scholarly journals Compliance to Screening Protocols for Multidrug-Resistant Microorganisms at the Emergency Departments of Two Academic Hospitals in the Dutch–German Cross-Border Region

2021 ◽  
Vol 6 (1) ◽  
pp. 15
Author(s):  
Lisa B. Gunnink ◽  
Donia J. Arouri ◽  
Floris E.J. Jolink ◽  
Mariëtte Lokate ◽  
Klaas de Jonge ◽  
...  
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Multidrug Resistant ◽  
Border Region ◽  
Cross Border ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Risk Of Mortality ◽  
Academic Hospitals ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Infections caused by multidrug-resistant organisms (MDROs) are associated with prolonged hospitalization and higher risk of mortality. Patients arriving in the hospital via the emergency department (ED) are screened for the presence of MDROs in compliance with the screening protocols in order to apply the correct isolation measures. In the Dutch–German border region, local hospitals apply their own screening protocols which are based upon national screening protocols. The contents of the national and local MDRO screening protocols were compared on vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenemase-producing and carbapenem-resistant Enterobacteriaceae (CPE/CRE). The practicality of the screening protocols was evaluated by performing an audit. As a result, the content of the MDRO screening protocols differed regarding risk factors for MDRO carriage, swab site, personal protective equipment, and isolation measures. The observations and questionnaires showed that the practicality was sufficient; however, the responsibility was not designated clearly and education regarding the screening protocols was deemed inappropriate. The differences between the MDRO screening protocols complicate patient care in the Dutch–German border region. Arrangements have to be made about the responsibility of the MDRO screening, and improvements are necessary concerning education regarding the MDRO screening protocols.

scholarly journals Prevention and Killing Efficacy of Carbapenem Resistant Enterobacteriaceae (CRE) and Vancomycin Resistant Enterococci (VRE) Biofilms by Antibiotic-Loaded Calcium Sulfate Beads

Materials ◽  
2020 ◽  
Vol 13 (15) ◽  
pp. 3258
Author(s):  
Paul Stoodley ◽  
Jacob Brooks ◽  
Casey W. Peters ◽  
Nan Jiang ◽  
Craig P. Delury ◽  
...  
Keyword(s):  
Biofilm Formation ◽  
Calcium Sulfate ◽  
Multidrug Resistant ◽  
Bacterial Cells ◽  
Joint Infections ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Confocal Images ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococci (VRE) have emerged as multidrug-resistant (MDR) pathogens associated with periprosthetic joint infections (PJI). In this study, we evaluated the efficacy of antibiotic-loaded calcium sulfate beads (ALCSB) in inhibiting bacterial growth, encouraging biofilm formation and killing preformed biofilms of CRE and VRE. Three strains of Klebsiella pneumoniae (KP) and a strain of Enterococcus faecalis (EF) were used. ALCSB of 4.8-mm diameter were loaded with vancomycin (V) and gentamicin (G), V and rifampicin (R), V and tobramycin (T) or R and meropenem (M), and placed onto tryptic soy agar (TSA), spread with one of the test strains and incubated for 24 h at 37 °C. Beads were transferred daily onto fresh TSA spread plates and the zone of inhibition (ZOI) was recorded until no inhibition was observed. ALCSB containing R + M or R + V produced the most extensive ZOI up to 5 weeks. Biofilm prevention efficacy was investigated by challenging ALCSB daily with 5 × 105 CFU/mL bacterial cells and analyzing for biofilm formation at challenges 1, 2 and 3. In the biofilm killing experiments, ALCSB were added to pre-grown 3-day biofilms of KP and EF strains, which were then analyzed at days 1 and 3 post-exposure. The CFU counts and confocal images of the attached cells showed that ALCSB treatment reduced colonization and biofilm formation significantly (5–7 logs) with combinations of R + M or R + V, compared to unloaded beads. This study provides evidence that the local release of antibiotics from ALCSB may be useful in treating the biofilms of multidrug-resistant strains of CRE and VRE.

scholarly journals Quantification of Airborne Resistant Organisms With Temporal and Spatial Diversity in Bangladesh: Protocol for a Cross-Sectional Study

10.2196/14574 ◽  
2019 ◽  
Vol 8 (12) ◽  
pp. e14574 ◽  
Author(s):  
Muhammad Asaduzzaman ◽  
Muhammed Iqbal Hossain ◽  
Sumita Rani Saha ◽  
Md Rayhanul Islam ◽  
Niyaz Ahmed ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Air Samples ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Background Antimicrobial resistance is a widespread, alarming issue in global health and a significant contributor to human death and illness, especially in low and middle-income countries like Bangladesh. Despite extensive work conducted in environmental settings, there is a scarcity of knowledge about the presence of resistant organisms in the air. Objective The objective of this protocol is to quantify and characterize the airborne resistomes in Bangladesh, which will be a guide to identify high-risk environments for multidrug-resistant pathogens with their spatiotemporal diversity. Methods This is a cross-sectional study with an environmental, systematic, and grid sampling strategy focused on collecting air samples from different outdoor environments during the dry and wet seasons. The four environmental compartments are the frequent human exposure sites in both urban and rural settings: urban residential areas (n=20), live bird markets (n=20), rural households (n=20), and poultry farms (n=20). We obtained air samples from 80 locations in two seasons by using an active microbial air sampler. From each location, five air samples were collected in different media to yield the total bacterial count of 3rd generation cephalosporin (3GC) resistant Enterobacteriaceae, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci and methicillin-resistant Staphylococcus aureus. Results The study started in January 2018, and the collection of air samples was completed in November 2018. We have received 800 air samples from 80 study locations in both dry and wet seasons. Currently, the laboratory analysis is ongoing, and we expect to receive the preliminary results by October 2019. We will publish the complete result as soon as we clean and analyze the data and draft the manuscript. Conclusions The existence of resistant bacteria in the air like those producing extended-spectrum beta-lactamases, carbapenem-resistant Enterobacteriaceae, vancomycin-resistant Enterococci, and methicillin-resistant Staphylococcus aureus will justify our hypothesis that the outdoor environment (air) in Bangladesh acts as a reservoir for bacteria that carry genes conferring resistance to antibiotics. To our knowledge, this is the first study to explore the presence of superbugs in the air in commonly exposed areas in Bangladesh. International Registered Report Identifier (IRRID) DERR1-10.2196/14574

scholarly journals 563. Association Between Chlorhexidine Gluconate Concentrations and Resistant Bacterial Bioburden on Skin

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S267-S267
Author(s):  
Gita Nadimpalli ◽  
Lyndsay M O’Hara ◽  
Surbhi Leekha ◽  
Lisa Harris ◽  
Natalia Blanco ◽  
...  
Keyword(s):  
Methicillin Resistant Staphylococcus Aureus ◽  
Chlorhexidine Gluconate ◽  
Bacterial Burden ◽  
Positive Correlation ◽  
Carbapenem Resistant ◽  
Significant Difference ◽  
The Mean ◽  
Vancomycin Resistant ◽  
Spearman’S Correlation ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Little research exists to guide optimal Chlorhexidine gluconate (CHG) bathing practices. We examined the association between CHG concentrations and methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), and vancomycin-resistant Enterococcus (VRE) on the skin. Also, we studied whether bioburden is affected by bathing method (2% CHG cloth vs. 4% liquid CHG soap) and time since last CHG bath. Methods Patients with MRSA, CRE and VRE at 4 US hospitals were enrolled. Skin swabs (arm, chest) were collected to quantify bioburden and CHG concentrations. Information on bathing method and time since last CHG bath was collected. χ 2 test, Spearman’s correlation, and linear regression were performed. Results 253 patients were enrolled. On arm skin, MRSA was detected in 17 (19%), CRE on 16 (12%), and VRE on 12 (21%) patients. Detectable CHG levels were observed in 82 (93%) MRSA, 81 (79%) CRE, and 44 (79%) VRE patients. A negative correlation was observed between bioburden and CHG concentration for MRSA (rs = −0.11, P = 0.28) and CRE (rs = −0.02, P = 0.82) while a positive correlation was observed for VRE (rs = 0.15, P = 0.28). On chest skin, MRSA was detected in 25 (28%), CRE on 18 (12%), and VRE on 7 (13%) patients. Detectable CHG levels were observed in 83 (95.4%) MRSA, 78 (72%) CRE, and 43 (77%) VRE patients. MRSA bioburden was negatively correlated with CHG concentration (rs = −0.16, P = 0.12), while a positive correlation was noted for CRE (rs = 0.18, P = 0.06) and VRE (rs =0.24, P = 0.06). There was no significant difference in bacterial bioburden between CHG concentrations (>20 ppm vs. ≤20 ppm) at both skin sites (Table 1). The bioburden did not differ by method of CHG bath. The mean estimates of bacterial bioburden on both skin sites did not show a significant decrease with increase in CHG concentrations and were not affected by time since last bath (Table 2). Conclusion Detection of MRSA, CRE and VRE was infrequent irrespective of CHG bathing method and time since last bath. We found inconsistent associations between increasing CHG concentrations and bacterial bioburden. CHG bathing frequency may be optimized for individual patient populations to augment the reduction of bacteria. Additional research to understand the association of CHG skin concentrations and resistant bacterial burden is required. Disclosures All authors: No reported disclosures.

scholarly journals High Colonization Rate and Heterogeneity of ESBL- and Carbapenemase-Producing Enterobacteriaceae Isolated from Gull Feces in Lisbon, Portugal

2020 ◽  
Vol 8 (10) ◽  
pp. 1487
Author(s):  
Marta Aires-de-Sousa ◽  
Claudine Fournier ◽  
Elizeth Lopes ◽  
Hermínia de Lencastre ◽  
Patrice Nordmann ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bacterial Species ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Multidrug Resistant Bacteria ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant ◽  
Encoding Genes

In order to evaluate whether seagulls living on the Lisbon coastline, Portugal, might be colonized and consequently represent potential spreaders of multidrug-resistant bacteria, a total of 88 gull fecal samples were screened for detection of extended-spectrum β-lactamase (ESBL)- or carbapenemase-producing Enterobacteriaceae for methicillin-resistant Staphylococcus aureus (MRSA) and for vancomycin-resistant Enterococci (VRE). A large proportion of samples yielded carbapenemase- or ESBL-producing Enterobacteriaceae (16% and 55%, respectively), while only two MRSA and two VRE were detected. Mating-out assays followed by PCR and whole-plasmid sequencing allowed to identify carbapenemase and ESBL encoding genes. Among 24 carbapenemase-producing isolates, there were mainly Klebsiella pneumoniae (50%) and Escherichia coli (33%). OXA-181 was the most common carbapenemase identified (54%), followed by OXA-48 (25%) and KPC-2 (17%). Ten different ESBLs were found among 62 ESBL-producing isolates, mainly being CTX-M-type enzymes (87%). Co-occurrence in single samples of multiple ESBL- and carbapenemase producers belonging to different bacterial species was observed in some cases. Seagulls constitute an important source for spreading multidrug-resistant bacteria in the environment and their gut microbiota a formidable microenvironment for transfer of resistance genes within bacterial species.

scholarly journals 737. Novel Glycans Reduce Carbapenem-Resistant Enterobacteriaceae and Vancomycin-Resistant Enterococci Colonization in an Ex Vivo Assay by Supporting Growth and Diversity of Commensal Microbiota at the Expense of MultiDrug-Resistant Organisms (MDRO)

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S330-S330
Author(s):  
Gabby LeBlanc ◽  
Brandon Brooks ◽  
Madeline Hartman ◽  
Maxwell B Hecht ◽  
Hoa Luong ◽  
...  
Keyword(s):  
Critically Ill ◽  
Ex Vivo ◽  
Metagenomic Sequencing ◽  
Clinical Infection ◽  
Commensal Microbiota ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Increased Risk ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Background Infections with Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococci (VRE) can result in a 50% mortality rate in compromised hosts. A major risk factor for clinical infection is intestinal colonization with CRE or VRE. There are currently no FDA-approved compounds to decolonize these organisms from the gastrointestinal tract (gut). Commensal microbes offer protection from pathogen infection; however, in immunocompromised hosts or with antibiotic treatment, the protective properties of the microbial community are compromised, leaving the gut susceptible to pathogen colonization. Higher concentrations of pathogens within the gut correlate with an increased risk of infection with MDROs. Our hypothesis is that reducing colonization of the gut with MDROs would reduce the likelihood of a clinical infection. Methods Kaleido built a platform that emulates the gut environment and allows for high throughput screening of Kaleido’s Microbiome Metabolic Therapies (MMT™) in human gut microbiomes ex vivo. Over 500 compounds were screened for their ability to reduce the levels of CRE and VRE in fecal microbial communities from both healthy subjects and critically ill patients receiving broad-spectrum antibiotics. Results Kaleido’s lead MMTs selectively favor the growth of the commensal microbiota at the expense of pathogens, resulting in a decrease of CRE and VRE from 80% of the initial community to 5% in a single batch culture, as measured by 16S rRNA gene and shotgun metagenomic sequencing. Lead MMTs do not support growth of CRE and VRE strains in culture, nor of other pathogens frequently encountered in critically ill and immunocompromised patients, such as Clostridium difficile and common fungal pathogens. Conclusion These results suggest that intervention with MMTs may reduce CRE and VRE colonization and support further evaluation in patients colonized with CRE or VRE pathogens. Disclosures All authors: No reported disclosures.

scholarly journals Usefulness of surveillance Cultures for Carbapenem-resistant Enterobacteriaceae, Carbapenem-resistant Pseudomonas aeruginosa and Vancomycin-resistant Enterococci in Hematopoietic Stem Cell Transplant Unit

2020 ◽  
Author(s):  
Elisa Teixeira Mendes ◽  
Matias Chiarastelli Salomão ◽  
Lísia Moura Tomichi ◽  
Maura Salaroli Oliveira ◽  
Mariana Graça ◽  
...  
Keyword(s):  
Blood Stream Infection ◽  
Blood Stream ◽  
Cell Transplant ◽  
Surveillance Culture ◽  
Hematopoietic Stem ◽  
Carbapenem Resistant ◽  
Vancomycin Resistant Enterococci ◽  
Surveillance Cultures ◽  
Vancomycin Resistant ◽  
Carbapenem Resistant Enterobacteriaceae

Abstract Surveillance strategies to detect colonization is an important tool to prevent and control the spread of microorganisms especially among Hematopoietic Stem Cell Transplant (HSCT) patients. Colonization by Multidrug-resistant organisms (MDRO) has been evaluated as a risk factor for blood stream infection (BSI) in HSCT patients. The aim of this study was to evaluate the use of routine surveillance culture to screening colonization and infection by carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPa) and vancomycin-resistant enterococci (VRE) in a HSCT unit. Methods Surveillance cultures were collected from patients admitted to the HSCT unit over one-year, with swabs for cultures on admission and then weekly until discharge. We compared surveillance culture positivity for each site and agent, also clinical and epidemiological data according to the colonization status. Results 200 HSCT patients underwent surveillance, with 1.323 samples collected. Infection due to MDRO occurred in 52 (21.5%) patients, among them 45 (86.5%) were blood stream infection (BSI) and 12 (23%) had positive surveillance culture before infection. 554 (41.8%) surveillance cultures were performed for CRPa, 413 (31.2%) for VRE, and 356 (27%) for CRE. Of these, 179 (13.5%) surveillance culture were positive, with greater positivity for oropharynx (6, 35.3%) CRPa, and rectal samples (16, 20.7%) for CRE. Being colonized by any MDRO, CRE (p <0.001) and CRPa (p = 0.027) was associated with a higher risk of infection in the bivariate analysis but being colonized was not associated with risk of death. Conclusion Previous colonization by MDRO was a significant risk factor for infection by these pathogens, mainly colonization by CRE. Overall, rectal swab was the best site with the higher positivity, and the oropharynx was also an option for CRPa investigation. Feces culture showed low positivity and should be avoided. Although the impact of the strategy on the mortality of patients undergoing HSCT is not clear, VRE surveillance should be questioned in auto-HSCT patients as it has an additional cost and little impact on survival.

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