Presence Of Multidrug-resistant Organisms Research Articles

Quantifying patient bacterial exposure risk from reusable phlebotomy tourniquets in a New Zealand secondary level hospital.

This study aimed to assess for the presence of multi-drug resistant organisms (MDROs) on tourniquets and quantify the number of bacteria to which patients might be exposed with each blood collection episode. Tourniquets were randomly sampled in a 246-bed, secondary level, New Zealand hospital, which is currently non-endemic for MDROs. A 6-cm length of each tourniquet sampled was applied to the surface of an agar plate and the colony forming units (CFUs) were enumerated. All colonies were then screened for MDROs using standard methods. CFU counts per linear centimetre were multiplied by a range of patient arm circumference measurements. Comparison was also made between non-disinfected tourniquets left on the wards and phlebotomy service tourniquets after daily decontamination with a proprietary disinfectant. The median exposure risk from non-disinfected tourniquets was 173 CFUs per collect (95% CI, 104-861). None of the general ward tourniquets grew any MDROs but four out of five dedicated, single-patient reusable isolation room tourniquets grew MRSA. Disinfected tourniquets had few if any CFUs and CFU counts were significantly lower than non-disinfected tourniquets (P = 0.0001). The quantitative risk from reusable tourniquets appears low in the setting of MDRO non-endemicity, with the application of standard infection control practices.

English

CONTEXT: Infection in burn patients is the leading cause of morbidity and mortality, and remains one of the most challenging concerns for the burn team. The bacteriology of burn wounds is often polymicrobial in nature, and the presence of multi-drug resistant organisms is associated with poor response to antimicrobial therapy, high risk of bacterial sepsis, multi-organ failure and death following burn injury. AIM: This study analyzes the bacterial isolates from burn wounds and their antimicrobial sensitivity patterns. MATERIALS AND METHODS: Three hundred randomly selected patients with varying degrees of burn injuries, admitted to the burn unit of a tertiary care hospital in Patna, were included in this study. Wound swab/pus/debrided tissue cultures were assessed at weekly intervals. Seven hundred and thirty six samples were eventually collected and analyzed in this study. The samples were cultured on 5% sheep blood agar and Mac Conkey agar for isolation of organisms. Antimicrobial sensitivity test was performed on Mueller Hinton agar by the disk diffusion method. RESULTS: Patients between 30-40 years of age were more prone to burn injury. Females outnumbered males as regards prevalence of burn cases. Positive wound cultures were obtained in 631 (85.7%) cases. Staphylococcus aureus (40.4%) was the most common isolate in the first week, but was replaced by Pseudomonas spp. in the second (26.0%) and third (28.8%) post-burn weeks. High level resistance to oxacillin was observed in Staphylococcus aureus and Coagulase negative Staphylococci. Vancomycin was the most effective drug for the gram positive isolates. Pseudomonas and Acinetobacter isolates were resistant to most of the drugs tested. Imipenem was effective against all the gram negative isolates. CONCLUSIONS: It is crucial for every burn unit to determine the specific pattern of burn wound microbial colonization, time-related changes in the dominant flora and their antimicrobial sensitivity profiles. This would enable early treatment of imminent septic episodes with proper empirical antibiotics, without waiting for culture reports, thus improving the overall infection- related morbidity and mortality.

Risk factors and healing impact of multidrug-resistant bacteria in diabetic foot ulcers

Aim To determine the risk factors for acquiring multidrug-resistant organisms (MDRO) and their impact on outcome in infected diabetic foot ulcers. Methods Patients hospitalized in our diabetic foot unit for an episode of infected foot ulcer were prospectively included. Diagnosis of infection was based on clinical findings using the International Working Group on the Diabetic Foot–Infectious Diseases Society of America (IWGDF–ISDA) system, and wound specimens were obtained for bacterial cultures. Each patient was followed-up for 1 year. Univariate analysis was performed to compare infected ulcers according to the presence or absence of MDRO; logistic regression was used to identify explanatory variables for MDRO presence. Factors related to healing time were evaluated by univariate and multivariate survival analyses. Results MDRO were isolated in 45 (23.9%) of the 188 patients studied. Deep and recurrent ulcer, previous hospitalization, HbA 1c level, nephropathy and retinopathy were significantly associated with MDRO-infected ulceration. By multivariate analysis, previous hospitalization (OR = 99.6, 95% CI = [19.9–499.0]) and proliferative retinopathy (OR = 7.4, 95% CI = [1.6–33.7]) significantly increased the risk of MDRO infection. Superficial ulcers were associated with a significant decrease in healing time, whereas neuroischaemic ulcer, proliferative retinopathy and high HbA 1c level were associated with an increased healing time. In the multivariate analysis, presence of MDRO had no significant influence on healing time. Conclusion MDRO are pathogens frequently isolated from diabetic foot infection in our foot clinic. Nevertheless, their presence appears to have no significant impact on healing time if early aggressive treatment, as in the present study, is given, including empirical broad-spectrum antibiotic treatment, later adjusted according to microbiological findings.

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Mortality from battlefield wounds has historically declined, thanks to better surgical management, faster transport of casualties, and improved antibiotics. Today, one of the major challenges facing U.S. military caregivers is the presence of multidrug-resistant organisms in orthopaedic extremity wounds. The most frequently identified resistant strains of bacteria are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex. Overuse of broad-spectrum antibiotics may be an important factor in building resistant strains. Acinetobacter infections appear to hospital-acquired and not from an initial colonization of the injury. More research is required to give military physicians the tools they require to reduce the infection rate and defeat multidrug-resistant organisms.

A Needs Assessment: Infection Control Practices in Home Healthcare and Current Standards of Care

ISSUE: There is little research evidence on infection control practices in home healthcare agencies. Clinical guidelines set for acute- and long-term-care institutions have been used to “bridge the gap” to the home-care setting. Very little research evidence exists regarding the use of supplies for wound care and best practices in the home-care setting. PROJECT: A needs assessment was conducted to assess both the extent of the problem of wound care supplies in the home and the microbiological impact on patients with special emphasis placed on the presence of multidrug-resistant organisms. Items that the home-care nurses take from home to home as possible sources of fomites were examined, especially when multidrug-resistant organisms from institutions have been identified. RESULTS: Clearly, the needs assessment established that the extent of the problem of wound care supplies in the home, and guidelines for the treatment of wound infections in the home, require more research. The one research study done on bacterial contamination and wound care supplies found that bacteria were present in 75% of all wound care supplies left in homes for 7 days or more. Further research is necessary in this area to provide agencies with sound scientific data and to serve as guidelines for the development of evidence-based policies and procedures. LESSONS LEARNED: A tool for the quantification of the living conditions of the home-healthcare patients must be generated. Strong evidence can be provided for cause-and-effect relationships, with control of potential bias in the measurement of predictor variables.