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Sarah Browning, Nicole M. White, Edward Raby, Joshua S. Davis, Brett G. Mitchell
Clinical Microbiology and Infection, 16.05.2024
Tilføjet 16.05.2024
Gown and glove use as a component of ‘contact precautions’ was first recommended by the United States Healthcare Infection Control Practices Advisory Committee (HICPAC) in 1996 and remains widely adhered to today (1, 2). Despite a lack of randomised trial evidence in support of this practice, donning of gowns and gloves upon entry to the patient area (room or cubicle) continues to be ‘strongly recommended’ when the patient is infected or colonised with pathogens of epidemiological importance and the potential for contact transmission (3).
Læs mere Tjek på PubMedClinical Infectious Diseases, 15.05.2024
Tilføjet 15.05.2024
Abstract Background Environmental disinfection is essential for reducing spread of healthcare associated infections (HAIs). Previous studies report conflicting results regarding the effects of ultraviolet light (UV) in reducing infections. This trial evaluated the impact of adding pulsed xenon UV (PX-UV) to standard terminal cleaning in reducing environmentally-implicated HAIs (eiHAIs).Methods The LAMP trial was conducted in 2 hospitals (15 inpatient wards) utilizing a cluster randomized controlled, double-blinded, interventional crossover trial comparing standard terminal cleaning followed by either pulsed xenon ultraviolet (PX-UV) disinfection (intervention arm) or sham disinfection (control arm). The primary outcome was incidence of eiHAIs from clinical microbiology tests on the 4th day of stay or later or within 3 days after discharge from the study unit. EiHAIs included clinical cultures positive for vancomycin-resistant enterococci (VRE), extended spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumonia, methicillin-resistant Staphylococcus aureus (MRSA), and Acinetobacter baumannii, and stool PCR positive for Clostridiodes difficile.Findings Between May 18, 2017 to Jan 7, 2020, 25,732 patients were included, with an incidence of 601 eiHAI and 180,954 patient days. There was no difference in the rate of eiHAIs in the intervention and sham arms (3.49 vs 3.17 infections/1000 patient days respectively, RR 1.10 CI (0.94, 1.29, p= 0.23)). Study results were similar when stratified by eiHAI type, hospital, and unit type.Conclusion The LAMP study failed to demonstrate an effect of the addition of UV light disinfection following terminal cleaning on reductions in rates of eiHAIs. Further investigations targeting hospital environmental surfaces and the role of no touch technology to reduce HAIs are needed.
Læs mere Tjek på PubMedInfection, 3.05.2024
Tilføjet 3.05.2024
Abstract Purpose To analyse recent epidemiological trends of bloodstream infections (BSI) caused by Enterococcus spp. In adult patients admitted to tertiary care centres in Germany. Methods Epidemiological data from the multicentre R-NET study was analysed. Patients presenting with E. faecium or E. faecalis in blood cultures in six German tertiary care university hospitals between October 2016 and June 2020 were prospectively evaluated. In vancomycin-resistant enterococci (VRE), the presence of vanA/vanB was confirmed via molecular methods. Results In the 4-year study period, 3001 patients with BSI due to Enterococcus spp. were identified. E. faecium was detected in 1830 patients (61%) and E. faecalis in 1229 patients (41%). Most BSI occurred in (sub-) specialties of internal medicine. The pooled incidence density of enterococcal BSI increased significantly (4.0–4.5 cases per 10,000 patient days), which was primarily driven by VRE BSI (0.5 to 1.0 cases per 10,000 patient days). In 2020, the proportion of VRE BSI was > 12% in all study sites (range, 12.8–32.2%). Molecular detection of resistance in 363 VRE isolates showed a predominance of the vanB gene (77.1%). Conclusion This large multicentre study highlights an increase of BSI due to E. faecium, which was primarily driven by VRE. The high rates of hospital- and ICU-acquired VRE BSI point towards an important role of prior antibiotic exposure and invasive procedures as risk factors. Due to limited treatment options and high mortality rates of VRE BSI, the increasing incidence of VRE BSI is of major concern.
Læs mere Tjek på PubMedInfection, 1.05.2024
Tilføjet 1.05.2024
Abstract Purpose To analyse recent epidemiological trends of bloodstream infections (BSI) caused by Enterococcus spp. In adult patients admitted to tertiary care centres in Germany. Methods Epidemiological data from the multicentre R-NET study was analysed. Patients presenting with E. faecium or E. faecalis in blood cultures in six German tertiary care university hospitals between October 2016 and June 2020 were prospectively evaluated. In vancomycin-resistant enterococci (VRE), the presence of vanA/vanB was confirmed via molecular methods. Results In the 4-year study period, 3001 patients with BSI due to Enterococcus spp. were identified. E. faecium was detected in 1830 patients (61%) and E. faecalis in 1229 patients (41%). Most BSI occurred in (sub-) specialties of internal medicine. The pooled incidence density of enterococcal BSI increased significantly (4.0–4.5 cases per 10,000 patient days), which was primarily driven by VRE BSI (0.5 to 1.0 cases per 10,000 patient days). In 2020, the proportion of VRE BSI was > 12% in all study sites (range, 12.8–32.2%). Molecular detection of resistance in 363 VRE isolates showed a predominance of the vanB gene (77.1%). Conclusion This large multicentre study highlights an increase of BSI due to E. faecium, which was primarily driven by VRE. The high rates of hospital- and ICU-acquired VRE BSI point towards an important role of prior antibiotic exposure and invasive procedures as risk factors. Due to limited treatment options and high mortality rates of VRE BSI, the increasing incidence of VRE BSI is of major concern.
Læs mere Tjek på PubMedAnca Rath, Bärbel Kieninger, Nilufarbayim Mirzaliyeva, Stephan Schmid, Patricia Mester, Wulf Schneider-Brachert
Clinical Microbiology and Infection, 24.04.2024
Tilføjet 24.04.2024
Surveillance of multidrug-resistant bacteria like vancomycin-resistant enterococci (VRE) and prompt outbreak recognition are vital for infection prevention and control (IPC). Yet, data collection is laborious, and analysis prone to errors due to limited resolution of common diagnostic tools. Precision in defining \'the same pathogen\' is, however, critical for nosocomial transmission analysis.
Læs mere Tjek på PubMedJoachim MariënMickaël SageUmaru BanguraAlicia LaméMichel KoropoguiToni RiegerBarré SoropoguiMoussa DounoN’Faly MagassoubaElisabeth Fichet-Calveta Evolutionary Ecology group, Department of Biology University of Antwerp, Antwerp, Belgiumb Virus Ecology unit, Department of Biomedical sciences, Institute of Tropical Medicine, Antwerp, Belgiumc Faune INNOV’ R&D – Wildlife INNOVATION, Besançon, Franced Implementation Research, Zoonoses Control group, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germanye Projet des fièvres Hémorragiques en Guinée, Laboratoire de Virologie, Conakry, Guineaf Department of Virology, Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany
Emerg Microbes Infect, 21.04.2024
Tilføjet 21.04.2024