Asymptomatic carriage of extensively drug-resistant bacteria (eXDR), a simple way to assess spontaneous clearance

Farfour, Éric; Larbi, Anis; Couturier, Jeanne; Lecuru, Marion; Decousser, J.-W.; Renvoisé, Aurélie; Faibis, F.; Lawrence, Christine; Nerome, Simone; Lecointe, Didier; Barbut, Frédéric; Karnycheff, F.; Barbahn, N.; Beaujon,; Costa, Yannick; Fontaine, Amélie; Lepainteur, M.; Seguier, J.-C.

doi:10.1016/j.jhin.2019.12.013

Cited by 4 publications

(3 citation statements)

References 19 publications

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“…Around 30% of the population can carry the opportunistic pathogen Staphylococcus aureus in the anterior nares [12]. In a recent surveillance study at a French hospital, almost 40% of the patients who underwent a rectal screening were carrying Vancomycin-Resistant Enterococci (VRE) [9]. These results were similar to a previous hospital study where approximately 26% and 39% of the patients with antibiotic-resistant staphylococcal and enterococcal infections, respectively, had previous colonisation with their respective pathogens [8].…”

Section: Introductionsupporting

confidence: 70%

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Dealing with Hidden Threats: The Antimicrobial Effect of the Embalming Process

Swift

Casu

et al. 2022

Microorganisms

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Individuals naturally carry bacteria and other microbes as part of their natural flora, with some being opportunistic pathogens. Approximately 30% of the population is known to carry Staphylococcus aureus in their nasal cavity, an organism that causes infections ranging from soft tissue abscesses to toxic shock syndrome. This problem is compounded by the presence of antibiotic-resistant strains such as Methicillin-Resistant Staphylococcus aureus (MRSA). Commensal bacteria present on cadavers pose a risk to those who handle the body. As a Medical School Anatomy laboratory that performs hands-on cadaveric dissection, we wanted to know whether the embalming process is sufficient to kill all commensal bacteria that pose a risk to staff and students. Even if these strains do not cause disease in these individuals, secondary transmission could occur to friends and family, who may be at higher risk of acquiring an infection. Embalming is assumed to eliminate all microbial contamination on the body. However, there are limited studies to confirm this. This study characterises the incidence of antibiotic sensitive and resistant bacteria in cadavers donated for medical teaching and research. We have screened for Methicillin-Resistant Organisms (MRO) and Extended-Spectrum Beta-Lactamase (ESBL) producing bacteria. In this study group of cadavers, approximately 46% (16/35) carry an MRO, while 51% (18/35) carry an ESBL positive organism prior to embalming. By determining the organisms’ presence pre- and post-embalming, we can evaluate the embalming procedure’s effectiveness. Our results show embalming eliminates detectable microbes in about 51% (18/35) of the cadavers. MRO dropped by 75% (16 to 4 positive cadavers), while ESBL organisms went down by almost 95% (from 18 to 1 positive cadaver). There was a further decrease in the number of positive cadavers after storage at 4 °C to 6% (2/32). Thus, although the embalming process does not immediately sterilise all the cadavers, prolonged storage at 4 °C can further reduce the number of viable bacteria.

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Section: Introductionsupporting

confidence: 70%

“…Individuals colonised by antibiotic-resistant bacteria without an active infection are regarded as carriers, and fall into three broad categories: long-term carriers; spontaneous decolonises; and undetermined status [9]. The status can only be confirmed through constant monitoring and is unknown for most people.…”

Section: Introductionmentioning

confidence: 99%

Dealing with Hidden Threats: The Antimicrobial Effect of the Embalming Process

Swift

Casu

et al. 2022

Microorganisms

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“…Although there are no reports that clearly indicate how long an observation period is required to achieve spontaneous clearance, a previous systematic review showed that spontaneous clearance of VRE colonization was seen in half of cases at 26 weeks from the time of documented colonization ( 15 ). Another retrospective study showed that 56.8% of patients with VRE colonization demonstrated clearance within a median follow-up duration of 382 days ( 16 ). Therefore, if spontaneous clearance is not obtained within 6 to 12 months, it might be reasonable to consider decolonization, depending on the need.…”

Section: Discussionmentioning

confidence: 99%

Digestive Decolonization of Colorectal Carriage of Vancomycin-resistant <i>Enterococcus faecium</i> in a Japanese Adult

et al. 2022

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Patients with vancomycin-resistant Enterococcus (VRE) colonization should be managed in an isolation room with contact precautions. We herein report a patient whose colorectal carriage of VRE was successfully decolonized using concomitant bowel irrigation with polyethylene glycol, probiotics, and oral antimicrobials, linezolid and orally-administered daptomycin, for release from isolation and contact precautions. We therefore would like to suggest a potential strategy for managing patients with VRE colonization.

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