Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Baraboutis, Ioannis G.; Tsagalou, Eleftheria P.; Papakonstantinou, Ilias; Marangos, Markos; Gogos, Charalambos; Skoutelis, Athanasios; Bassaris, H.

doi:10.1016/s1413-8670(11)70223-9

Cited by 11 publications

(7 citation statements)

References 52 publications

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“…Alternatively, there is a possibility that some of the patients may have not recalled properly the information on antibiotic use for the past 3 months and even for those who reported some could not mention the name of antibiotic or type of drug used thus underestimating the role of this factor as risk for MRSA acquisition. Furthermore, our findings differ from the findings of other studies, which have reported history of previous hospitalization to be associated with increased risk of MRSA carriage [ 18 , 38 ]. The lack of association may be due to the small number of patients with such risk in the population investigated resulting into lack of power to identify such associations, and this is another limitation of our study.…”

Section: Discussioncontrasting

confidence: 99%

“…This can be due to the fact that most of the patients with chronic disease visit hospital often and thus increasing the chance of acquiring the pathogen. Previous studies have reported exposure to antibiotic is associated with risk of MRSA colonization [ 18 , 38 ]. Our findings showed a trend of but non-significantly higher MRSA among patients with previous exposure to antibiotics.…”

Section: Discussionmentioning

confidence: 99%

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Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania

et al. 2017

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BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen responsible for hospital and community acquired infection. Colonization with MRSA is associated with a high risk of developing infection. This study aimed to determine the rate of MRSA carriage on admission and the associated risk factors among patients attending regional hospitals, in Dar es Salaam, Tanzania.ResultsA total of 258 patients were included in this study. Nasal swabs were collected on admission to the hospital and after 48 h of hospital stay for detection of MRSA. Of 258 patients enrolled, 89 (34.5%) were colonized with S. aureus and out them 22 (24.7%) were carriers of MRSA, giving an overall MRSA nasal carriage rate of 8.5% (22/258). One patient acquired MRSA while admitted in the hospital. Most of the S. aureus isolates 85 (95.5%) were resistant to penicillin. Resistance to gentamycin, ciprofloxacin, kanamycin, linezolid and mupirocin were 14.6, 11.2, 11.2, 3.4 and 1.1%, respectively. The prevalence of inducible clindamycin resistance, constitutive clindamycin resistance, MS phenotype (resistance to erythromycin alone), and multidrug resistance was 21.3, 3.4, 12.4, and 16.9%, respectively. We observed a statistically significant association between MRSA and multiple drugs resistance among S. aureus isolates (p = 0.001). Of the risk factors investigated none were statistically significant associated with MRSA.ConclusionThere is a high prevalence of MRSA among patients on admission at the two municipal hospitals in Dar es Salaam. The high prevalence of MRSA and the increased rates of resistance to commonly used antimicrobials among MRSA isolates call for attention to the importance of including the screening of MRSA in our hospitals setting in order to prevent further spread of MRSA strains to other patients and to the communities. Control and prevention strategies should be emphasized including decolonization.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania

et al. 2017

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“…Biofilms are highly tolerant to high amounts of antibiotics and antimicrobial drugs, therefore many biofilm associated infections are considered unhealable [28]. Along with the intrinsic tolerance of biofilms to antibiotic therapy, resistant pathogenic bacteria represent an additional inquiry in antimicrobial therapy [29,30,31,32,33]. The alarming increase of multi-drug resistant bacterial strains and difficult to treat biofilm related infections in wounds require the development of new wound care approaches and therapeutic strategies.…”

Section: Resultsmentioning

confidence: 99%

Silver Nanocoatings for Reducing the Exogenous Microbial Colonization of Wound Dressings

et al. 2016

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The aim of this work was to obtain an antimicrobial coating (NanoAg) for polyester-nylon wound dressings (WDs) for reducing the risk of exogenous wound related infections. The as-prepared NanoAg-WDs were characterized by XRD (X-ray Diffraction), SEM (Scanning Electron Microscopy), TEM (Transmission Electron Microscopy), SAED (Selected Area Electron Diffraction) and IRM (InfraRed Microscopy). Biological characterization consisted of in vitro evaluation of the interaction with fibroblast cell cultures and in vivo biodistribution studies of AgNPs on mice models. Then, specimens of commercial WDs were immersed in a glucose and NaOH solution of silver nanoparticles, followed by the subsequent dropwise addition of AgNO3 solution. The antimicrobial efficiency of the NanoAg-WDs was assessed by in vitro qualitative and quantitative analyses on Staphylococcus aureus and Pseudomonas aeruginosa strains. The in vitro and in vivo studies demonstrated that the tested nanoparticles utilized to coat WDs have a good biocompatibility, allowing the normal development of cultured human cells and revealing a normal biodistribution within a mouse model, without toxic effects. The modified and viable cells count analyses proved that the modified WDs exhibit an improved inhibitory activity of microbial colonization, attachment and biofilm growth. The reported data recommend this type of coatings to obtain modified WDs with antibacterial properties, able to prevent the exogenous microbial contamination of the wound tissue, colonization and further biofilm development.

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“…However, these studies concerned open fractures, with time delays ranging from 0 to 24 h [ 18 ]. We found only one study specifically linking longer hospitalization delays with healthcare-associated infections [ 30 ]. In this study from Brazil, patients with nosocomial infections due to MSSA (not only orthopedic implants) revealed a median delay of prior hospital stay of 9 days, compared to MRSA infections with a past median delay of 18 days [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay?

Davat

Wuarin

Stafylakis

et al. 2018

Antimicrob Resist Infect Control

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BackgroundProlonged hospital stay before surgery is a risk for colonization with antibiotic-resistant microorganisms and possible antibiotic-resistant surgical site infections (SSI), which lacks acknowledgement in international guidelines for perioperative antibiotic prophylaxis.MethodRetrospective cohort study focusing on prophylaxis-resistant SSI in adult orthopedic implant patients; with emphasis on length of hospital stay prior to the index surgery.ResultsWe enrolled 611 cases of SSI (median age, 65 years; 241 females and 161 immune-suppressed) in four large implant groups: arthroplasties (n = 309), plates (n = 127), spondylodeses (n = 31), and nails (n = 46). The causative pathogen was resistant to the perioperative antibiotic prophylaxis regimen in 307 cases (307/611; 50%), but the length of pre-surgical hospitalization did not influence the incidences of prophylaxis-resistant SSIs. These incidences were (107/211;51%) for the admission day, (170/345;49%) within 10 days of delay, (19/35;54%) between 10 and 20 days, and (11/20; 55%) beyond 20 days of hospital stay before surgery. The corresponding incidences of methicillin-resistant staphylococci were 13%, 14%, 17%, and 5%, respectively. In adjusted group comparisons, the length of prior hospital stay was equally unrelated to future prophylaxis-resistant SSI (odds ratio 1.0, 95% confidence interval 0.99–1.01).ConclusionsIn our retrospective cohort of orthopedic implant SSI, the length of pre-surgical hospital stay was unrelated to the incidence of prophylaxis-resistant pathogens.

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Length of exposure to the hospital environment is more important than antibiotic exposure in healthcare associated infections by methicillin-resistant Staphylococcus aureus: a comparative study

Cited by 11 publications

References 52 publications

Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania

Prevalence of methicillin-resistant Staphylococcus aureus carriage on admission among patients attending regional hospitals in Dar es Salaam, Tanzania

Silver Nanocoatings for Reducing the Exogenous Microbial Colonization of Wound Dressings

Should antibiotic prophylaxis before orthopedic implant surgery depend on the duration of pre-surgical hospital stay?

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