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Michele L Shaffer, Erika M C D'Agata, Daniel Habtemariam, Susan L Mitchell
PURPOSE: Methodological approaches to examine the association between antimicrobial exposure and multidrug-resistant organism (MDRO) acquisition are complex. This report's objectives are to review approaches used in and findings of prior studies in the long-term care setting, illustrate how these challenges were addressed in a recently completed large prospective study, and discuss strategies for future studies. METHODS: Key design and analytic approaches used in studies conducted since 2000 examining the association between antimicrobial exposure and MDRO acquisition in the long-term care setting were reviewed...
September 23, 2016: Annals of Epidemiology
Stefan Erb, Reno Frei, Marc Dangel, Andreas F Widmer
BACKGROUND Infections and colonization with multidrug-resistant organisms (MDROs) identified >48 hours after hospital admission are considered healthcare-acquired according to the definition of the Centers for Disease Control and Prevention (CDC). Some may originate from delayed diagnosis rather than true acquisition in the hospital, potentially diluting the impact of infection control programs. In addition, such infections are not necessarily reimbursed in a healthcare system based on the diagnosis-related groups (DRGs)...
October 17, 2016: Infection Control and Hospital Epidemiology
James A McKinnell, Loren G Miller, Raveena Singh, Ken Kleinman, Ellena M Peterson, Kaye D Evans, Tabitha D Dutciuc, Lauren Heim, Adrijana Gombosev, Marlene Estevez, Bryn Launer, Tom Tjoa, Steven Tam, Michael A Bolaris, Susan S Huang
Nursing home residents are at risk for acquiring and transmitting MDROs. A serial point-prevalence study of 605 residents in 3 facilities using random sampling found MDRO colonization in 45% of residents: methicillin-resistant Staphylococcus aureus (MRSA, 26%); extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL, 17%); vancomycin-resistant Enterococcus spp. (VRE, 16%); carbapenem-resistant Enterobacteriaceae (CRE, 1%). MDRO colonization was associated with history of MDRO, care needs, incontinence, and catheters...
September 27, 2016: Infection Control and Hospital Epidemiology
Cheston B Cunha, Erika M C D'Agata
PURPOSE OF REVIEW: Rates of multidrug-resistant organisms (MDRO), including methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant gram-negative bacteria, continue to rise among the population of chronic hemodialysis. Antimicrobial exposure is the main risk factor for MDRO emergence and dissemination. Up to 30% of antimicrobial doses administered in out-patient dialysis units may not be indicated. Antimicrobial stewardship programs (ASP) improve antimicrobial prescribing patterns...
November 2016: Current Opinion in Nephrology and Hypertension
Alicia M Shams, Laura J Rose, Jonathan R Edwards, Salvatore Cali, Anthony D Harris, Jesse T Jacob, Anna LaFae, Lisa L Pineles, Kerri A Thom, L Clifford McDonald, Matthew J Arduino, Judith A Noble-Wang
OBJECTIVE To determine the typical microbial bioburden (overall bacterial and multidrug-resistant organisms [MDROs]) on high-touch healthcare environmental surfaces after routine or terminal cleaning. DESIGN Prospective 2.5-year microbiological survey of large surface areas (>1,000 cm2). SETTING MDRO contact-precaution rooms from 9 acute-care hospitals and 2 long-term care facilities in 4 states. PARTICIPANTS Samples from 166 rooms (113 routine cleaned and 53 terminal cleaned rooms). METHODS Using a standard sponge-wipe sampling protocol, 2 composite samples were collected from each room; a third sample was collected from each Clostridium difficile room...
September 13, 2016: Infection Control and Hospital Epidemiology
Michael Jung, Ulrike Beilenhoff
BACKGROUND: Since the late 1970s there have been sporadic reports of nosocomial infections linked to endoscopic procedures. Infections by multidrug-resistant organisms (MDRO) have an increasing impact on healthcare systems worldwide. Since 2010 outbreaks involving MDRO have been reported as a result of endoscopic retrograde cholangiopancreatography (ERCP) from the USA, France, Germany and the Netherlands. METHODS: This article evaluates the recent outbreaks and developments and demonstrates a structural approach to how to prevent future infections...
February 2016: Visc Med
Ursel Heudorf, Sabine Albert-Braun, Klaus-Peter Hunfeld, Franz-Ulrich Birne, Jörg Schulze, Klaus Strobel, Knut Petscheleit, Volkhard A J Kempf, Christian Brandt
INTRODUCTION: The refugee crisis is a great challenge to the social and healthcare system in European countries, especially in Germany. An abundance of data has been published on the refugees' health problems (infections as well as physical diseases and psychiatric problems) and their prevention (i.e., sanitary and vaccination programs). However, data on prevalences of multidrug-resistant organisms (MDRO) in refugees are scarce, although it is known that most refugees are from or travelled through countries with high prevalences of MDRO...
2016: GMS Hygiene and Infection Control
Tobias Tenenbaum, Klaus-Peter Becker, Bettina Lange, Anka Martin, Peter Schäfer, Stefan Weichert, Horst Schroten
OBJECTIVE To determine the prevalence of multidrug-resistant organisms (MDROs) colonizing in pediatric refugees admitted to a University Children Hospital in Germany. DESIGN Retrospective observational study. SETTING General pediatric and pediatric surgery units. PATIENTS In Germany, recommendations for MDRO screening of pediatric refugees were recently published. According to these and institutional recommendations, all hospitalized pediatric refugees were screened for MDROs between October 2015 and March 2016...
August 15, 2016: Infection Control and Hospital Epidemiology
Sandra Schneider, Florian Salm, Christin Schröder, Norman Ludwig, Regina Hanke, Petra Gastmeier
BACKGROUND: The network project RAI (Rational Use of Antibiotics via Information and Communication) is aimed at developing tailored information and communication tools on the subject of antibiotic (AB) resistance for various stakeholder groups. During the preparation phase, a survey was performed addressing the German general population. OBJECTIVES: To gain insights into the knowledge, attitudes, and behavior of nonprescribers concerning AB and multidrug-resistant organisms (MDRO)...
September 2016: Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
S Dubler, S Zimmermann, M Fischer, P Schnitzler, T Bruckner, M A Weigand, U Frank, S Hofer, A Heininger
BACKGROUND: In the past, anaesthetic breathing circuits were identified as a source of pathogen transmission. It is still debated, whether breathing circuits combined with breathing system filters can be safely used for more than 1 day. The aim of this study was to evaluate the transmission risk of bacteria and also viruses via breathing circuits after extended use. METHODS: The inner and outer surface of 102 breathing circuits used for 1 day and of 101 circuits used for 7 days were examined for bacteria and viruses...
October 2016: Acta Anaesthesiologica Scandinavica
Anat Schwartz-Neiderman, Tali Braun, Noga Fallach, David Schwartz, Yehuda Carmeli, Vered Schechner
OBJECTIVE Carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) are extremely drug-resistant pathogens. Screening of contacts of newly identified CP-CRE patients is an important step to limit further transmission. We aimed to determine the risk factors for CP-CRE acquisition among patients exposed to a CP-CRE index patient. METHODS A matched case-control study was performed in a tertiary care hospital in Israel. The study population was comprised of patients who underwent rectal screening for CP-CRE following close contact with a newly identified CP-CRE index patient...
October 2016: Infection Control and Hospital Epidemiology
Rafael Araos, Albert K Tai, Graham M Snyder, Martin J Blaser, Erika M C D'Agata
BACKGROUND: The emergence and dissemination of multidrug-resistant organisms (MDROs) is a global threat. Characterizing the human microbiome among hospitalized patients and identifying unique microbial signatures among those patients who acquire MDROs may identify novel infection prevention strategies. METHODS: Adult patients admitted to 5 general medical-surgical floors at a 649-bed, tertiary care center in Boston, Massachusetts, were classified according to in-hospital antimicrobial exposure and MDRO colonization status...
October 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Lindsey M Weiner, Amy K Webb, Maroya S Walters, Margaret A Dudeck, Alexander J Kallen
We examined reported policies for the control of common multidrug-resistant organisms (MDROs) in US healthcare facilities using data from the National Healthcare Safety Network Annual Facility Survey. Policies for the use of Contact Precautions were commonly reported. Chlorhexidine bathing for preventing MDRO transmission was also common among acute care hospitals. Infect Control Hosp Epidemiol 2016:1-4.
September 2016: Infection Control and Hospital Epidemiology
N Esther Babady
Hospital-associated infection (HAI) in immunocompromised patients can result in high rates of morbidity and mortality. Infections caused by multidrug-resistant organisms (MDROs) are especially worrisome because of the limited choice of remaining antibiotics available when a patient becomes colonized or infected with an MDRO. It is therefore important that immunocompromised patients be cared for in an environment that limits the risk for acquiring infections. However, with healthcare being increasingly delivered in settings other than the traditional inpatient hospital wards, a bigger effort will need to be set forth to prevent or rapidly diagnose HAI...
June 2016: Microbiology Spectrum
A Hamprecht, A M Rohde, M Behnke, S Feihl, P Gastmeier, F Gebhardt, W V Kern, J K Knobloch, A Mischnik, B Obermann, C Querbach, S Peter, C Schneider, W Schröder, F Schwab, E Tacconelli, M Wiese-Posselt, T Wille, M Willmann, H Seifert, J Zweigner
OBJECTIVES: The objectives of this study were to prospectively assess the rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) in non-ICU patients on hospital admission and to investigate resistance mechanisms and risk factors for carriage. METHODS: Adult patients were screened for 3GCREB carriage at six German tertiary care hospitals in 2014 using rectal swabs or stool samples. 3GCREB isolates were characterized by phenotypic and molecular methods...
October 2016: Journal of Antimicrobial Chemotherapy
Petra Gastmeier, Klaus-Peter Kämpf, Michael Behnke, Christine Geffers, Frank Schwab
OBJECTIVES: To investigate the effect of universal decolonization with octenidine on the incidence of ICU-acquired bloodstream infections (BSI) and MDR organisms (MDRO). METHODS: A system-wide change in practice was performed in the ICUs of a university hospital with three campuses (eight medical ICUs and nine surgical ICUs). All ICUs had a general admission screening strategy for MRSA with subsequent isolation in the 12 month baseline period, which was stopped...
September 2016: Journal of Antimicrobial Chemotherapy
Joanna R Wares, Barry Lawson, Douglas Shemin, Erika M C D'Agata
Patients receiving chronic hemodialysis (CHD) are among the most vulnerable to infections caused by multidrug-resistant organisms (MDRO), which are associated with high rates of morbidity and mortality. Current guidelines to reduce transmission of MDRO in the out-patient dialysis unit are targeted at patients considered to be high-risk for transmitting these organisms: those with infected skin wounds not contained by a dressing, or those with fecal incontinence or uncontrolled diarrhea. Here, we hypothesize that targeting patients receiving antimicrobial treatment would more effectively reduce transmission and acquisition of MDRO...
2016: PloS One
R Mutters, N T Mutters
The prevention of infections is the purpose of hospital hygiene/infection control using control and preventive measures and strategies to achieve this. Especially in intensive care units with seriously ill patients. The continuous increase of multidrug-resistant organisms (MDRO) and as a consequence difficult to treat infections clearly shows the importance of prevention. Furthermore success and failure of hygienic/infection control activities is one of the few measurable quality and performance characteristics in the era of quality medicine and is therefore crucial for the evaluation of hospitals...
May 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
Sofanne J Ravensbergen, Mariëtte Lokate, Darren Cornish, Eveline Kloeze, Alewijn Ott, Alex W Friedrich, Rob van Hest, Onno W Akkerman, Wiel C de Lange, Tjip S van der Werf, Erik Bathoorn, Ymkje Stienstra
INTRODUCTION: The current refugee crisis emphasizes the need for information on infectious diseases and resistant microorganisms in asylum seekers with possible consequences for public health and infection control. METHODS: We collected data from asylum seekers admitted to our university hospital or who presented at the Emergency Department (n = 273). We collected general and demographic characteristics including country of origin, the reason of presentation, and the screening results of multi-drug resistant organisms...
2016: PloS One
N T Mutters, F Günther, U Frank, A Mischnik
BACKGROUND: Multidrug-resistant organisms (MDROs) are an economic burden, and infection control (IC) measures are cost- and labour-intensive. A two-tier IC management strategy was developed, including active screening, in order to achieve effective use of limited resources. Briefly, high-risk patients were differentiated from other patients, distinguished according to type of MDRO, and IC measures were implemented accordingly. AIM: To evaluate costs and benefits of this IC management strategy...
June 2016: Journal of Hospital Infection
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