in which a risk assessment was performed on all 11 patients admitted to the combined cardiothoracic surg