Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department

New risk factors and occurrence in patients coming directly from the community | Journal of Hospital Infection

Aim: To investigate the prevalence of patients harboring CRE on hospital admission, risk factors associated and the acquisition rate within the emergency department (ED).

Methods: We conducted a cross-sectional with 676 patients consecutively admitted to the ED study during the months of May to July 2016. A questionnaire was performed and rectal swabs were collected from patients on admission, for culture and for multiplex real-time polymerase chain-reaction (RT-PCR). If the patient was hospitalized for more than one week in the ED, samples were taken again to determine the acquisition rate of CRE.

Findings: Forty-six patients were colonized, all positive RT-PCR were KPC. The acquisition rate was 18%. Patients CRE colonized presented a higher mortality rate. Previous exposure to healthcare in the last year, liver disease and use of antibiotics in the last month were risk factors for colonization. Six patients with no previous exposure to healthcare were CRE-colonized on admission, suggesting transmission of CRE within the community.

Conclusion: Screening of high-risk patients on admission to the ED is a strategy to early identify CRE carriage and may contribute to control CRE dissemination.

Full reference: Salomão, M.C. et al. (2017) Carbapenem-resistant Enterobacteriaceae in patients admitted to the Emergency Department: new risk factors and occurrence in patients coming directly from the community. Journal of Hospital Infection. Published online: 18 August 2017

Advertisements

The association between infection control interventions and CRE incidence

The aim of this study was to assess the association between infection control (IC) interventions implemented in a referral hospital in Israel and (CRE) incidence | Journal of Hospital Infection

https://www.flickr.com/photos/niaid/13743456084

Image source: NIAID – FLickr // CC BY 2.0

Image shows a human neutrophil interacting with Klebsiella pneumoniae (pink).

Background: Israel experienced a national outbreak of carbapenem-resistant Enterobacteriaceaee (CRE) starting in 2006.

Methods: Retrospective quasi-experimental study of prospectively collected data. CRE incidence, defined as the number of patients newly acquiring CRE in surveillance or clinical samples per 100,000 hospitals days (HD), was plotted quarterly between 2005 to 2016. IC interventions were applied at different time-points throughout this period. We collected data on IC staffing, number of rectal surveillance cultures and carbapenem consumption. We used auto-correlated segmented linear regression analysis to assess the time-points where a significant change in the CRE incidence trend occurred and assessed the relationship between the timing of IC intervention implementation and observed CRE trends. Trends between time-points are expressed as quarterly percent change (QPC) with 95% confidence intervals.

Findings: Between 2005-2008, CRE incidence increased significantly, QPC 19.7% (11.5-28.4%), reaching a peak of 186.6 new acquisitions/100,000 HD. From mid-2011 until the end of follow-up, there was a significant decreasing incidence trend, QPC -4.5 (-6.4 to -2.5). Cohorting of patients, screening of contacts and high-risk patients on admission were insufficient to control the epidemic. Improved hand hygiene compliance, cohorting with dedicated nursing staff, addition of regular screening in high-risk departments and carbapenem restriction were required. Decreasing CRE incidence was observed with an ID/IC staffing of 1.2-1.5/100 beds and 20,000-36,000 yearly CRE surveillance samples.

Conclusions: A multifaceted hospital-wide intervention program is required to control CRE in hospital settings.

Full reference: Hussein, K. et al. (2017) The association between infection control interventions and CRE incidence in an endemic hospital. Journal of Hospital Infection. Published online: 22 July 2017

Scientists stumble across new method of making antibiotics

Cancer researchers may have stumbled across a solution to reverse antibiotic drug resistance and stop infections like MRSA. | Via ScienceDaily

Experts warn we are decades behind in the race against superbugs having already exploited naturally occurring antibiotics, with the creation of new ones requiring time, money and ingenuity.

But a team of scientists at the University of Salford say they may have found a very simple way forward — even though they weren’t even looking for antibiotics.

And they have created and validated several new antibiotics already — many of which are as potent, or more so, than standard antibiotics, such as amoxicillin.

“A little like Alexander Fleming, we weren’t even looking for antibiotics rather researching into new compounds that might be effective against cancer stem cells,” explains Michael P. Lisanti, Chair of Translational Medicine at the University’s Biomedical Research Centre.

“I think we’ve accidentally invented a systemic way of creating new antibiotics which is simple, cheap and could be very significant in the fight against superbugs,” added Dr Federica Sotgia, a co-author on the study.

Full story at ScienceDaily

Full reference:  Bela Ozsvari et al.  Mitoriboscins: Mitochondrial-based therapeutics targeting cancer stem cells (CSCs), bacteria and pathogenic yeast | Oncotarget, Advance Publications | published online July 7th 2017

Antibiotic Therapy for Nearly 1 in 4 Adults with Pneumonia Does Not Work

Approximately 1 in 4 (22.1 percent) adults prescribed an antibiotic in an outpatient setting for community-acquired pneumonia does not respond to treatment, according to a new study presented at the 2017 American Thoracic Society International Conference | Infection Control Today

B0007348 Streptococcus pneumoniae

Image source: Debbie Marshall – Wellcome Images // CC BY 4.0

Image shows colour enhanced scanning electron micrograph of a colony of Streptococcus pneumoniae, the species of bacterium that is the commonest cause of pneumonia.

McKinnell and colleagues conducted this study because current community-acquired pneumonia guidelines from the American Thoracic Society and the Infectious Disease Society of America, published in 2007, provide some direction, but large-scale, real-world data are needed to better understand and optimize antibiotic choices and to better define clinical risk factors that may be associated with treatment failure.

The researchers examined databases containing records for 251,947 adult patients who were treated between 2011 and 2015 with a single class of antibiotics (beta-lactam, macrolide, tetracycline, or fluoroquinolone) following a visit to their physician for treatment for community-acquired pneumonia.  The scientists defined treatment failure as either the need to refill antibiotic prescriptions, antibiotic switch, ER visit or hospitalization within 30 days of receipt of the initial antibiotic prescription.  The total antibiotic failure rate was 22.1 percent, while patients with certain characteristics — such as older age, or having certain other diseases in addition to pneumonia — had higher rates of drug failure.  After adjusting for patient characteristics, the failure rates by class of antibiotic were:  beta-lactams (25.7 percent), macrolides (22.9 percent), tetracyclines (22.5 percent), and fluoroquinolones (20.8 percent).

New test identifies antibiotic-resistant bacteria

New research suggests it is possible to quickly and accurately diagnose drug-resistant bacterial infections using existing hospital equipment | OnMedica

N0013868 E coli cultures

Image source: Wellcome Images // CC BY-NC-ND 4.0

Image shows petri dish cultures infected with phage-galactose bacteria.

In a presentation at the 27th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), taking place this week in Vienna, researchers described how they were able to test bacteria to quickly tell whether they were resistant to the antibiotic of last resort, colistin, and how easily they might pass this resistance on to other bacteria.

Knowing which patients have these most dangerous infections means it is possible to use quarantine measures to halt their spread, say the scientists.

Read the full overview here

The presentation abstract is available here

Antimicrobial Resistance: resource handbook

This handbook collates national resources on antimicrobial resistance, antimicrobial stewardship and infection prevention and control | PHE

thumbnail_phe_amr_resource_handbook-pdf

Image source: PHE

This handbook identifies current national policy, guidance and supporting materials in relation to the infection prevention and control of healthcare associated infections (HCAI) and antimicrobial stewardship in order to aid in the reduction of antimicrobial resistance. It is designed to assist local health and social care professionals in quickly retrieving relevant information provided by Public Health England, the Department of Health and a wide variety of key stakeholders.

The handbook includes supporting materials relating to:

  • strategy and national guidance
  • policy and recommendations
  • education and training
  • guidance and tools
  • surveillance
  • international resources

Read the full overview here

The full handbook is available here

 

Reducing the impact of serious infections CQUIN

Resources to support delivery of the ‘Reducing the impact of serious infections (antimicrobial resistance and sepsis)’ CQUIN, parts 2c and 2d | NHS Improvement

  • Reducing the impact of serious infections CQUIN, parts 2c and 2d – questions and answersPDF, 185.4 KB – Questions and answers relating to parts 2c and 2d of the ‘Reducing the impact of serious infections’ CQUIN.
  • Part 2c data collection and submissionXLSX, 236.1 KB – PHE has developed this submission tool (and sample data collection form) to facilitate the submission of part 2c (antibiotic review). All data submitted will be available on AMR Fingertips.
  • Part 2d antibiotic consumption submission toolXLSM, 91.4 KB – The data submitted as part of this year’s antimicrobial resistance (AMR) CQUIN has been used to develop this baseline data. Providers that did not take part in the 2016/17 AMR CQUIN or submitted previous annual data should submit quarterly data from January to December 2016, using the antibiotic consumption spreadsheets available on the NHS England AMR CQUIN webpage. Without this data a baseline cannot be calculated for your provider.
  • Part 2d baseline dataXLS, 259.5 KB – Use this to submit quarterly antibiotic consumption data to PHE. All data once submitted will be available via AMR Fingertips after an eight week data cleaning period.