Spread Of Multidrug-resistant Bacteria Research Articles

3D impedimetric sensors as a tool for monitoring bacterial response to antibiotics.

The presence of antimicrobial contaminants like antibiotics in the environment is a major concern because they promote the emergence and the spread of multidrug resistant bacteria. Since the conventional systems for the determination of bacterial susceptibility to antibiotics rely on culturing methods that require long processing times, the implementation of novel strategies is highly required for fast and point-of-care applications. Here the development and characterization of a novel label-free biosensing platform based on a microbial biosensor approach to perform antibiotic detection bioassays in diluted solution is presented. The microbial biosensor is based on a three-dimensional interdigitated electrode array (3D-IDEA) impedimetric transducer with immobilized E. coli bacteria. In 3D-IDEA to increase the sensitivity to superficial impedance changes the electrode digits are separated by insulating barriers. A novel strategy is employed to selectively immobilize bacteria in the spaces over the electrode digits between the barriers, referred to here as trenches, in order to concentrate bacteria, improve the reproducibility of the E. coli immobilization and increase the sensitivity for monitoring bacterial response. For effective attachment of bacteria within the trenches an initial anchoring layer of a highly charged polycation, polyethyleneimine (PEI), was used. To facilitate immobilization of bacteria within the trenches and prevent their deposition on top of the barriers an important novelty is the use of poly(N-isopropylmethacrylamide) p(NIPMAM) microgels working as antifouling agents, deposited on top of the barriers by microcontact printing. The reported microbial biosensor approach allows the bacterial response to ampicillin, a bacteriolytic antibiotic, to be registered by means of impedance variations in a rapid and label-free operation that enables new possibilities in bioassays for toxicity testing.

Molecular epidemiology & therapeutic options of carbapenem-resistant Gram-negative bacteria.

Background & objectives:The growing incidence and the wide diversity of carbapenemase-producing bacterial strains is a major concern as only a few antimicrobial agents are active on carbapenem-resistant bacteria. This study was designed to study molecular epidemiology of carbapenem-resistant Gram-negative bacterial (GNB) isolates from the community and hospital settings.Methods:In this study, non-duplicate GNB were isolated from clinical specimens, and phenotypic test such as modified Hodge test, metallo β-lactamase E-strip test, etc. were performed on carbapenem-resistant bacteria. Multiplex PCR was performed to identify the presence of blaIMP, blaVIM, blaKPC, blaOXA48, blaOXA23, blaSPM, blaGIM, blaSIM and blaNDM. Minimum inhibitory concentration (MIC) of colistin, fosfomycin, minocycline, chloramphenicol and tigecycline was also determined.Results:Of the 3414 GNB studied, carbapenem resistance was 9.20 per cent and maximum resistance (11.2%) was present at tertiary care centre, followed by secondary care (4%) and primary centre (2.1%). Among the carbapenem-resistant bacteria, overall, the most common isolate was Pseudomonas aeruginosa (24%). On multiplex PCR 90.3 per cent carbapenem-resistant isolates were positive for carbapenemase gene. The blaNDM (63%) was the most prevalent gene followed by blaVIM (18.4%). MIC results showed that 88 per cent carbapenem-resistant Enterobacteriaceae were sensitive to fosfomycin, whereas 78 per cent of P. aeruginosa and 85 per cent Acinetobacter spp. were sensitive to colistin.Interpretation & conclusions:Carbapenem resistance in GNB isolates from the community and hospital settings was found to be on the rise and should be closely monitored. In the absence of new antibiotics in pipeline and limited therapeutic options, prudent use of antibiotics and strict infection control practices should be followed in hospital to limit the emergence and spread of multidrug-resistant bacteria.

Universal decolonization with octenidine: First experiences in a tertiary burn intensive care unit

BackgroundBurn patients are predisposed for nosocomial infections during their stay on a burn intensive care unit. Moreover, several outbreaks affecting burn units for example caused by Methicillin-resistant Staphylococcus aureus (MRSA) have been reported. One attempt to address these challenges is the use of universal decolonization. MethodsIn 2015 we implemented universal decolonization for all burn patients using the antiseptic agent octenidine for intact skin and the nasopharyngeal mucosa. We conducted a retrospective analysis to evaluate the effect of the decolonization on primary, central line (central venous catheter)-associated bloodstream infections (CLABSI), the frequency of nosocomial clusters (4 or more cases with epidemiologic link and identical molecular pattern) with multidrug-resistant bacteria (MDRB) and the incidence of MRSA. ResultsIn the decolonization period a reduction of the incidence of CLABSI, nosocomial MRSA acquisition and the frequency of nosocomial MDRB clusters was observed. The incidence rate of CLABSI decreased from 2/1000 central venous catheter days in the pre-decolonization phase to 0.8/1000 central venous catheter days in the decolonization period, although this was not statistically significant. The implementation was accompanied by several feedback talks and training for the staff. The user experience was positive and no adverse effects occurred. ConclusionOur results show that universal decolonization in burn patients using octenidine is a promising concept to address hospital acquisition of MRSA; occurrence of CLABSI as well as the spread of MDRB causing clusters. It is of high relevance to further assess the value of this measure in terms of reducing CLABSI in burn patients in larger study groups. Therefore further studies including more burn patients guaranteeing adequate sample size are needed.

Novel 3D Structure Based Model for Activity Prediction and Design of Antimicrobial Peptides

The emergence and worldwide spread of multi-drug resistant bacteria makes an urgent challenge for the development of novel antibacterial agents. A perspective weapon to fight against severe infections caused by drug-resistant microorganisms is antimicrobial peptides (AMPs). AMPs are a diverse class of naturally occurring molecules that are produced as a first line of defense by all multi-cellular organisms. Limited by the number of experimental determinate 3D structure, most of the prediction or classification methods of AMPs were based on 2D descriptors, including sequence, amino acid composition, peptide net charge, hydrophobicity, amphiphilic, etc. Due to the rapid development of structural simulation methods, predicted models of proteins (or peptides) have been successfully applied in structure based drug design, for example as targets of virtual ligand screening. Here, we establish the activity prediction model based on the predicted 3D structure of AMPs molecule. To our knowledge, it is the first report of prediction method based on 3D descriptors of AMPs. Novel AMPs were designed by using the model, and their antibacterial effect was measured by in vitro experiments.

Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations.

The spread of multidrug-resistant bacteria in resource-poor settings affects the military medical service in case of deployments of soldiers to war and crisis zones. Patients with war injuries are prone to colonization or infection with multidrug-resistant bacteria. Resistant Gram-negative bacteria play a dominant role in military wound infections. Problematic hygiene conditions on deployment facilitate exposition of soldiers with subsequent colonization. Although colonizing strains are frequently cleared from their hosts after returning from deployment, transmission to close contacts of the soldiers in the home country cannot be excluded and therapeutic options are reduced if colonization progresses to invasive infection. Since sophisticated culture-based diagnostic approaches are typically not available in the field setting on deployment, molecular rapid diagnostic test systems are an option for transmission control if the locally prevalent molecular resistance mechanisms are known. Efforts for global resistance surveillance can contribute to better understanding of resistance distribution and spread at deployment sites. This review summarizes experience of the military medical services with multidrug resistance on deployment and with the influx of resistant strains to the home country and discusses potential use of available molecular rapid test systems as an option for the field setting.

Incidence of Resistance Phenotypes of Escherichia coli Strains Isolated from an Obstetrics and Gynecology Unit Unicentric Prospective Transversal Study

Multiple microbial resistance is a global alarming phenomenon in modern medicine, which is experiencing a decrease in the therapeutic options and in the rate of discovery of new antimicrobials. The aim of this study was to analyze the incidence of Escherichia coli resistance phenotypes to suitable antimicrobial chemotherapies in strains isolated from urine samples. The study was conducted between 01.04.2016 and 31.03.2017 in the Department of Microbiology of the Municipal Emergency Clinical Hospital of Timisoara - Obstetrics and Gynecology unit. We used 1931 urine samples collected from the patients in this department. Identification of pathogens was performed on the API system, and chemotherapy sensitivity testing was based on the disk diffusion method. Of the 1931 urine samples, 210 were non-sterile (94 samples from the obstetrics department, 116 from the gynaecology department). The identified pathogens were Staphylococcus aureus (7 samples), coagulase-negative staphylococci (7 samples), Streptococcus spp. (37 samples), Escherichia coli (138 samples), Klebsiella spp. (9 samples), Proteus spp. (6 samples), Serratia spp. (6 samples). The identified resistance phenotypes for Escherichia coli strains were: wild-type strains (36) 25.92%, penicillinase-secreting strains (50) 35.84%, penicillinase-hypersecreting strains (26) 18.91% cephalosporinases (11) 7.98%, ESBL-producing strains (15) 11.17%. The prevention and spread of multidrug-resistant bacteria requires knowledge of bacterial resistance mechanisms and the development and application of appropriate in-hospital protocols.

Clinical impact of rapid bacterial identification by MALDI-TOF MS combined with the bêta-LACTA™ test on early antibiotic adaptation by an antimicrobial stewardship team in bloodstream infections

Background: Bloodstream infections (BSI) can potentially be life-threatening infections and are associated with a high crude mortality, moreover with an inappropriate first-line antibiotic therapy. Bacterial resistance is more and more frequently observed. New strategies of BSI management are urgently needed.Materials and methods: During an 18-months period, we prospectively evaluated the clinical impact of rapid bacterial identification by MALDI-TOF MS technology combined with an antimicrobial stewardship team (AST) intervention. Furthermore, during an 8-months period, we combined this strategy with the rapid detection of third-generation cephalosporin (3GC) resistance by the Bêta-LACTA™ test (BLT) directly on blood cultures. We then evaluated the theoretical impact of BLT on antibiotic therapy adaptation and establishment of infection control measures.Results: A total of 335 blood cultures were enrolled during the study. MALDI-TOF MS gave accurate identification for 301 blood cultures (89,8%) and led to early antibiotic therapy adaptation for 73 episodes (21.8%). BLT was performed on 141 blood cultures, revealing 28 3GC-resistant bacteria (19.9%). Twenty-one patients (75%) received a non-adapted first-line treatment. The antibiotic therapy adaptation was delayed by 28.1 hours and the establishment of infection control measures by 35 hours with antimicrobial susceptibility testing, compared to the theoretical adaptation with BLT result.Conclusions: These tools can be included in a strategy of bloodstream infections management for a better patient care, optimizing and saving the use of antibiotics, notably carbapenems as well as diminishing the spread of multi-drug resistant bacteria by applying rapidly infection control measures.

Bacterial Infections in Neonates, Madagascar, 2012-2014.

Severe bacterial infections are a leading cause of death among neonates in low-income countries, which harbor several factors leading to emergence and spread of multidrug-resistant bacteria. Low-income countries should prioritize interventions to decrease neonatal infections; however, data are scarce, specifically from the community. To assess incidence, etiologies, and antimicrobial drug–resistance patterns of neonatal infections, during 2012–2014, we conducted a community-based prospective investigation of 981 newborns in rural and urban areas of Madagascar. The incidence of culture-confirmed severe neonatal infections was high: 17.7 cases/1,000 live births. Most (75%) occurred during the first week of life. The most common (81%) bacteria isolated were gram-negative. The incidence rate for multidrug-resistant neonatal infection was 7.7 cases/1,000 live births. In Madagascar, interventions to improve prevention, early diagnosis, and management of bacterial infections in neonates should be prioritized.

Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit

BackgroundCross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU.MethodsWe performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room). These periods were compared with respect to the occurrence of representative MDR Gram-negative bacteria. Routine microbiological screening, was performed on all patients on admission to the ICU and then twice a week. Multi-drug resistance was defined according to a national guideline. The first isolates per patient that met the MDR-criteria, detected during the ICU admission were included in the analysis. To investigate the clonality, isolates were genotyped by DiversiLab (bioMérieux, France) or Amplified Fragment Length Polymorphism (AFLP). To guarantee the comparability of the two periods, the ‘before’ and ‘after’ periods were chosen such that they were approximately identical with respect to the following factors: number of admissions, number of beds, bed occupancy rate, per year and month.ResultsDespite infection prevention efforts, high prevalence of MRD bacteria continue to occur in the original facility. A marked and sustained decrease in the prevalence of MDR-GN bacteria was observed after the migration to the new ICU, while there appear to be no significant changes in the other variables including bed occupancy and numbers of patient admissions.ConclusionSingle room ICU design contributes significantly to the reduction of cross transmission of MRD-bacteria.

Characterization of Four Multidrug Resistance Plasmids Captured from the Sediments of an Urban Coastal Wetland

Self-transmissible and mobilizable plasmids contribute to the emergence and spread of multidrug-resistant bacteria by enabling the horizontal transfer of acquired antibiotic resistance. The objective of this study was to capture and characterize self-transmissible and mobilizable resistance plasmids from a coastal wetland impacted by urban stormwater runoff and human wastewater during the rainy season. Four plasmids were captured, two self-transmissible and two mobilizable, using both mating and enrichment approaches. Plasmid genomes, sequenced with either Illumina or PacBio platforms, revealed representatives of incompatibility groups IncP-6, IncR, IncN3, and IncF. The plasmids ranged in size from 36 to 144 kb and encoded known resistance genes for most of the major classes of antibiotics used to treat Gram-negative infections (tetracyclines, sulfonamides, β-lactams, fluoroquinolones, aminoglycosides, and amphenicols). The mobilizable IncP-6 plasmid pLNU-11 was discovered in a strain of Citrobacter freundii enriched from the wetland sediments with tetracycline and nalidixic acid, and encodes a novel AmpC-like β-lactamase (blaWDC-1), which shares less than 62% amino acid sequence identity with the PDC class of β-lactamases found in Pseudomonas aeruginosa. Although the IncR plasmid pTRE-1611 was captured by mating wetland bacteria with P. putida KT2440 as recipient, it was found to be mobilizable rather than self-transmissible. Two self-transmissible multidrug-resistance plasmids were also captured: the small (48 kb) IncN3 plasmid pTRE-131 was captured by mating wetland bacteria with Escherichia coli HY842 where it is seemed to be maintained at nearly 240 copies per cell, while the large (144 kb) IncF plasmid pTRE-2011, which was isolated from a cefotaxime-resistant environmental strain of E. coli ST744, exists at just a single copy per cell. Furthermore, pTRE-2011 bears the globally epidemic blaCTX-M-55 extended-spectrum β-lactamase downstream of ISEcp1. Our results indicate that urban coastal wetlands are reservoirs of diverse self-transmissible and mobilizable plasmids of relevance to human health.

Prevalence of Multidrug Resistant Bacteria in Refugees: A Prospective Case Control Study in an Obstetric Cohort

Purpose To determine the prevalence of multidrug resistant (MDR) bacteria in a cohort of pregnant refugee women. Methods In a prospective case control study, surveillance cultures for MDR bacteria (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], MDR Gram-negative bacteria [MRGN]) were analysed between October 2015 and June 2016 from a cohort of 50 pregnant refugee women and 50 resident controls in the obstetric unit of a German tertiary referral hospital. Results Prevalence of MRSA was noticeably higher among refugee women compared to residents (6 vs. 0%). In addition, a trend towards a higher prevalence of VRE and MDR Gram-negative bacteria in refugees was shown (1.8 vs. 0%). Conclusions Due to the higher prevalence of MDR bacteria, surveillance cultures are justified in order to prevent nosocomial spread of MDR bacteria.

The Impact of Antibiotic Stewardship Programs in Combating Quinolone Resistance: A Systematic Review and Recommendations for More Efficient Interventions.

Quinolones are among the most commonly prescribed antibiotics worldwide. A clear relationship has been demonstrated between excessive quinolone use and the steady increase in the incidence of quinolone-resistant bacterial pathogens, both in hospital and community sites. In addition, exposure to quinolones has been associated with colonization and infection with healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus and Clostridium difficile in hospitalized patients. Therefore, the management of quinolone prescribing in hospitals through antibiotic stewardship programs is considered crucial. Although suggestions have been made by previous studies on the positive impact of stewardship programs concerning the emergence and spread of multidrug-resistant bacteria at hospital level, the association of quinolone-targeted interventions with reduction of quinolone resistance is vague. The purpose of this article was to evaluate the impact of stewardship interventions on quinolone resistance rates and healthcare-associated infections, through a literature review using systematic methods to identify and select the appropriate studies. Recommendations for improvements in quinolone-targeted stewardship programs are also proposed. Efforts in battling quinolone resistance should combine various interventions such as restriction formulary policies, prospective audits with feedback to prescribers, infection prevention and control measures, prompt detection of low-level resistance, educational programs, and guidelines for optimal quinolone usage. However, the effectiveness of such strategies should be assessed by properly designed and conducted clinical trials. Finally, novel approaches in diagnostic stewardship for rapidly detecting bacterial resistance, including PCR-based techniques, mass spectrometry, microarrays, and whole-genome sequencing as well as the prompt investigation on the clonality of quinolone-resistant strains, will strengthen our ability to personalize quinolone prescribing to individual patients.

Correlation between antibiotic consumption and resistance of bloodstream bacteria in a University Hospital in North Eastern Italy, 2008-2014.

The spread of multidrug-resistant bacteria is a worrisome problem worldwide. This study investigated the correlation between antibiotic consumption and antimicrobial resistance trends of the most important bacteria causing bacteremia at the University hospital of Trieste, Italy, from 2008 to 2014. Antibiotic consumption (Defined Daily Dose-DDD-per 100 patient/days) and antibiotic resistance (percentage of antibiotic intermediate o resistant isolates) were analyzed independently with linear correlation by year. Potential correlations between antibiotic consumption and bacteria resistance rates were investigated through the Pearson's correlation. The overall consumption of antibiotic grew from 80 to 97 DDD 100 patient/days (p=0.005) during the study period. The increased consumption of amoxicillin/clavulanate and piperacillin/tazobactam was associated with the reduction of MRSA rate from 48.5 to 25.9% (p=0.007 and p=0.04, respectively). The increased consumption of piperacillin/tazobactam was associated with the reduction of ESBL-positive Enterobacteriaceae rate from 28.9 to 20.9% (p=0.01). The increased consumption of carbapenems was associated with the increased rate of carbapenem-resistant Acinetobacter baumannii from 0 to 96.4% (p=0.03). No carbapenem-resistant Enterobacteriaceae isolates were reported. The consumption of vancomycin grew significantly (p=0.005). A dramatic spread of vancomycin-resistant Enterococcus faecium occurred in 2014. The consumption of fluoroquinolones and extended-spectrum cephalosporins remained stable. An antibiotic stewardship program targeted to limit the consumption of extended-spectrum cephalosporins and fluoroquinolones in favor of amoxicillin/clavulanate and piperacillin/tazobactam correlates with a decreasing rate of MRSA and ESBL-positive Enterobacteriaceae. The analysis of correlations between antibiotic consumption and bacterial resistance rates is a useful tool to orient antimicrobial stewardship policies at local level.

Nonviral Genome Editing Based on a Polymer-Derivatized CRISPR Nanocomplex for Targeting Bacterial Pathogens and Antibiotic Resistance.

The overuse of antibiotics plays a major role in the emergence and spread of multidrug-resistant bacteria. A molecularly targeted, specific treatment method for bacterial pathogens can prevent this problem by reducing the selective pressure during microbial growth. Herein, we introduce a nonviral treatment strategy delivering genome editing material for targeting antibacterial resistance. We apply the CRISPR-Cas9 system, which has been recognized as an innovative tool for highly specific and efficient genome engineering in different organisms, as the delivery cargo. We utilize polymer-derivatized Cas9, by direct covalent modification of the protein with cationic polymer, for subsequent complexation with single-guide RNA targeting antibiotic resistance. We show that nanosized CRISPR complexes (= Cr-Nanocomplex) were successfully formed, while maintaining the functional activity of Cas9 endonuclease to induce double-strand DNA cleavage. We also demonstrate that the Cr-Nanocomplex designed to target mecA-the major gene involved in methicillin resistance-can be efficiently delivered into Methicillin-resistant Staphylococcus aureus (MRSA), and allow the editing of the bacterial genome with much higher efficiency compared to using native Cas9 complexes or conventional lipid-based formulations. The present study shows for the first time that a covalently modified CRISPR system allows nonviral, therapeutic genome editing, and can be potentially applied as a target specific antimicrobial.

First Report of bla CTX-M-15-Type ESBL-Producing Klebsiella pneumoniae in Wild Migratory Birds in Pakistan

We investigated wild migratory birds faecal swabs for extended-spectrum β-lactamases-producing Klebsiella pneumoniae (ESBL-K. pneumoniae) from wetland habitats in Pakistan. ESBL-K. pneumoniae were analysed for MDR phenotype, ESBL genotype and genetic diversity. A total of 13 (8.6%) ESBL-K. pneumoniae were recovered. Of these, 8 (61%) isolates were MDR. DNA sequencing confirmed bla CTX-M-15 as the dominant ESBL genotype. BOX-PCR fingerprints showed most of the isolates are unrelated. This study is the first to report the wildlife contamination of CTX-M-15-producing K. pneumoniae in Pakistan. Due to long-range migration, these birds could be responsible for trans-boundary spread of multidrug-resistant bacteria.

Evolution of Antimicrobial Resistance in Europe: A Factual Review

Introduction and Objectives: The objective of this study was to conduct a review from the literature of the emergence of antimicrobial resistance, the spread of bacteria, their mutations, and policy strategies for the prevention and control of bacterial infections in Europe. Materials and methods: A bibliographic survey was conducted for 2001 to 2016 on the Medline, Lilacs, Scielo, and Google Scholar databases; WHO reports-World Health Organization, ECDC - European Center for Disease Prevention and Control; SNS-National Health Service-Portuguese Republic and basic technical literature books. Searches were conducted in the Portuguese and English language. Results: Resistance to antibiotics has been a worldwide public health problem. The European continent has suffered from the spread of multi-drug resistant bacteria. The literature indicates that antimicrobial resistance has increased significantly and that several factors are responsible for this increased resistance, such as the indiscriminate use of antibiotics in both animal food production and human health care, and that the agents of greatest epidemiological significance in Europe are methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), Enterobacteriaceae producing ESBLs, Acinetobacter spp and Pseudomonas spp. Conclusion: Proper and rational use of antibiotics is of the utmost importance at present to avoid an epidemic of bacterial infections. Controlling the spread of resistant bacteria depends not only on correct therapeutic use, but also on basic measures of extreme importance.

Влияние ареницинов и других β-шпилечных АНТИмикробных пептидов на биоплёнки бактерий <i>Pseudomonas aeruginosa</i> PAO1

Одной из ключевых проблем современной медицины является распространение штаммов бактерий, обладающих множественной устойчивостью к различным классам антибиотиков. Высокая устойчивость бактерий к действию антибиотических препаратов обусловлена, в частности, их способностью к формированию биоплёнок. В связи с этим необходим поиск новых антимикробных соединений, эффективно действующих на патогенные бактерии независимо от их метаболической активности, физиологических свойств и локализации. Среди таких веществ особый интерес представляют катионные антимикробные пептиды (АМП). Целью данной работы было изучение антибиоплёночной активности ареницина-1 и полученного нами его терапевтически ценного аналога V8R в сравнении с рядом известных β-шпилечных АМП животного происхождения. Показано, что многие β-шпилечные АМП в микромолярном диапазоне концентраций полностью подавляют не только планктонный рост, но и образование биоплёнок Pseudomonas aeruginosa PAO1, а также убивают бактерии внутри биоплёнок, вызывая при этом их деградацию.

Antimicrobial resistance in Saudi Arabia. An urgent call for an immediate action.

Antimicrobial resistance (AMR) is increasingly being highlighted as an urgent public and animal health issue worldwide. This issue is well demonstrated in bacteria that are resistant to last-line antibiotics, suggesting a future with untreatable infections. International agencies have suggested combating strategies against AMR. Saudi Arabia has several challenges that can stimulate the emergence and spread of multidrug-resistant bacteria. Tackling these challenges need efforts from multiple sectors to successfully control the spread and emergence of AMR in the country. Actions should include active surveillance to monitor the emergence and spread of AMR. Infection prevention and control precautions should also be optimized to limit further spread. Raising awareness is essential to limit inappropriate antibiotics use, and the antibiotic stewardship programs in hospital settings, outpatients, and community pharmacies, should regulate the ongoing use of antimicrobials.

Bed occupancy and hospital mortality

British Journal of Healthcare ManagementVol. 22, No. 7 Money MattersBed occupancy and hospital mortalityRod JonesRod JonesSearch for more papers by this authorRod JonesPublished Online:18 Jul 2016https://doi.org/10.12968/bjhc.2016.22.7.380AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Boyle J, Zeitz K, Hoffman R, Khanna S, Beltrame J et al. (2013) Probability of severe adverse events as a function of hospital occupancy. IEEE J Biomed Health Inform 18(1): 15–20. doi: https://doi.org/10.1109/JBHI.2013.2262053. Crossref, Google ScholarGriffiths P, Ball J, Murrells T et al. (2015) Registered nurse, healthcare support workers, medical staffing levels and mortality in English hospital trusts: a cross-sectional study. BMJ Open 5: e008751. doi: https://doi.org/10.1136/bmjopen-2015-008751 Crossref, Google ScholarHealth and Social Care Information Centre (2016) Summary Hospital-level Mortality Indicator. Available at: www.hscic.gov.uk/SHMI (accessed 15 June 2016) Google ScholarJones R (2011) Hospital bed occupancy demystified and why hospitals of different size and complexity must operate at different average occupancy. BJHCM 17(6): 242–8 Google ScholarJones R (2013) Optimum bed occupancy in psychiatric hospitals. www.priory.com/psychiatry/psychiatric_beds.htm (accessed 15 June 2016) Google ScholarJones R (2015) Recurring outbreaks of an infection apparently targeting immune function, and consequent unprecedented growth in medical admission and costs in the United Kingdom: A review. British Journal of Medicine and Medical Research 6(8): 735–70. doi: https://doi.org/10.9734/BJMMR/2015/14845 Crossref, Google ScholarJones R (2016a) Hospital bed occupancy and deaths (all-cause mortality) in 2015. BJHCM 22(5): 283–5 Google ScholarJones R (2016b) Is cytomegalovirus involved in recurring periods of higher than expected death and medical admissions, occurring as clustered outbreaks in the northern and southern hemispheres? British Journal of Medicine and Medical Research 11(2): 1–31. doi: https://doi.org/10.9734/BJMMR/2016/20062 Crossref, Google ScholarKaier K, Meyer E, Dettenkofer M, Frank U (2010) Epidemiology meets econometrics: using time-series analysis to observe the impact of bed occupancy rates on the spread of multidrug-resistant bacteria. J Hosp Infect 76(2): 108-13. doi: https://doi.org/10.1016/j.jhin.2010.04.010 Crossref, Google ScholarKaier K, Mutters N, Frank U (2012) Bed occupancy rates and hospital-acquired infections – should beds be kept empty? Clin Microbiol Infect 18(10): 941–5. doi: https://doi.org/10.1111/j.1469-0691.2012.03956.x Crossref, Google ScholarKuntz L, Mennicken R, Scholtes S (2014) Stress on the ward: Evidence for safety tipping points in hospitals. Manage Sci 61: 754-771. doi: https://doi.org/10.1287/mnsc.2014.1917 Crossref, Google ScholarNHS England (2016) Bed availability and occupancy data. https://www.england.nhs.uk/statistics/statistical-work-areas/bed-availability-and-occupancy/bed-data-overnight/ (accessed 15 June 2016) Google ScholarOzdemir B, Sinha S, Karthikesalingam A, et al. (2016) Mortality of emergency general surgical patients and associations with hospital structures and processes. Brit J Anaesthesia 116(1): 1–9. doi: https://doi.org/10.1093/bja/aev372 Crossref, Google ScholarPublic Health England (2016) National End of Life Care Intelligence Network. www.endoflifecare-intelligence.org.uk/data_sources/place_of_death (accessed Google ScholarTeitelbaum A, Lahad A, Calfon N, Gun-Usishkin M, Lubin G, Tsur A (2016) Overcrowding in psychiatric wards is associated with increased risk of adverse events. Medical Care 54(3): 296–302. doi: https://doi.org/10.1097/MLR.0000000000000501 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 July 2016Volume 22Issue 7ISSN (print): 1358-0574ISSN (online): 1759-7382 Metrics History Published online 18 July 2016 Published in print 2 July 2016 Information© MA Healthcare LimitedPDF download

Wireless Microcurrent-Generating Antimicrobial Wound Dressing in Primary Total Knee Arthroplasty: A Single-Center Experience.

The spread of multidrug-resistant bacteria and financial burden of periprosthetic joint infection (PJI) further the need for treatments to address pathogenic contamination and expedite healing. This retrospective study was a chart review of a series of 92 patients who underwent 100 total knee arthroplasties performed by the same surgeon and treated with a novel microcurrent-generating antimicrobial dressing (MCD). Mean hospital length of stay was 2.3±0.9 days, while the mean length of treatment with MCD was 8.3±1.2 days. No major complications, PJI or major infectious complications were reported, with two readmissions (2%) within 30 days of surgery. Knee Society Score function showed statistically significant improvements post-operatively, with a mean six-month score of 75.0±20.3 and mean change from baseline of 36.3±21.1 (P<0.0001). These results support previous findings that use of the MCD may result in improved outcomes as an element in post-operative wound management.