Collagen Hydrogels Loaded with Silver Nanoparticles and Cannabis Sativa Oil

Wounds represent a major healthcare problem especially in hospital-associated infections where multi-drug resistant strains are often involved. Nowadays, biomaterials with therapeutic molecules play an active role in wound healing and infection prevention. In this work, the development of collagen hydrogels loaded with silver nanoparticles and Cannabis sativa oil extract is described. The presence of the silver nanoparticles gives interesting feature to the biomaterial such as improved mechanical properties or resistance to collagenase degradation but most important is the long-lasting antimicrobial effect. Cannabis sativa oil, which is known for its anti-inflammatory and analgesic effects, possesses antioxidant activity and successfully improved the biocompatibility and also enhances the antimicrobial activity of the nanocomposite. Altogether, these results suggest that this novel nanocomposite biomaterial is a promising alternative to common treatments of wound infections and wound healing.

Prevalence of Hospital Associated Infections and Health Care Workers Compliance with Hand Hygiene Practices in a Tertiary Hospital in Sokoto, Nigeria

Background: Hospital associated infections (HAIs) remain a significant cause of morbidity and mortality. And despite the simplicity of hand hygiene practice, an important preventive measure that has been proven to reduce the risk of acquiring and transmitting HAIs, Health care workers (HCW) compliance with the recommendations is of serious concern. Aim: The aim of this study was to determine the prevalence of hospital associated infections and HCWs compliance with hand hygiene practice in a tertiary hospital. Methods and material: This was a hospital-based descriptive cross-sectional study among 110 patients on admission selected using universal sampling, and 377 HCWs selected using a multistage sampling technique. Data collected with self-administered questionnaire for HCWs, interviewer-administered proforma for the patients and data extraction sheet for laboratory analysis. Data analyzed for descriptive statistics using SPSS version 20.0. Results: Patients' mean age was 32.8, IQR: 10.5-37.9 years. Majority, 56(50.9%) were females; Hausa/Fulani, 91(82.7%) and 37(33.6%) had only Qur'anic education while only 20(18.2%) had tertiary education. Health care workers' mean age was 31.8 5.3 years. Majority 227(60.2%) are females, and 267(71.8%) of the participants have received training on hospital infection control. Overall prevalence of HAIs was 42.7%, highest in surgical unit. Commonest HAIs being blood stream infections, and the least, Health Care Associated Pneumonia. Most of the infections were due to Staphylococcus aureus, 22(46.8%) and Pseudomonas aeruginosa, 14(29.8%). Highest hand hygiene practice was reported after contact with body fluid and highest non-compliance reported was before touching patient. Hand hygiene compliance rate was 49.6% and main reasons to non-compliance were high work load, lack of running water and soap, and regular use of hand gloves. Conclusions: Prevalence of HAIs was reportedly high, and low hand hygiene compliance and rate despite majority of the HCWs having received training on Hospital infection control. To reduce the prevalence and the associated burden of HAIs, there is need to put in measures to improve compliance to quality hand hygiene practice by health workers.

ddcP, pstB, and excess D-lactate impact synergism between vancomycin and chlorhexidine against Enterococcus faecium 1,231,410

Vancomycin-resistant enterococci (VRE) are important nosocomial pathogens that cause life-threatening infections. To control hospital-associated infections, skin antisepsis and bathing utilizing chlorhexidine is recommended for VRE patients in acute care hospitals. Previously, we reported that exposure to inhibitory chlorhexidine levels induced the expression of vancomycin resistance genes in VanA-type Enterococcus faecium. However, vancomycin susceptibility actually increased for VanA-type E. faecium in the presence of chlorhexidine. Hence, a synergistic effect of the two antimicrobials was observed. In this study, we used multiple approaches to investigate the mechanism of synergism between chlorhexidine and vancomycin in the VanA-type VRE strain E. faecium 1,231,410. We generated clean deletions of 7 of 11 pbp, transpeptidase, and carboxypeptidase genes in this strain (ponA, pbpF, pbpZ, pbpA, ddcP, ldtfm, and vanY). Deletion of ddcP, encoding a membrane-bound carboxypeptidase, altered the synergism phenotype. Furthermore, using in vitro evolution, we isolated a spontaneous synergy escaper mutant and utilized whole genome sequencing to determine that a mutation in pstB, encoding an ATPase of phosphate-specific transporters, also altered synergism. Finally, addition of excess D-lactate, but not D-alanine, enhanced synergism to reduce vancomycin MIC levels. Overall, our work identified factors that alter chlorhexidine and vancomycin synergism in a model VanA-type VRE strain.

The Changing Landscape of Molecular Epidemiology of Staphylococcus Aureus Infections in Children.

Background: Staphylococcus aureus infections cause significant morbidity and mortality in children and adolescents. Aim of this study was to investigate the molecular epidemiology and antibiotic resistance of Staphylococcus aureus clinical isolates from children and adolescents.Methods: All S. aureus isolates recovered from patients aged < 18 years, admitted to a referral hospital, with culture-proven invasive or non-invasive, community-associated or community-onset healthcare-associated or hospital-associated infections during the 4-year period from January 2015 to December 2018 were analyzed for antimicrobial resistance, virulence genes, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).Results: Among 139 S. aureus clinical isolates, 16 (11.5%) were methicillin-resistant (MRSA) and 123 (88.5%) methicillin-susceptible (MSSA). MSSA infections increased significantly over time (2017-2018 vs. 2015-2016, 0R 3.32; 95%CI 1.18-8.96; p 0.03) along with increasing resistance to fusidic acid (OR 2.38; 95%CI 1.14-5.12; p 0.02) and in staphylococcal scalded skin syndrome prevalence (OR 3.24; 95% CI 1.10-8.36; p 0.03). A total of five sequence types (ST) were identified among 58 isolates that were analyzed by MLST. By PFGE typing, 22 pulsotypes were identified, whereas, PFGE type 1 classified as ST121 clone was the predominant (40/58,68.9%). MRSA were distributed into four pulsotypes and PFGE type C- ST80 was the most frequent. ST121 strains carried fnbA (40/40), eta/etb genes (29/40) and lukF/S-PVL genes in 3/40 cases. All ST121 exhibited high resistance percentage to fusidic acid and were increasingly resistant to mupirocin. Conclusion: In our population, a CA-MSSA clone emerged, resistant to fusidic acid and increasingly resistant to mupirocin which belonged to the PFGE type 1, ST121 clone, harbored exfoliative toxins genes and was associated with rising trends of SSSS.

The global dissemination of hospital clones of Enterococcus faecium

Background The hospital-adapted A1 group of Enterococcus faecium remains an organism of significant concern in the context of drug-resistant hospital-associated infections. How this pathogen evolves and disseminates remains poorly understood. Methods A large, globally representative collection of short-read genomic data from the hospital-associated A1 group of Enterococcus faecium was assembled (n = 973). We analysed, using a novel analysis approach, global diversity in terms of both the dynamics of the accessory genome and homologous recombination among conserved genes. Results Two main modes of genomic evolution continue to shape E. faecium: the acquisition and loss of genes, including antimicrobial resistance genes, through mobile genetic elements including plasmids, and homologous recombination of the core genome. These events lead to new clones emerging at the local level, followed by the erosion of signals of clonality through recombination, and in some identifiable cases producing new clonal clusters. These patterns lead to new, emerging lineages which are able to spread globally over relatively short timeframes. Conclusions The ability of A1 E. faecium to continually present new combinations of genes for potential selection suggests that controlling this pathogen will remain challenging but establishing a framework for understanding genomic evolution is likely to aid in tracking the threats posed by newly emerging lineages.

Preventing Hospital Infections

This book provides a detailed, step-by-step description of a model quality improvement intervention for hospitals, pinpointing the obstacles and showing how to surmount them. This second edition has been carefully updated, with new material describing some technical aspects of infection prevention, new tools for use by front-line providers, and results of recent large collaborative infection prevention studies. In easy-to-read, user-friendly language, it explains why clinicians neglect or actively oppose quality changes—from physicians who distrust change, to nurses who want to protect their turf, to infection preventionists who avoid the wards. The book also sheds light on how and why hospitals embark on quality improvements, the role of the hospital’s leadership cadre, the selection and training of the project team, and how to sustain quality gains long term. The intervention framework described in the book focuses on the prevention of hospital-associated infections—in particular, catheter-associated urinary tract infection (CAUTI)—but it is directly applicable to a variety of other hospital issues, such as falls, pressure sores, and Clostridioides difficile infection (CDI). In fact, the book includes a chapter applying this framework to a CDI prevention initiative. In addition, for hospitals having trouble with staff adherence to a quality initiative, we provide three infection-specific questionnaires (for CAUTI, CLABSI, and CDI) to help pinpoint individual problems, and provide a link to a website offering advice tailored to their specific circumstances.

Prevalence and Characterization of Methicillin-Resistant Staphylococcus aureus from Community- and Hospital-Associated Infections: A Tertiary Care Center Study

The community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become increasingly prevalent in both community and hospital settings. The aim of this study was to determine the prevalence, molecular characteristics and antibiotic resistance profiles of CA-MRSA from community- and hospital-associated infections in a tertiary care hospital in Mangalore, India. Of 520 S. aureus isolates, 362 were from inpatients (IP) and 158 were from outpatients (OP). One-hundred and thirty-two MRSA isolates obtained from 94 inpatients and 38 outpatients with complete clinical details were further analyzed. Of these, 81 (61.4%) were CA-MRSA (IP-47.9%, OP-94.7%) and 51 (38.6%) were HA-MRSA (IP-52.1%, OP-5.3%). All (100%) MRSA isolates were mecA gene positive. SCCmec typing identified SCCmec type IV (50.6%) and SCCmec type V (66.7%) in CA-MRSA, while SCCmec type I (41.2%), SCCmec type III (19.6%), SCCmec type IV (31.4%) and SCCmec type V (25.5%) were detected in HA-MRSA isolates. The Panton–Valentine Leukocidin (PVL) gene was found in 70.4% of CA-MRSA, 43.1% of HA-MRSA with SCCmec type IV and SCCmec type V, and in 7.8% of true HA-MRSA. The antibiotic resistance profiles were determined by the disc diffusion method. Resistance to cefoxitin was used to identify MRSA. A significant difference (p < 0.05) was observed between CA-MRSA and HA-MRSA with respect to resistance against cephalexin, cefotaxime, levofloxacin, linezolid and teicoplanin. CA-MRSA was predominantly resistant to ciprofloxacin (86.4%), erythromycin (66.7%), ofloxacin (49.4%), cefotaxime (44.4%), gentamicin (40.7%) and clindamycin (40.7%), while HA-MRSA showed resistance against ciprofloxacin (80.4%), erythromycin (80.1%), cefotaxime (70.6%),ofloxacin (58.8%), clindamycin (47.1%) and levofloxacin (41.2%).This study reports the prevalence of CA-MRSA in community and hospital settings and the possibility of multidrug-resistant CA-MRSA replacing HA-MRSA in hospitals. The observations from our study emphasize the need for urgent measures to manage this emerging crisis in healthcare settings.

The Irish National Adverse Event Study-2 (INAES-2): longitudinal trends in adverse event rates in the Irish healthcare system

ObjectivesTo quantify the prevalence and nature of adverse events in acute Irish hospitals in 2015 and to assess the impact of the National Clinical Programmes and the National Clinical Guidelines on the prevalence of adverse events by comparing these results with the previously published data from 2009.Design and methodsA retrospective chart review of 1605 admissions to eight Irish hospitals in 2015, using identical methods to those used in 2009.ResultsThe percentage of admissions associated with one or more adverse events was unchanged (p=0.48) at 14% (95% CI=10.4% to 18.4%) in 2015 compared with 12.2% (95% CI=9.5% to 15.5%) in 2009. Similarly, the prevalence of preventable adverse events was unchanged (p=0.3) at 7.4% (95% CI=5.3% to 10.5%) in 2015 compared with 9.1% (95% CI=6.9% to 11.9%) in 2009. The incidence densities of preventable adverse events were 5.6 adverse events per 100 admissions (95% CI=3.4 to 8.0) in 2015 and 7.7 adverse events per 100 admissions (95% CI=5.8 to 9.6) in 2009 (p=0.23). However, the percentage of preventable adverse events due to hospital-associated infections decreased to 22.2% (95% CI=15.2% to 31.1%) in 2015 from 33.1% (95% CI=25.6% to 41.6%) in 2009 (p=0.01).ConclusionAdverse event rates remained stable between 2009 and 2015. The percentage of preventable adverse events related to hospital-associated infection decreased, which may represent a positive impact of the related national programmes and guidelines.

Prevalence and Susceptibility Profiles of Methicillin Sensitive Staphylococcus aureus from Community and Hospital Associated Infections

Introduction: Methicillin Sensitive Staphylococcus aureus(MSSA) is a significant human pathogen, involved in both hospital and community associated settings. MSSA, being more susceptible to antibiotics compared to Methicillin Resistant Staphylococcus aureus(MRSA), is found to acquire Multidrug Resistance (MDR) and with the presence of virulence factors can pose difficulty in patient treatment. Aim: To study the prevalence and antibiotic resistance profile of MSSA from community and hospital associated infections. Materials and Methods: The present cross-sectional study was conducted in tertiary care hospital in Mangalore, Karnataka, India from January 2015 to February 2017. Three hundred and five Staphylococcus aureuswere isolated from various clinical specimens and tested for methicillin susceptibility using cefoxitin disc. Antibiotic resistance profiles against 23 antibiotics were determined by disc diffusion method. The difference was compared for antibiotic sensitivity with respect to Community Associated Methicillin Sensitive Staphylococcus aureus (CA-MSSA) and Hospital Associated Methicillin Sensitive Staphylococcus aureus (HA-MSSA) and Chi-square test was used for statistical analysis. Results: Of 305 MSSA isolated, 219 (71.8%) were CA-MSSA and 86 (28.2%) were HA-MSSA. S. aureus was isolated mostly from Skin and Soft Tissue Infections (SSTI, 61.3%). Resistance was observed against ciprofloxacin (64.6%), erythromycin (43.9%), ofloxacin (42.3%), clindamycin (20.7%), ampicillin (100%) and penicillin (90.5%). There was a significant difference (p<0.05) between the resistance of CA-MSSA and HA-MSSA against cefotaxime and co-trimoxazole. Conclusion: The present study showed the increasing prevalence of MSSA in the community and hospital settings with the emergence of MDR which has to be dealt immediately with appropriate control measures.

The review on Epidemiology, Prevention, Control and Surveillance of Nosocomial Infections

Nosocomial infection or hospital associated infections occur to the patients who are admitted inside the hospital. This occurs both in developed and developing countries with a measure of 7% in developed and 10% in developing countries. According to WHO, as this infection occurs after 48 hours of hospital admission so it prolongs the duration of the admission and it increases the economic burden. There is most common aetiology of nosocomial infections are catheter induced infection, surgical sight infections and ventilation associated infections. According to WHO upper respiratory tract infection is the most common nosocomial infections. Nosocomial pathogens are bacteria, Virus and funguses. Patient acquired this infection through hospital environments and people who are surrounded the patients, so in prevention, discontinuation of the transmission chain is very important. Hospital waste is a possible source of contaminants and 20-25% of the sources are dangerous. Nosocomial infections can be managed by a policy for disease prevention, the use of antibiotics and surveillance about antibiotic resistance and the implementation of antibiotic management policies. A good protocol and surveillance system can reduce the Nosocomial infections. This is a detail review of 5 years on epidemiology, prevention, control and surveillance of Nosocomial infections or Hospital associated infections