Hospital infection control in an era of HIV infection and multi-drug resistant tuberculosis

Hannan, Margaret M.; Azadian, B S; Gazzard, Brian; Hawkins, David; Hoffman, P.N.

doi:10.1053/jhin.1999.0651

Cited by 29 publications

(17 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This is especially true in wards caring for people living with human immunodeficiency virus (HIV) infection due to the heightened risk of TB among immunosuppressed patients 3. Compounding this problem is the growing threat of multidrug-resistant tuberculosis (MDRTB), defined as strains of TB resistant to rifampin and isoniazid, because patients living with HIV infection and MDRTB infection have extremely high mortality and require complicated and expensive treatment 4,5…”

Section: Introductionmentioning

confidence: 99%

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection

Dudley

Sheen

Gilman

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

Hospital infection control measures are crucial to tuberculosis (TB) control strategies within settings caring for human immunodeficiency virus (HIV)–positive patients, as these patients are at heightened risk of developing TB. Pyrazinamide (PZA) is a potent drug that effectively sterilizes persistent Mycobacterium tuberculosis bacilli. However, PZA resistance associated with mutations in the nicotinamidase/pyrazinamidase coding gene, pncA, is increasing. A total of 794 patient isolates obtained from four sites in Lima, Peru, underwent spoligotyping and drug resistance testing. In one of these sites, the HIV unit of Hospital Dos de Mayo (HDM), an isolation ward for HIV/TB coinfected patients opened during the study as an infection control intervention: circulating genotypes and drug resistance pre- and postintervention were compared. All other sites cared for HIV-negative outpatients: genotypes and drug resistance rates from these sites were compared with those from HDM. HDM patients showed high concordance between multidrug resistance, PZA resistance according to the Wayne method, the two most common genotypes (spoligotype international type [SIT] 42 of the Latino American-Mediterranean (LAM)-9 clade and SIT 53 of the T1 clade), and the two most common pncA mutations (G145A and A403C). These associations were absent among community isolates. The infection control intervention was associated with 58–92% reductions in TB caused by SIT 42 or SIT 53 genotypes (odds ratio [OR] = 0.420, P = 0.003); multidrug-resistant TB (OR = 0.349, P < 0.001); and PZA-resistant TB (OR = 0.076, P < 0.001). In conclusion, pncA mutation typing, with resistance testing and spoligotyping, was useful in identifying a nosocomial TB outbreak and demonstrating its resolution after implementation of infection control measures.

show abstract

Section: Introductionmentioning

confidence: 99%

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection

Dudley

Sheen

Gilman

et al. 2016

The American Society of Tropical Medicine and Hygiene

View full text Add to dashboard Cite

show abstract

“…Control of tuberculosis transmission relies on ensuring early diagnosis and effective treatment of cases so that they remain infectious for the minimum time possible [3]. Transmission of tuberculosis in hospital settings has also been a very important problem in some cities [4]. Estimates of the extent of transmission of tuberculosis and risk factors for transmission are therefore needed to identify aspects of tuberculosis control in London that should be strengthened.…”

Section: Introductionmentioning

confidence: 99%

The molecular epidemiology of tuberculosis in inner London

Hayward

Goss²,

Drobniewski³

et al. 2002

Epidemiol. Infect.

View full text Add to dashboard Cite

SUMMARYThe study used DNA fingerprint typing (spoligotyping and Heminested-Inverse-PCR) of Mycobacterium tuberculosis from all culture-confirmed inner London patients over a 12-month period to describe transmission. The methodology was evaluated by comparison with standard IS6110 typing and by examining its ability to identify known household clusters of cases. Isolates sharing indistinguishable typing patterns using both techniques were defined as clustered. Clusters were investigated to identify epidemiological links. The methodology showed good discriminatory power and identified known household clusters of cases. Of 694 cultureconfirmed cases, 563 (81 %) were typed. Eleven (2 %) were due to laboratory crosscontamination and were excluded. Of the remaining 552 isolates 148 (27 %) were clustered. Multivariate analysis indicated that clustering was more common in those with pulmonary smear positive disease (P 0n02) ; those born in the United Kingdom (P 0n0003) and in patients living in south London (P l 0n02). There was also a trend towards clustering being more common in those not known to have HIV infection (P l 0n051). The results suggest that in inner London, recent local transmission makes an important contribution to notification rates.

show abstract

“…Spacecraft and their components are constructed and assembled in high classification clean room facilities (30,38) similar to that used in medical (12,16,42) and industrial pharmaceutical (31) applications. Although it might be expected that the contaminating organisms of these facilities will be the result of human activity (30), the highly desiccated and nutrient-limited environment of spacecraft assembly clean rooms demonstrate selective pressure toward oligotrophic organisms that can persist in the environment (30).…”

mentioning

confidence: 99%

Low-Temperature Decontamination with Hydrogen Peroxide or Chlorine Dioxide for Space Applications

Pottage¹,

Macken²,

Giri³

et al. 2012

Appl Environ Microbiol

View full text Add to dashboard Cite

ABSTRACTThe currently used microbial decontamination method for spacecraft and components uses dry-heat microbial reduction at temperatures of >110°C for extended periods to prevent the contamination of extraplanetary destinations. This process is effective and reproducible, but it is also long and costly and precludes the use of heat-labile materials. The need for an alternative to dry-heat microbial reduction has been identified by space agencies. Investigations assessing the biological efficacy of two gaseous decontamination technologies, vapor hydrogen peroxide (Steris) and chlorine dioxide (ClorDiSys), were undertaken in a 20-m3exposure chamber. Five spore-formingBacillusspp. were exposed on stainless steel coupons to vaporized hydrogen peroxide and chlorine dioxide gas. Exposure for 20 min to vapor hydrogen peroxide resulted in 6- and 5-log reductions in the recovery ofBacillus atrophaeusandGeobacillus stearothermophilus, respectively. However, in comparison, chlorine dioxide required an exposure period of 60 min to reduce bothB. atrophaeusandG. stearothermophilusby 5 logs. Of the three otherBacillusspp. tested,Bacillus thuringiensisproved the most resistant to hydrogen peroxide and chlorine dioxide with D values of 175.4 s and 6.6 h, respectively. Both low-temperature decontamination technologies proved effective at reducing theBacillusspp. tested within the exposure ranges by over 5 logs, with the exception ofB. thuringiensis, which was more resistant to both technologies. These results indicate that a review of the indicator organism choice and loading could provide a more appropriate and realistic challenge for the sterilization procedures used in the space industry.

show abstract

Hospital infection control in an era of HIV infection and multi-drug resistant tuberculosis

Cited by 29 publications

References 28 publications

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection

Detecting Mutations in the Mycobacterium tuberculosis Pyrazinamidase Gene pncA to Improve Infection Control and Decrease Drug Resistance Rates in Human Immunodeficiency Virus Coinfection

The molecular epidemiology of tuberculosis in inner London

Low-Temperature Decontamination with Hydrogen Peroxide or Chlorine Dioxide for Space Applications

Contact Info

Product

Resources

About