RESUMO
This study was carried out to evaluate hypotheses generated by fundamental cause theory regarding the socioeconomic status (SES) gradient in colonization with Staphylococcus aureus among Hispanic and non-Hispanic adults living in a border community. Participants (n = 613) recruited in naturally occurring small groups at public and private sites throughout Yuma County, AZ, completed a sociodemographic survey and swabbed their palms, noses, and throats to sample microbial flora. Positive S. aureus colonization among non-Hispanic white participants was nominally higher (39.0%; 95% confidence interval [CI] = 32.4 to 46.1%) than that in Hispanics (31.3%; 95% CI = 26.4 to 36.8%), but there was no education gradient for the sample overall (incidence rate ratio = 1.00; 95% CI = 0.90 to 1.12) or within each ethnic group separately. The education gradient between Hispanic and non-Hispanic whites was statistically equivalent. Results were consistent when home ownership was used as the SES indicator. These data show that S. aureus colonization is not linked to two different SES indicators or Hispanic ethnicity. S. aureus colonization may be considered a less preventable health risk that is outside the influence of SES-based resources.IMPORTANCE Unlike some types of S. aureus infections, S. aureus colonization is not associated with ethnicity or educational attainment and thus may be outside the influence of socioeconomic status-based resources typically mobilized to avoid or mitigate preventable health risks. This assessment of a clinically silent risk that usually precedes infections may illustrate a boundary of fundamental cause theory.
Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Escolaridade , Staphylococcus aureus/fisiologia , Adulto , Arizona/epidemiologia , Estudos Transversais , Etnicidade/estatística & dados numéricos , Feminino , Disparidades nos Níveis de Saúde , Hispânico ou Latino/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/etnologia , Staphylococcus aureus/genética , Inquéritos e Questionários , População Branca/estatística & dados numéricosRESUMO
Teenagers have a higher risk of invasive meningococcal disease (IMD) than the general population. This cross-sectional study aimed to characterise strains of Neisseria meningitidis circulating among Norwegian teenagers and to assess risk factors for meningococcal carriage. Oropharyngeal swabs were collected from secondary-school students in southeastern Norway in 2018-2019. Meningococcal isolates were characterised using whole genome sequencing. Risk factors for meningococcal carriage were assessed from questionnaire data. Samples were obtained from 2296 12-24-year-olds (majority 13-19-year-olds). N. meningitidis was identified in 167 (7.3%) individuals. The highest carriage rate was found among 18-year-olds (16.4%). Most carriage isolates were capsule null (40.1%) or genogroup Y (33.5%). Clonal complexes cc23 (35.9%) and cc198 (32.3%) dominated and 38.9% of carriage strains were similar to invasive strains currently causing IMD in Norway. Use of Swedish snus (smokeless tobacco) (OR 1.56, 95% CI 1.07-2.27), kissing >two persons/month (OR 2.76, 95% CI 1.49-5.10) and partying >10 times/3months (OR 3.50, 95% CI 1.45-8.48) were associated with carriage, while age, cigarette smoking, sharing of drinking bottles and meningococcal vaccination were not. The high meningococcal carriage rate among 18-year-olds is probably due to risk-related behaviour. Use of Swedish snus is possibly a new risk factor for meningococcal carriage. Almost 40% of circulating carriage strains have invasive potential.
Assuntos
Portador Sadio/epidemiologia , Infecções Meningocócicas/epidemiologia , Neisseria meningitidis/isolamento & purificação , Adolescente , Portador Sadio/microbiologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Infecções Meningocócicas/microbiologia , Neisseria meningitidis/genética , Noruega/epidemiologia , Filogenia , Fatores de Risco , Adulto JovemRESUMO
BACKGROUND: Despite the well-documented associations between poor maternal oral health and increased risk for adverse birth outcomes and dental caries in children after birth, prenatal oral health care is under-utilized, especially among the underserved population. In addition, oral Candida has recently been suggested as a potential culprit for children's dental caries, with evident maternal contributions. Therefore, this study aimed to obtain epidemiological data on the oral health and oral Candida carriage in a cohort of underserved US pregnant women, and reveal factors associated with their oral Candida carriage. METHODS: Demographic-medical-oral hygiene practice data were collected. Comprehensive oral examination was conducted. Caries status and plaque index were recorded. Oral samples (saliva, plaque and swab) were processed to identify Candida species and Streptococcus mutans by culturing-dependent and -independent methods. Multiple logistic regression analyses were used to identify factors associated with oral Candida carriage and caries severity. RESULTS: Eighty-two socioeconomically disadvantaged women (48 pregnant and 34 non-pregnant) were enrolled. More pregnant women (79.1%) had > = 1 untreated decayed tooth when compared to their non-pregnant counterparts (47.1%) (p = 0.01). The average number of decayed teeth in pregnant and non-pregnant women was 3.9 and 3.1 (p > 0.05). Caries severity was positively associated with race (African American vs. white), plaque index and salivary Candida albicans level. C. albicans was the most predominant/abundant Candida strain, with cheek and tonsil as the most common colonized sites. The detection of C. albicans was 56%/56% in saliva and 40%/47% in plaque of the pregnant and non-pregnant groups, respectively. Study women's oral Candida carriage is positively associated with hypertension [p = 0.03, odds ratio = 14.47(1.28, 163.51)], decayed teeth number [p = 0.04, odds ratio = 1.31 (1.01,1.69)] and salivary S. mutans level [p = 0.03, odds ratio = 4.80 (1.18-19.43)]. CONCLUSIONS: Socioeconomically disadvantaged US women are in need of improved prenatal oral health, a large proportion of them have untreated decayed teeth and high carriage of oral Candida. Due to the observed significant association between the decayed teeth number and oral Candida carriage, providing oral health care during pregnancy (including limiting decayed teeth) will not only improve women's oral health, but also present as a promising approach to reduce oral Candida carriage in women.
Assuntos
Candida/isolamento & purificação , Portador Sadio/epidemiologia , Boca/microbiologia , Saúde Bucal/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Candida albicans/isolamento & purificação , Candidíase Bucal/epidemiologia , Portador Sadio/microbiologia , Estudos de Casos e Controles , Cárie Dentária/microbiologia , Feminino , Humanos , Modelos Logísticos , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Fatores de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Vagina/microbiologia , Adulto JovemRESUMO
BACKGROUND: An intervention that successfully reduced colonization and infection with carbapenemase-producing Enterobacteriaceae (CPE) in Chicago-area long-term acute-care hospitals included active surveillance and contact precautions. However, the specific effects of contact precautions applied to surveillance-detected carriers on patient-to-patient transmission are unknown, as other, concurrent intervention components or changes in facility patient dynamics also could have affected the observed outcomes. METHODS: Using previously published data from before and after the CPE intervention, we designed a mathematical model with an explicit representation of postintervention surveillance. We estimated preintervention to postintervention changes of 3 parameters: ß, the baseline transmission rate excluding contact precaution effects; δb, the rate of a CPE carrier progressing to bacteremia; and δc, the progression rate to nonbacteremia clinical detection. RESULTS: Assuming that CPE carriers under contact precautions transmit carriage to other patients at half the rate of undetected carriers, the model produced no convincing evidence for a postintervention change in the baseline transmission rate ß (+2.1% [95% confidence interval {CI}, -18% to +28%]). The model did find evidence of a postintervention decrease for δb (-41% [95% CI, -60% to -18%]), but not for δc (-7% [95% CI, -28% to +19%]). CONCLUSIONS: Our results suggest that contact precautions for surveillance-detected CPE carriers could potentially explain the observed decrease in colonization by itself, even under conservative assumptions for the effectiveness of those precautions for reducing cross-transmission. Other intervention components such as daily chlorhexidine gluconate bathing of all patients and hand-hygiene education and adherence monitoring may have contributed primarily to reducing rates of colonized patients progressing to bacteremia.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Portador Sadio/microbiologia , Infecção Hospitalar/prevenção & controle , Infecções por Enterobacteriaceae/prevenção & controle , Hospitais/estatística & dados numéricos , Controle de Infecções/métodos , Doença Aguda , Bacteriemia/prevenção & controle , Proteínas de Bactérias , Chicago/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/transmissão , Humanos , Assistência de Longa Duração , Modelos Teóricos , beta-LactamasesRESUMO
In 2012, the Dutch Working Party for Infection Control (WIP) issued the first Guideline for prevention of transmission of highly-resistant micro-organisms (HRMO) in Hospitals. The next step was to focus on long-term care facilities (LTCFs) both for nursing homes as for small-scale living facilities with nursing home care. These facilities providing care for residents with functional disabilities, chronical illnesses and cognitive disorders, such as dementia. The objective was to adapt the Guideline for prevention of transmission of HRMO in hospitals to LTCFs with a strong accent on living conditions and social interactions. Residents of LTCFs may be carriers of HRMO over a long period of time and most of the residents of the LTCF stay for extended periods of time. To respect individual living circumstances and to prevent unnecessary limitations in the social life of the residents due to the use of isolation measures, the WIP has chosen to describe infection control precautions per individual micro-organism instead of a 'one size fits all' method. The term "isolation" was therefore replaced by the term "additional" precautions. This guideline describes the screening policies for residents in LTCFs, definition and detection of HRMO carriage, standard and additional infection control precautions for HRMO positive residents, documentation and communication of HRMO carriage and discontinuation of additional infection control precautions. It also describes contact tracing of HRMO, environmental control/investigation, surveillance of HRMO and what is important when there is an outbreak.
Assuntos
Portador Sadio/diagnóstico , Infecção Hospitalar/prevenção & controle , Farmacorresistência Bacteriana , Controle de Infecções/normas , Bactérias/classificação , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Portador Sadio/microbiologia , Infecção Hospitalar/transmissão , Medicina Baseada em Evidências , Política de Saúde , Humanos , Controle de Infecções/métodos , Assistência de Longa Duração , Países Baixos/epidemiologia , Casas de Saúde , Transferência de Pacientes , Guias de Prática Clínica como AssuntoRESUMO
BACKGROUND: The rise of methicillin-resistant Staphylococcus aureus (MRSA) is a global health concern. Paucity of data on MRSA carriage prevalence and diagnostic methods in resource-limited settings hampers efforts to define the problem and plan an appropriate response. Additionally, high variability in cost and logistical characteristics of MRSA screening methods may impede infection control efforts. We compared the performance of locally-available chromogenic agar BD CHROMagar MRSA II and two PCR-based assays (Hain GenoQuick MRSA and Cepheid Xpert SA Complete) for the detection of asymptomatic MRSA carriage in nasal swabs. RESULTS: During 2015, we enrolled 500 patients from five hospital wards at a Ugandan regional referral hospital. We found 30% prevalence of methicillin-sensitive Staphylococcus aureus (MSSA) nasal carriage, and 5.4% MRSA nasal carriage prevalence. Compared to a composite reference standard defined as a positive test result on any one of the three assays, Hain GenoQuick MRSA demonstrated the highest sensitivity (96%) followed by direct plating on CHROMagar at (70%), with the lowest sensitivity observed with Xpert SA Complete (52%). Cepheid Xpert provided the most rapid results (< 1 h) but was the most expensive (US $45-50/test). Substantially more labor was required for the Hain GenoQuick MRSA compared to Xpert SA Complete or CHROMagar tests. CONCLUSION: MRSA nasal carriage prevalence rates were low, and high diagnostic sensitivity was achieved using Hain GenoQuick MRSA. Chromogenic media had significantly lower sensitivity, but may represent a viable local option given its lower cost compared to PCR-based assays.
Assuntos
Contagem de Colônia Microbiana/métodos , Testes Diagnósticos de Rotina/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Reação em Cadeia da Polimerase/métodos , Infecções Estafilocócicas/diagnóstico , Adulto , Portador Sadio/diagnóstico , Portador Sadio/microbiologia , Estudos Transversais , Feminino , Humanos , Masculino , Staphylococcus aureus Resistente à Meticilina/genética , Staphylococcus aureus Resistente à Meticilina/crescimento & desenvolvimento , Cavidade Nasal/microbiologia , Infecções Estafilocócicas/microbiologiaRESUMO
Multi-drug-resistant Gram-negative bacteria are of major clinical concern. The increasing prevalence of carbapenemase-producing Enterobacteriaceae (CPE), resistant to all beta-lactams including carbapenems and able to colonize the large intestine, represents a key threat. Rapid, accurate detection of intestinal CPE colonization is critical to minimize transmission, and hence reduce costly, difficult-to-treat CPE infections. There is currently no 'gold standard' CPE detection method. A survey of diagnostic laboratories in England found considerable heterogeneity in diagnostic CPE testing methods and procedures.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Portador Sadio/diagnóstico , Testes Diagnósticos de Rotina/métodos , Infecções por Enterobacteriaceae/diagnóstico , Monitoramento Epidemiológico , Pesquisa sobre Serviços de Saúde , Programas de Rastreamento/métodos , Portador Sadio/microbiologia , Inglaterra , Infecções por Enterobacteriaceae/microbiologia , Política de Saúde , Hospitais , Humanos , Política OrganizacionalRESUMO
BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important opportunistic pathogens in HIV+ patients, resulting in considerable morbidity and mortality. METHODS: The MEDLINE, Scopus, Web of Science, and EMBASE databases were comprehensively searched for studies that investigated the prevalence of MRSA colonization in HIV+ patients. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CI) and analyzed data based on World Health Organization regions. RESULTS: Among 9,772 records identified, 69 were included in the meta-analysis, comprising 30,050 HIV+ patients from 21 countries. We estimated the pooled worldwide prevalence of MRSA in people living with HIV to be 7% (95% CI 5%-9%, 1,623/30,050), with the highest prevalence in Southeast Asia (16%, 95% CI 9%-24%) and the region of the Americas (10%; 95% CI 7%-13%) and lowest prevalence in the European region (1%; 95% CI 0%-1%). Globally, we estimated approximately 2,659,000 (95% CI 1,835,000-3,303,000) HIV+ patients with colonized MRSA. Potential risk factors for MRSA colonization in HIV+ patients included previous MRSA infection (OR, 7.5; 95% CI, 3.91-14.37), hospitalization in the past year (OR, 1.87; 95% CI 1.11-3.16), and use of antibiotics (OR, 2.52; 95% CI 1.39-4.58). CONCLUSIONS: Our findings emphasize the importance of routine screening for MRSA among all HIV+ patients throughout the world, especially in regions that have a high burden of disease.
Assuntos
Portador Sadio/epidemiologia , Infecções por HIV/complicações , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Portador Sadio/microbiologia , Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Feminino , Saúde Global , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Infecções Estafilocócicas/microbiologia , Adulto JovemRESUMO
Report from the 28th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID 2018), Madrid, Spain, 21-24 April 2018 Gram-negative bacteria such as Klebsiella, Acinetobacter and Pseudomonas cause some of the most serious infections and are increasingly resistant to multiple drugs and in some cases, to all available antibiotics. Management of infections caused by these organisms is a global challenge that has serious implications for every hospital and department and therefore every delegate attending ECCMID 2018.
Assuntos
Gestão de Antimicrobianos , Portador Sadio/tratamento farmacológico , Desenvolvimento de Medicamentos , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Animais , Gestão de Antimicrobianos/economia , Compostos Azabicíclicos/uso terapêutico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Ceftazidima/uso terapêutico , Cefalosporinas/uso terapêutico , Combinação de Medicamentos , Desenvolvimento de Medicamentos/economia , Quimioterapia Combinada , Bactérias Gram-Negativas/patogenicidade , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Humanos , Tazobactam/uso terapêuticoRESUMO
Although catch-up campaigns (CCs) at the introduction of pneumococcal conjugate vaccines (PCVs) may accelerate their impact, supply constraints may limit their benefit if the need for additional PCV doses results in introduction delay. We studied the impact of PCV13 introduction with and without CC in Nha Trang, Vietnam - a country that has not yet introduced PCV - through a dynamic transmission model. We modelled the impact on carriage and invasive pneumococcal disease (IPD) of routine vaccination (RV) only and that of RV with CCs targeting <1y olds (CC1), <2y olds (CC2) and <5y olds (CC5). The model was fitted to nasopharyngeal carriage data, and post-PCV predictions were based on best estimates of parameters governing post-PCV dynamics. With RV only, elimination in carriage of vaccine-type (VT) serotypes is predicted to occur across all age groups within 10 years after introduction, with near-complete replacement by non-VT. Most of the benefit of CCs is predicted to occur within the first 3 years with the highest impact at one year, when IPD incidence is predicted to be 11% (95%CrI 9 - 14%) lower than RV with CC1, 25% (21 - 30 %) lower with CC2 and 38% (32 - 46%) lower with CC5. However, CCs would only prevent more cases of IPD insofar as such campaigns do not delay introduction by more than about 6, 12 and 18 months for CC1, CC2 and CC5. Those findings are important to help guide vaccine introduction in countries that have not yet introduced PCV, particularly in Asia.
Assuntos
Portador Sadio/epidemiologia , Modelos Biológicos , Infecções Pneumocócicas/prevenção & controle , Vacinas Pneumocócicas/administração & dosagem , Streptococcus pneumoniae/isolamento & purificação , Adolescente , Adulto , Portador Sadio/microbiologia , Portador Sadio/terapia , Portador Sadio/transmissão , Criança , Pré-Escolar , Humanos , Incidência , Lactente , Recém-Nascido , Cadeias de Markov , Vacinação em Massa/métodos , Nasofaringe/microbiologia , Infecções Pneumocócicas/epidemiologia , Infecções Pneumocócicas/microbiologia , Infecções Pneumocócicas/transmissão , Prevalência , Sorogrupo , Streptococcus pneumoniae/genética , Resultado do Tratamento , Vacinas Conjugadas/administração & dosagem , Vietnã/epidemiologia , Adulto JovemRESUMO
Streptococcus pneumoniae is an important cause of infection and commonly colonizes the nasopharynx of young children, along with other potentially pathogenic bacteria. The objectives of this study were to estimate the carriage prevalence of S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, and Staphylococcus aureus in young children in Indonesia, and to examine interactions between these bacterial species. 302 healthy children aged 12-24 months were enrolled in community health centers in the Bandung, Central Lombok, and Padang regions. Nasopharyngeal swabs were collected and stored according to World Health Organization recommendations, and bacterial species detected by qPCR. Pneumococcal serotyping was conducted by microarray and latex agglutination/Quellung. Overall carriage prevalence was 49.5% for S. pneumoniae, 27.5% for H. influenzae, 42.7% for M. catarrhalis, and 7.3% for S. aureus. Prevalence of M. catarrhalis and S. pneumoniae, as well as pneumococcal serotype distribution, varied by region. Positive associations were observed for S. pneumoniae and M. catarrhalis (OR 3.07 [95%CI 1.91-4.94]), and H. influenzae and M. catarrhalis (OR 2.34 [95%CI 1.40-3.91]), and a negative association was found between M. catarrhalis and S. aureus (OR 0.06 [95%CI 0.01-0.43]). Densities of S. pneumoniae, H. influenzae, and M. catarrhalis were positively correlated when two of these species were present. Prior to pneumococcal vaccine introduction, pneumococcal carriage prevalence and serotype distribution varies among children living in different regions of Indonesia. Positive associations in both carriage and density identified among S. pneumoniae, H. influenzae, and M. catarrhalis suggest a synergistic relationship among these species with potential clinical implications.
Assuntos
Portador Sadio/epidemiologia , Haemophilus influenzae/isolamento & purificação , Moraxella catarrhalis/isolamento & purificação , Staphylococcus aureus/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Técnicas de Tipagem Bacteriana , Portador Sadio/microbiologia , Serviços de Saúde da Criança , Pré-Escolar , Estudos Transversais , Feminino , Geografia , Infecções por Haemophilus/epidemiologia , Humanos , Indonésia/epidemiologia , Lactente , Látex , Masculino , Infecções por Moraxellaceae/epidemiologia , Nasofaringe/microbiologia , Razão de Chances , Análise de Sequência com Séries de Oligonucleotídeos , Infecções Pneumocócicas/epidemiologia , Reação em Cadeia da Polimerase , Sorotipagem , Infecções Estafilocócicas/epidemiologiaRESUMO
BACKGROUND Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-E) are emerging worldwide. Contact precautions are recommended for known ESBL-E carriers to control the spread of ESBL-E within hospitals. OBJECTIVE This study quantified the acquisition of ESBL-E rectal carriage among patients in Dutch hospitals, given the application of contact precautions. METHODS Data were used from 2 cluster-randomized studies on isolation strategies for ESBL-E: (1) the SoM study, performed in 14 Dutch hospitals from 2011 through 2014 and (2) the R-GNOSIS study, for which data were limited to those collected in a Dutch hospital in 2014. Perianal cultures were obtained, either during ward-based prevalence surveys (SoM), or at admission and twice weekly thereafter (R-GNOSIS). In both studies, contact precautions were applied to all known ESBL-E carriers. Estimates for acquisition of ESBL-E were based on the results of admission and discharge cultures from patients hospitalized for more than 2 days (both studies) and a Markov chain Monte Carlo (MCMC) model, applied to all patients hospitalized (R-GNOSIS). RESULTS The absolute risk of acquisition of ESBL-E rectal carriage ranged from 2.4% to 2.9% with an ESBL-E acquisition rate of 2.8 to 3.8 acquisitions per 1,000 patient days. In addition, 28% of acquisitions were attributable to patient-dependent transmission, and the per-admission reproduction number was 0.06. CONCLUSIONS The low ESBL-E acquisition rate in this study demonstrates that it is possible to control the nosocomial transmission of ESBL in a low-endemic, non-ICU setting where Escherichia coli is the most prevalent ESBL-E and standard and contact precautions are applied for known ESBL-E carriers. TRIAL REGISTRATION Nederlands Trialregister, NTR2799, http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2799; ISRCTN Registry, ISRCTN57648070, http://www.isrctn.com/ISRCTN57648070 Infect Control Hosp Epidemiol 2018;39:32-39.
Assuntos
Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecções por Enterobacteriaceae/epidemiologia , Infecção Hospitalar/prevenção & controle , Enterobacteriaceae , Infecções por Enterobacteriaceae/prevenção & controle , Fezes/microbiologia , Hospitais , Humanos , Controle de Infecções/métodos , Cadeias de Markov , Estudos Multicêntricos como Assunto , Países Baixos/epidemiologia , Prevalência , Ensaios Clínicos Controlados Aleatórios como Assunto , beta-LactamasesRESUMO
OBJECTIVES: We aimed to assess the asymptomatic Clostridium difficile carriage rates following fecal microbiota transplantation (FMT). METHODS: All patients who underwent FMT for recurrent Clostridium difficile infection (CDI) via colonoscopy or sigmoidoscopy between June 2013 and April 2015 and had a minimum of 8-week follow-up post FMT at two tertiary care referral centres were included in the study. Patients were prospectively followed both clinically and with stool assessments for 8 weeks post FMT. Assessments occurred at 1 week and 4 weeks post FMT to assess for failure. Failure was defined as presence of diarrhoeal symptoms and a positive CDI stool test by polymerase chain reaction for toxin gene (PCR) at any time point during the 8-week follow-up period. CDI stool testing using PCR was performed at weeks 1 and 4 post FMT in asymptomatic patients as well. RESULTS: 167 patients were included. Twenty-eight patients (16.7% (28/167)) were FMT failures throughout the 8-week period. At week 1, seven patients had already failed the FMT. Of the remaining 160 patients, 144 were asymptomatic, and among these, 141 were negative for C. difficile toxin gene by PCR. This resulted in an asymptomatic carriage rate of 2.1% (3/144). At week 4, 143 patients had not yet failed FMT. Of these patients 129 patients were asymptomatic and among those, 125 were negative by PCR, resulting in an asymptomatic carriage rate of 3% (3/129). CONCLUSIONS: Asymptomatic carriage after FMT is rare. This suggests that testing for cure after FMT in asymptomatic patients is not necessary.
Assuntos
Portador Sadio/microbiologia , Clostridioides difficile/isolamento & purificação , Infecções por Clostridium/microbiologia , Infecções por Clostridium/terapia , Transplante de Microbiota Fecal/estatística & dados numéricos , Fezes/microbiologia , Colonoscopia , DNA Bacteriano/genética , Genes Bacterianos/genética , Humanos , Indiana , Massachusetts , Reação em Cadeia da Polimerase , Estudos Prospectivos , Recidiva , Centros de Atenção Terciária , Resultado do TratamentoRESUMO
Since 2006, Israel has been confronting an outbreak of carbapenem-resistant Enterobacteriaceae (CRE), and in 2007 Israel implemented a national strategy to contain spread. The intervention was initially directed toward acute-care hospitals and later expanded to include an established reservoir of carriage in long-term-care hospitals. It included regular reporting of CRE cases to a central registry and daily oversight of management of the outbreak at the institutional level. Microbiological methodologies were standardized in clinical laboratories nationwide. Uniform requirements for carrier screening and isolation were established, and a protocol for discontinuation of carrier status was formulated. In response to the evolving epidemiology of CRE in Israel and the continued need for uniform guidelines for carrier detection and isolation, the Ministry of Health in 2016 issued a regulatory circular updating the requirements for CRE screening, laboratory diagnosis, molecular characterization, and carrier isolation, as well as reporting and discontinuation of isolation in healthcare institutions nationwide. The principal elements of the circular are contained herein. Infect Control Hosp Epidemiol 2018;39:85-89.
Assuntos
Enterobacteriáceas Resistentes a Carbapenêmicos , Infecção Hospitalar , Infecções por Enterobacteriaceae , Guias como Assunto , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Carbapenêmicos/uso terapêutico , Portador Sadio/microbiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Surtos de Doenças/prevenção & controle , Infecções por Enterobacteriaceae/diagnóstico , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Infecções por Enterobacteriaceae/prevenção & controle , Política de Saúde , Hospitais , Humanos , Israel/epidemiologia , Notificação de Abuso , Isolamento de Pacientes , Administração em Saúde Pública , Sistema de Registros , Fatores de RiscoRESUMO
OBJECTIVE: To compare two methods for Streptococcus mutans detection and quantification in the human oral cavity: a chairside commercial test and a molecular-based real-time quantitative polymerase chain reaction (qPCR) method. METHODS: A total of 688 whole saliva samples were collected from 344 children aged 3 and 5 and their biological mothers. Caries status was examined using a World Health Organisation survey method. S. mutans levels were measured using the Dentocult SM Strip mutans test and scored as colony forming units per millilitre of saliva. Meanwhile, bacterial genomic DNA was extracted from the saliva, qPCR was performed with S. mutans species-specific primers, and absolute S. mutans DNA concentrations were obtained and scored as micrograms of DNA per millilitre of saliva. The two methods were compared for sensitivity, specificity, agreement and correlation with caries status. RESULTS: Significantly more participants tested positive for S. mutans by qPCR than in the chairside SM Strip test (82.4% vs 71.4%). When only the highest and lowest test scores were considered, the agreement between the two methods assessing S. mutans colonisation was 0.956. Children with high levels of S. mutans in their saliva were six to eight times more likely to develop dental caries at 5 years old. CONCLUSION: The study provides new evidence supporting the use of the chairside SM Strip test or the qPCR assay for the detection and quantification of S. mutans colonisation in saliva as the analytical approach of choice for caries risk assessment in clinical and epidemiological studies.
Assuntos
Portador Sadio/diagnóstico , DNA Bacteriano/análise , Saliva/química , Infecções Estreptocócicas/diagnóstico , Streptococcus mutans/genética , Adulto , Portador Sadio/microbiologia , Pré-Escolar , Contagem de Colônia Microbiana , Feminino , Humanos , Masculino , Mães , Reação em Cadeia da Polimerase em Tempo Real , Saliva/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus mutans/isolamento & purificaçãoAssuntos
Antibacterianos/farmacologia , Portador Sadio/microbiologia , Farmacorresistência Bacteriana , Lipoglicopeptídeos/farmacologia , Mucosa Nasal/microbiologia , Infecções Cutâneas Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Administração Intravenosa , Antibacterianos/administração & dosagem , Método Duplo-Cego , Humanos , Lipoglicopeptídeos/administração & dosagem , Testes de Sensibilidade Microbiana , Staphylococcus aureus/isolamento & purificaçãoRESUMO
PURPOSE: Recent study showed that patients with acromegaly have typical skin findings including increased sebum secretion, decreased transepidermal water loss, more alkaline, and colder skin surface correlated with serum growth hormone and insulin-like growth factor 1 levels. Different anatomic localizations and texture of the skin differ in bacterial concentrations.Nasal carriage of Staphylococcus aureus and axillar flora in patients with acromegaly was compared with normal population with regard to duration of acromegaly as well as the growth hormone and insulin-like growth factor 1 levels. METHODS: This patient-control prospective study was conducted in university hospitals in Mersin, Turkey. The study consisted of 30 active acromegalic patients and 60 healthy adults who had no previously diagnosed chronic illness as a control group. A total of 90 volunteers were enrolled in this study; nasal and axillar cultures were obtained. Axillar and nasal specimens from anterior nares of the individuals were taken using sterile swabs. RESULTS: Nasal colonization of Staphylococcus aureus was 13.3% in acromegalic patients, but 43.4% in control group. This difference was statistically significant (Pâ=â0.004). Patients and control group compared according to axillar cultures, the authors determined proteus colonization 16.7% in patients with acromegaly but no proteus colonization in control group. This result was statistically significant (Pâ=â0.001). Proteus colonization was negatively correlated only with disease duration in acromegalic patients (Pâ=â0.017). CONCLUSION: The authors demonstrated that compared with healthy subjects, acromegalic patients had low percentage of nasal carriage of Staphylococcus aureus and more gram-negative basili in the axillar flora. These nasal and axillar flora changes should be considered for prophylactic antibiotics use before surgery and ampiric antibiotics use after surgery.
Assuntos
Acromegalia , Axila/microbiologia , Bactérias Gram-Negativas/isolamento & purificação , Hormônio do Crescimento/análise , Fator de Crescimento Insulin-Like I/análise , Cavidade Nasal/microbiologia , Staphylococcus aureus/isolamento & purificação , Acromegalia/sangue , Acromegalia/epidemiologia , Acromegalia/microbiologia , Adulto , Portador Sadio/diagnóstico , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Turquia/epidemiologiaRESUMO
BACKGROUND: To mitigate methicillin-resistant Staphylococcus aureus (MRSA) infections, intensive care units (ICUs) conduct surveillance through screening patients upon admission followed by adhering to isolation precautions. Two surveillance approaches commonly implemented are universal preemptive isolation and targeted isolation of only MRSA-positive patients. METHODS: Decision analysis was used to calculate the total cost of universal preemptive isolation and targeted isolation. The screening test used as part of the surveillance practice was varied to identify which screening test minimized inappropriate and total costs. A probabilistic sensitivity analysis was conducted to evaluate the range of total costs resulting from variation in inputs. RESULTS: The total cost of the universal preemptive isolation surveillance practice was minimized when a polymerase chain reaction screening test was used ($82.51 per patient). Costs were $207.60 more per patient when a conventional culture was used due to the longer turnaround time and thus higher isolation costs. The total cost of the targeted isolation surveillance practice was minimized when chromogenic agar 24-hour testing was used ($8.54 per patient). Costs were $22.41 more per patient when polymerase chain reaction was used. CONCLUSIONS: For ICUs that preemptively isolate all patients, the use of a polymerase chain reaction screening test is recommended because it can minimize total costs by reducing inappropriate isolation costs. For ICUs that only isolate MRSA-positive patients, the use of chromogenic agar 24-hour testing is recommended to minimize total costs.
Assuntos
Portador Sadio/diagnóstico , Custos e Análise de Custo , Unidades de Terapia Intensiva , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Técnicas Bacteriológicas/economia , Técnicas Bacteriológicas/métodos , Portador Sadio/microbiologia , Monitoramento Epidemiológico , Humanos , Controle de Infecções/métodos , Isolamento de Pacientes/métodos , Infecções Estafilocócicas/microbiologiaRESUMO
The purpose of this study was to assess the cost-effectiveness of screening all hospital inpatients for carbapenemase-producing Enterobacteriaceae (CPE) at the time of hospital admission, compared to not screening, from a US hospital perspective. We used a linked transmission/Markov model to compare outcomes for a typical hospitalized medical patient, from a community with a colonization prevalence of 0.05%. Outcomes were number of colonized patients, CPE-related clinical infections and deaths, expected quality-adjusted life years (QALYs), cost, and the incremental cost-effectiveness ratio (ICER). Sensitivity analyses were performed to assess the effect of parameter uncertainty, using a willingness-to-pay threshold of $100,000 per QALY gained. Screening prevented six CPE colonization cases per 1000 patients (1/1000 colonized with screening, 7/1000 without screening), over half of all symptomatic CPE infections (2/10,000 symptomatic with screening, 5/10,000 symptomatic without screening), and nearly half of all CPE-related deaths (8/100,000 deaths with screening, 15/100,000 deaths without screening). Screening accrued 0.0009 additional QALYs and cost an additional $24.68, compared to not screening, and was cost-effective (ICER $26,283 per QALY gained). Our results were sensitive to uncertainty in prevalence and the number of secondary colonizations per colonized patient. Screening was not cost-effective at a prevalence below 0.015% or if transmission to fewer than 0.9 new patients occurred for each colonized patient. At prevalence levels above 0.3%, screening was cost-saving compared to not screening. Screening inpatients for CPE carriage is likely cost-effective, and may be cost-saving, depending on the local prevalence of carriage.
Assuntos
Técnicas Bacteriológicas/economia , Técnicas Bacteriológicas/estatística & dados numéricos , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Portador Sadio/diagnóstico , Análise Custo-Benefício , Testes Diagnósticos de Rotina/economia , Testes Diagnósticos de Rotina/estatística & dados numéricos , Infecções por Enterobacteriaceae/diagnóstico , Programas de Rastreamento/economia , Programas de Rastreamento/estatística & dados numéricos , Técnicas Bacteriológicas/métodos , Portador Sadio/microbiologia , Testes Diagnósticos de Rotina/métodos , Infecções por Enterobacteriaceae/microbiologia , Hospitais , Humanos , Pacientes Internados , Programas de Rastreamento/métodosRESUMO
INTRODUCTION: A variable percentage of samples analysed using the Cobas 4800 assay can give an invalid result by PCR inhibition or erroneous due to incorrect DNA extraction with the Cobas 4800 CT/NG test. METHOD: An analysis was performed using the vortex agitation and dilution protocol on the original sample (swab or urine) for a total of 116 samples. In order to analyse the sensitivity of this method, 100 samples (swabs and urine) with known results were retested. RESULTS: A total of 98.3% (114/116) of the samples analysed were resolved with this protocol with 100% agreement after reviewing clinical data, Gram stain, and other samples analysed in parallel from the same patient. DISCUSSION: The data indicate no loss of sensitivity with this protocol; thus Cobas 4800 users could use this method without the need for alternative methods.