Although infections caused by methicillin-resistant Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS) have been reported from a number of countries, including Australia, the optimal therapy is unknown. We reviewed the clinical features, therapy, and outcome of 25 patients with serious infections due to SA-RVS in Australia and New Zealand. Eight patients had endocarditis, 9 had bacteremia associated with deep-seated infection, 6 had osteomyelitis or septic arthritis, and 2 had empyema. All patients had received vancomycin before the isolation of SA-RVS, and glycopeptide treatment had failed for 19 patients (76%). Twenty-one patients subsequently received active treatment, which was effective for 16 patients (76%). Eighteen patients received linezolid, which was effective in 14 (78%), including 4 patients with endocarditis. Twelve patients received a combination of rifampicin and fusidic acid. Surgical intervention was required for 15 patients (60%). Antibiotic therapy, especially linezolid with or without rifampicin and fusidic acid, in conjunction with surgical debulking is effective therapy for the majority of patients with serious infections (including endocarditis) caused by SA-RVS.

Objective: To assess the effect of a multifaceted hand hygiene culture‐change program on health care worker behaviour, and to reduce the burden of nosocomial methicillin‐resistant Staphylococcus aureus (MRSA) infections. Design and setting: Timetabled introduction of interventions (alcohol/chlorhexidine hand hygiene solution [ACHRS], improved cleaning of shared ward equipment, targeted patient decolonisation, comprehensive “culture change” package) to five clinical areas of a large university teaching hospital that had high levels of MRSA. Main outcome measures: Health care worker hand hygiene compliance; volume of ACHRS used; prevalence of patient and health care worker MRSA colonisation; environmental MRSA contamination; rates of clinical MRSA infection; and rates of laboratory detection of ESBL‐producing Escherichia coli and Klebsiella spp. Results: In study wards, health care worker hand hygiene compliance improved from a pre‐intervention mean of 21% (95% CI, 20.3%–22.9%) to 42% (95% CI, 40.2%–43.8%) 12 months post‐intervention (P < 0.001). ACHRS use increased from 5.7 to 28.6 L/1000 bed‐days. No change was observed in patient MRSA colonisation or environmental colonisation/contamination, and, except in the intensive care unit, colonisation of health care workers was unchanged. Thirty‐six months post‐intervention, there had been significant reductions in hospital‐wide rates of total clinical MRSA isolates (40% reduction; P < 0.001), patient‐episodes of MRSA bacteraemia (57% reduction; P = 0.01), and clinical isolates of ESBL‐producing E. coli and Klebsiella spp (90% reduction; P < 0.001). Conclusions: Introduction of ACHRS and a detailed culture‐change program was effective in improving hand hygiene compliance and reducing nosocomial MRSA infections, despite high‐level MRSA endemicity.

Alcohol-based disinfectants and particularly hand rubs are a key way to control hospital infections worldwide. Such disinfectants restrict transmission of pathogens, such as multidrug-resistant and Despite this success, health care infections caused by are increasing. We tested alcohol tolerance of 139 hospital isolates of obtained between 1997 and 2015 and found that isolates after 2010 were 10-fold more tolerant to killing by alcohol than were older isolates. Using a mouse gut colonization model of transmission, we showed that alcohol-tolerant resisted standard 70% isopropanol surface disinfection, resulting in greater mouse gut colonization compared to alcohol-sensitive We next looked for bacterial genomic signatures of adaptation. Alcohol-tolerant accumulated mutations in genes involved in carbohydrate uptake and metabolism. Mutagenesis confirmed the roles of these genes in the tolerance of to isopropanol. These findings suggest that bacterial adaptation is complicating infection control recommendations, necessitating additional procedures to prevent from spreading in hospital settings.

Background: Single-dose antimicrobial prophylaxis for major surgery is a widely accepted principle; recommendations have been based on laboratory studies and numerous clinical trials published in the last 25 years. In practice, single-dose prophylaxis has not been universally accepted and multiple-dose regimens are still used in some centres. Moreover, the principle has recently been challenged by the results of an Australian study of vascular surgery. The aim of this current systematic review is to determine the overall efficacy of single versus multiple-dose antimicrobial prophylaxis for major surgery and across surgical disciplines. Methods: Relevant studies were identified in the medical literature using the MEDLINE database and other search strategies. Trials included in the review were prospective and randomized, had the same antimicrobial in each treatment arm and were published in English. Rates of postoperative surgical site infections (SSI) were extracted, 2 x 2 tables prepared and odds ratios (OR) [with 95% confidence intervals (95% CI)] calculated. Data were then combined using fixed and random effects models to provide an overall figure.In this context, a high value for the combined OR, with 95% CI > 1 .O, indicates superiority of multiple-dose regimens and a low OR, with 95% CI < 1 .O, suggests the opposite. A combined OR close to 1 .O, with narrow 95% CI straddling 1 .O, indicates no clear advantage of one regimen over another. Further subgroup analyses were also performed. Results: Combined OR by both fixed (1.06,95% CI, 0.89-1.25) and random effects (1.04,95% CI, 0.86-1.25) models indicated no clear advantage of either single or multiple-dose regimens in preventing SSI. Likewise, subgroup analysis showed no statistically significant differences associated with type of antimicrobial used (beta-lactam vs other), blinded wound assessment, length of the multipledose arm (> 24 h vs 24 h or less) or type of surgery (obstetric and gynaecological vs other). Conclusions:Continued use of single-dose antimicrobial prophylaxis for major surgery is recommended. Further studies are required, especially in previously neglected surgical disciplines.

The application of multilocus sequence typing has uncovered the emergence of an epidemic clone of E. faecium ST203 that appears to have acquired the vanB locus and has caused a sustained outbreak of VRE bacteremia.