Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant<i>Staphylococcus aureus</i>(MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

García, Lola; Ramírez, Encarnación; Lupión, Carmen; Muniain, Miguel A.; Velasco, C.; Gálvez, Juan Francisco Pérez; Toro, María Dolores del; Millán, Antonio B.; López-Cerero, Lorena; Pascual, Álvaro

doi:10.1086/654003

Cited by 30 publications

(11 citation statements)

References 38 publications

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“…However, despite these system-wide approaches, recent reports suggest an increasing incidence of bacteremia; particularly with gram-negative organisms. [3–5] These reports indicate that while bacteremia can be reduced by these interventions, many occur despite optimized care and likely reflect factors specific to the individual patient, such as alterations in their immune response, as demonstrated here. We believe that without interventions aimed at injury-induced alterations in both innate and adaptive immunity, system-wide interventions will not eliminate gram-negative bacteremia.…”

Section: Discussionmentioning

confidence: 55%

Traumatic Injury, Early Gene Expression, and Gram-Negative Bacteremia*

Thompson

Park

Maier

et al. 2014

Critical Care Medicine

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Rationale Bacteremic trauma victims have a higher risk of death than their non-bacteremic counterparts. The role that altered immunity plays in the development of bacteremia is unknown. Objective Using an existing dataset, we sought to determine if differences in early post-injury immune-related gene expression are associated with subsequent gram-negative bacteremia (GNB). Design Retrospective cohort study, a secondary analysis of the Glue Grant database. Subjects Severely injured blunt trauma patients. Setting Seven level one trauma centers across the United States. Measurements Total leukocyte gene expression was compared between the subjects that developed GNB and those that did not. Main Results We observed that GNB was an independent risk factor for death (OR, 1.86; P=0.015). We then compared gene expression at 12 and 96 hours after injury in ten subjects who subsequently developed GNB matched to 26 that did not. At 12 hours, expression of 64 probes differed ≥1.5-fold; none represented genes related to innate or adaptive immunity. By 96 hrs, 102 probes were differentially expressed with 20 representing 15 innate or adaptive immunity genes; including downregulation of IL1B and upregulation of IL1R2, reflecting suppression of innate immunity in GNB subjects. We also observed downregulation of adaptive immune genes in the GNB subjects. Conclusions By 96 hours after injury, there are differences in leukocyte gene expression associated with the development of GNB, reflecting suppression of both innate and adaptive immunity. GNB after trauma is, in part, consequence of host immunity failure and may not be completely preventable by standard infection-control techniques.

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Section: Discussionmentioning

confidence: 55%

Traumatic Injury, Early Gene Expression, and Gram-Negative Bacteremia*

Thompson

Park

Maier

et al. 2014

Critical Care Medicine

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“…20 Por sua vez, num hospital espanhol, os autores conseguiram uma redução implementando rastreio ativo e descolonização numa população selecionada (doentes admitidos de outras unidades hospitalares) de 0,56 para 0,07 casos por mil dias de internamento. 21 Fraser et al também alcançaram uma redução de 6,38 para 3,32 casos (p = 0,04; RR 0,53; IC95%: 0,28-0,97) por mil dias de internamento ao aplicar rastreio ativo e descolonização numa UCI de 18 camas. 22 Por outro lado, num estudo britânico envolvendo seis hospitais foram levantadas algumas questões relativas à dificuldade de colocar em prática uma estratégia combinada de rastreio ativo e descolonização universal, nomeadamente: dificuldade em rastreio universal (abrangendo somente 88% dos casos) ou no processo de descolonização (atingindo 41% dos casos) devido à mobilidade dos doentes e curta duração dos internamentos, bem como a falta de estrutura física para isolamento dos doentes, deixando dúvidas relativamente ao papel da descolonização na redução do risco no ambiente hospitalar, preferindo frisar a importância das precauções em controlo de infeção.…”

Section: Resultsunclassified

Estratégia para Controlar o Staphylococcus Aureus Resistente à Meticilina: A Experiência de Cinco Anos de um Hospital

et al. 2014

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“…In contradistinction, there have been three studies that have had rigorous controls supporting ADI, those by Robicsek, et al [ 11 ], Rodriguez-Bano, et al [ 12 ], and Lee, et al [ 13 ] In addition to isolation, Rodriguez-Bano, et al [ 12 ] and Lee, et al [ 13 ] also decolonized their patients. Lee, et al [ 13 ] also observed that, except in clean surgical wards, ADI and decolonization alone were not effective, nor was enhanced hand hygiene.…”

Section: Reviewmentioning

confidence: 99%

Viewpoint: a response to “Screening and isolation to control methicillin-resistant Staphylococcus aureus: sense, nonsense, and evidence”

Kavanagh

Calderon

Saman

2015

Antimicrob Resist Infect Control

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Surveillance and isolation for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) has become a controversial topic, one that causes heated debate and appears to be surrounded by both politics and industrial conflicts-of-interest. There have been calls from numerous authors for a movement away from rigid mandates and toward an evidence-based medicine approach. However, much of the evidence can be viewed with an entirely different interpretation. Two major studies with negative findings have had an adverse impact on recommendations regarding active detection and isolation (ADI) for MRSA. However the negative findings in these studies can be explained by shortcomings in study implementation rather than the ineffectiveness of ADI. The use of daily chlorhexidine bathing has also been proposed as an alternative to ADI in ICU settings. There are shortcomings regarding the evidence in the literature concerning the effectiveness of daily chlorhexidine bathing. One of the major concerns with universal daily chlorhexidine bathing is the development of bacterial resistance. The use of surveillance and isolation to address epidemics and common dangerous pathogens should solely depend upon surveillance and isolation’s ability to prevent further spread to and infection of other patients through indirect contact. At present, there is a preponderance of evidence in the literature to support continuing use of surveillance and isolation to prevent the spread of MRSA.

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Long-Term Control of Endemic Hospital-Wide Methicillin-ResistantStaphylococcus aureus(MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

Cited by 30 publications

References 38 publications

Traumatic Injury, Early Gene Expression, and Gram-Negative Bacteremia*

Traumatic Injury, Early Gene Expression, and Gram-Negative Bacteremia*

Estratégia para Controlar o Staphylococcus Aureus Resistente à Meticilina: A Experiência de Cinco Anos de um Hospital

Viewpoint: a response to “Screening and isolation to control methicillin-resistant Staphylococcus aureus: sense, nonsense, and evidence”

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