Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Percival, Steven L.; Suleman, Louise; Vuotto, Claudia; Donelli, Gianfranco

doi:10.1099/jmm.0.000032

Cited by 576 publications

(498 citation statements)

References 126 publications

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“…A recent, large-scale survey found that 25.6% of all hospital-acquired infections were due to device-associated infections (i.e., ventilator-associated pneumonia, catheter-associated urinary tract infection, and central catheter-associated bloodstream infection) (5). These kinds of infections are usually accompanied by the formation of biofilms (57), showing that there is an urgent need for a better understanding of persister cell formation by nosocomial pathogens.…”

Section: Figmentioning

confidence: 99%

In Vitro Emergence of High Persistence upon Periodic Aminoglycoside Challenge in the ESKAPE Pathogens

Michiels

Bergh

Verstraeten

et al. 2016

Antimicrob Agents Chemother

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bHealth care-associated infections present a major threat to modern medical care. Six worrisome nosocomial pathogens-Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.-are collectively referred to as the "ESKAPE bugs." They are notorious for extensive multidrug resistance, yet persistence, or the phenotypic tolerance displayed by a variant subpopulation, remains underappreciated in these pathogens. Importantly, persistence can prevent eradication of antibiotic-sensitive bacterial populations and is thought to act as a catalyst for the development of genetic resistance. Concentration-and time-dependent aminoglycoside killing experiments were used to investigate persistence in the ESKAPE pathogens. Additionally, a recently developed method for the experimental evolution of persistence was employed to investigate adaptation to high-dose, extended-interval aminoglycoside therapy in vitro. We show that ESKAPE pathogens exhibit biphasic killing kinetics, indicative of persister formation. In vitro cycling between aminoglycoside killing and persister cell regrowth, evocative of clinical high-dose extended-interval therapy, caused a 37-to 213-fold increase in persistence without the emergence of resistance. Increased persistence also manifested in biofilms and provided cross-tolerance to different clinically important antibiotics. Together, our results highlight a possible drawback of intermittent, high-dose antibiotic therapy and suggest that clinical diagnostics might benefit from taking into account persistence.

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Section: Figmentioning

confidence: 99%

In Vitro Emergence of High Persistence upon Periodic Aminoglycoside Challenge in the ESKAPE Pathogens

Michiels

Bergh

Verstraeten

et al. 2016

Antimicrob Agents Chemother

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“…20 Pseudomonas has been linked to waterborne biofilm infections, particularly in burn and cystic fibrosis patients, and infections involving solutions used for surface sterilization, indwelling catheters, bronchoscopes, hot tubs, and sink traps and aerosolizers. 9,10 This increase in reported Pseudomonas infections has been demonstrable despite incomplete reporting for key OPPP organisms.…”

Section: Discussionmentioning

confidence: 99%

“…The ability of OPPP to grow as microbial biofilms in water provides them selective advantages, including (1) growth in low nutrient conditions, (2) resistance to antibiotics and disinfectants, (3) high metabolic and phenotypic diversity, enabling them to withstand environmental stresses (pH, UV, low oxygen), (4) horizontal gene transfer of antibiotic resistance and virulence genes, and (5) efficient transmission via ingestion, aerosols, and contact. 8,10,12,13 A recent study of OPPP in chloraminated drinking water distribution systems using quantitative PCR methods revealed a high occurrence of Legionella spp. (C69 per cent) and nontuberculous mycobacteria (100 per cent), a lower prevalence of L. pneumophila (B20 per cent) and M. avium (B33.3 per cent), and uncommon detection of Pseudomonas aeruginosa (B13.3 per cent).…”

Section: -11mentioning

confidence: 99%

Hospitalizations due to selected infections caused by opportunistic premise plumbing pathogens (OPPP) and reported drug resistance in the United States older adult population in 1991–2006

Naumova

Liss

Jagai

et al. 2016

J Public Health Pol

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The Flint Water Crisis -due to changes of water source and treatment procedures -has revealed many unsolved social, environmental, and public health problems for US drinking water, including opportunistic premise plumbing pathogens (OPPP). The true health impact of OPPP, especially in vulnerable populations such as the elderly, is largely unknown. We explored 10 8 claims in the largest US national uniformly collected data repository to determine rates and costs of OPPP-related hospitalizations. In 1991-2006, 617,291 cases of three selected OPPP infections resulted in the elderly alone of $0.6 billion USD per year of payments. Antibiotic resistance significantly increased OPPP illness costs that are likely to be underreported. More precise estimates for OPPP burdens could be obtained if better clinical, microbiological, administrative, and environmental monitoring data were cross-linked. An urgent dialog across governmental and disciplinary divides, and studies on preventing OPPP through drinking water exposure, are warranted.

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“…Health care-associated infections related to medical device contamination and biofilm formation have been documented in the literature (1). Recently, heater-cooler devices (HCDs) used during cardiopulmonary bypass (CPB) for cardiac surgeries and during extracorporeal membrane oxygenation (ECMO) have come under scrutiny due to infections linked to contaminated devices (2,3).…”

Section: Introductionmentioning

confidence: 99%

Mycobacterium chimaera infections in post–operative patients exposed to heater–cooler devices: An overview

Ogunremi

Taylor

Johnston

et al. 2017

Canada Communicable Disease Report

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A multi-country outbreak of Mycobacterium chimaera infection associated with contaminated heater-cooler devices (HCDs) has been reported, with more than 70 cases in Europe and the United States and two cases in Canada to date. The epidemiological and microbiological characteristics of this outbreak provide evidence for common-source transmission of M. chimaera from the exhaust air of intrinsically contaminated HCDs to patients during cardiac surgery. To date, all reported cases have been associated with Stöckert 3T HCDs manufactured at one plant by LivaNova prior to September 2014. Implantation of prosthetic material increases the risk of infection. Infections usually present as prosthetic valve endocarditis, vascular graft infection or disseminated infection. Reported mortality rates have varied, but were often over 40%.Several measures are recommended to facilitate case-finding and mitigate risk of exposure. The feasibility of some risk mitigation measures and their effectiveness in reducing the risk of exposure are yet to be determined. Until HCDs are redesigned in a manner that prevents water contamination and aerosolization, separating the HCD exhaust air from the operating room air during surgery may be the most effective risk mitigation strategy. However, possible unintended consequences of this approach should be considered. This overview summarizes findings from peer-reviewed and other relevant national documents on key features of the outbreak, including the source, identified risk factors for infection, signs and symptoms of infection, burden of disease, risk mitigation measures, management challenges and knowledge gaps.Affiliations

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Healthcare-associated infections, medical devices and biofilms: risk, tolerance and control

Cited by 576 publications

References 126 publications

In Vitro Emergence of High Persistence upon Periodic Aminoglycoside Challenge in the ESKAPE Pathogens

In Vitro Emergence of High Persistence upon Periodic Aminoglycoside Challenge in the ESKAPE Pathogens

Hospitalizations due to selected infections caused by opportunistic premise plumbing pathogens (OPPP) and reported drug resistance in the United States older adult population in 1991–2006

Mycobacterium chimaera infections in post–operative patients exposed to heater–cooler devices: An overview

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