Pub Date : 2025-01-11DOI: 10.1016/j.idnow.2025.105025
Arthur Charazac , Raphael Delage , Maxime Pichon , Laure Kamus , Benoit Pichard , Laura Peyret-Moreau , Olivier Belmonte , Guillaume Miltgen , Christophe Burucoa
Introduction
The increasing resistance of Helicobacter pylori to clarithromycin leads to an ongoing adaptation of empirical first-line treatment for H. pylori infections.
Patients and methods
Prospective study (2022–2023) of 364 patients with no previous treatment for H. pylori infection, addressed for gastroduodenal endoscopy to the University Hospital of Reunion Island.
Results
PCR tests (AllplexTMH. pylori & ClariRAssay, Seegene) performed on gastric biopsy samples detected H. pylori DNA in 100 samples (100/364; 27.5 %) and mutations conferring resistance to clarithromycin in 10 of the positive samples (10/100; 10 %). Prevalence of resistance determined by MICs (E-test method) was 41.2 % for metronidazole, 13.2 % for levofloxacin, 8.8 % for clarithromycin. No resistance was detected for tetracycline, rifampicin, and amoxicillin.
Conclusion
The prevalence of primary clarithromycin-resistant H. pylori in Reunion Island is below 15 %. Recommendation for the standard clarithromycin-based triple therapy as a first-line treatment can thus be maintained, even though antimicrobial susceptibility testing seems preferable.
{"title":"Low-level primary clarithromycin resistance of Helicobacter pylori in Reunion Island","authors":"Arthur Charazac , Raphael Delage , Maxime Pichon , Laure Kamus , Benoit Pichard , Laura Peyret-Moreau , Olivier Belmonte , Guillaume Miltgen , Christophe Burucoa","doi":"10.1016/j.idnow.2025.105025","DOIUrl":"10.1016/j.idnow.2025.105025","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing resistance of <em>Helicobacter pylori</em> to clarithromycin leads to an ongoing adaptation of empirical first-line treatment for <em>H. pylori</em> infections.</div></div><div><h3>Patients and methods</h3><div>Prospective study (2022–2023) of 364 patients with no previous treatment for <em>H. pylori</em> infection, addressed for gastroduodenal endoscopy to the University Hospital of Reunion Island.</div></div><div><h3>Results</h3><div>PCR tests (Allplex<sup>TM</sup> <em>H. pylori</em> & ClariRAssay, Seegene) performed on gastric biopsy samples detected <em>H. pylori</em> DNA in 100 samples (100/364; 27.5 %) and mutations conferring resistance to clarithromycin in 10 of the positive samples (10/100; 10 %). Prevalence of resistance determined by MICs (E-test method) was 41.2 % for metronidazole, 13.2 % for levofloxacin, 8.8 % for clarithromycin. No resistance was detected for tetracycline, rifampicin, and amoxicillin.</div></div><div><h3>Conclusion</h3><div>The prevalence of primary clarithromycin-resistant <em>H. pylori</em> in Reunion Island is below 15 %. Recommendation for the standard clarithromycin-based triple therapy as a first-line treatment can thus be maintained, even though antimicrobial susceptibility testing seems preferable.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 2","pages":"Article 105025"},"PeriodicalIF":2.9,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978329","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-10DOI: 10.1016/j.idnow.2025.105024
M. Howarth-Maddison , I.N. Okoliegbe , N. El Sakka
Context
Recent advances in the development of rapid SARS-CoV-2 point of care (POC) testing provided an opportunity to aid clinical decision making in front-line healthcare settings. Perspectives of POC COVID-19 screening of pregnant women are under-researched.
Objective
To assess the impact of a SARS-CoV-2 POC testing platform implemented in a busy maternity hospital, with limited isolation capacity, during the third wave of the COVID-19 pandemic.
Methods
We conducted a before and after comparison of two consecutive 12-month periods and a retrospective evaluation of staff attitudes and POC test acceptance. Turnaround Time (TAT) and testing numbers were assessed by computer audit. Qualitative data was collected using confidential questionnaires.
Results
Mean TAT for the POC platform was 5.3x quicker (p < 0.001, chi-square test) when compared with local virus laboratory PCR testing. Samples sent for laboratory testing reduced by almost one third, following introduction of the POC device. A total of 27 staff members completed a POC testing satisfaction survey, which documented ease of use and benefits for diagnosis assistance, patient management and patient experience.
Conclusion.
In this single-center maternity setting, POC testing decreased laboratory testing volume and SARS-Cov-2 result TAT for symptomatic women and those awaiting crucial investigations. POC COVID-19 investigation was deemed acceptable by the clinical team for facilitating patient placement, management, and use of limited isolation capacity.
{"title":"Introduction of molecular point-of-care testing for SARS-CoV-2 in a triage unit of a large maternity hospital: An evaluation of staff experiences","authors":"M. Howarth-Maddison , I.N. Okoliegbe , N. El Sakka","doi":"10.1016/j.idnow.2025.105024","DOIUrl":"10.1016/j.idnow.2025.105024","url":null,"abstract":"<div><h3>Context</h3><div>Recent advances in the development of rapid SARS-CoV-2 point of care (POC) testing provided an opportunity to aid clinical decision making in front-line healthcare settings. Perspectives of POC COVID-19 screening of pregnant women are under-researched.</div></div><div><h3>Objective</h3><div>To assess the impact of a SARS-CoV-2 POC testing platform implemented in a busy maternity hospital, with limited isolation capacity, during the third wave of the COVID-19 pandemic.</div></div><div><h3>Methods</h3><div>We conducted a before and after comparison of two consecutive 12-month periods and a retrospective evaluation of staff attitudes and POC test acceptance. Turnaround Time (TAT) and testing numbers were assessed by computer audit. Qualitative data was collected using confidential questionnaires.</div></div><div><h3>Results</h3><div>Mean TAT for the POC platform was 5.3x quicker (p < 0.001, chi-square test) when compared with local virus laboratory PCR testing. Samples sent for laboratory testing reduced by almost one third, following introduction of the POC device. A total of 27 staff members completed a POC testing satisfaction survey, which documented ease of use and benefits for diagnosis assistance, patient management and patient experience.</div><div>Conclusion.</div><div>In this single-center maternity setting, POC testing decreased laboratory testing volume and SARS-Cov-2 result TAT for symptomatic women and those awaiting crucial investigations. POC COVID-19 investigation was deemed acceptable by the clinical team for facilitating patient placement, management, and use of limited isolation capacity.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 2","pages":"Article 105024"},"PeriodicalIF":2.9,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970514","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-01-09DOI: 10.1016/j.idnow.2025.105022
Rafay Ali Syed, Javaria Qazi
{"title":"WPV1 resurgence in Pakistan: Endangering the global polio eradication goal","authors":"Rafay Ali Syed, Javaria Qazi","doi":"10.1016/j.idnow.2025.105022","DOIUrl":"10.1016/j.idnow.2025.105022","url":null,"abstract":"","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 2","pages":"Article 105022"},"PeriodicalIF":2.9,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-13DOI: 10.1016/j.idnow.2024.105010
Keerthi Anpalagan , Asha C. Bowen , Leanne Lamborn , Derek Roebuck , Tina Carter , Jeffrey W. Cannon , Caitlin Symons , Jane McNally , Gillian Woods , Brendan McMullan , Amanda Gwee , Steven Y.C. Tong , Joshua S. Davis , Anita J. Campbell
Introduction
Staphylococcus aureus bacteraemia (SAB) is the most common cause of sepsis, contributing to paediatric intensive care unit admission in Australia and New Zealand. While deep venous thrombosis (DVT) has been reported in children with invasive S. aureus infections, the actual frequency and possible effects of thrombosis on disease severity and outcome in paediatric SAB remain unknown. Moreover, guidance regarding imaging for paediatric SAB management are poorly defined.
Methods and analysis
We report the protocol for the SNOOPY (Staphylococcus aureus Network; ultrasOund for diagnOsis of endovascular disease in Paediatrics and Youth) study. SNOOPY is a pilot prospective single-arm interventional study that aims to investigate the proportion of children with SAB that have venous thrombosis detected using whole body doppler ultrasound.
导言：金黄色葡萄球菌菌血症（SAB）是败血症最常见的病因，也是澳大利亚和新西兰儿童入住重症监护病房的主要原因。虽然有报道称在患侵袭性金葡菌感染的儿童中存在深静脉血栓（DVT），但血栓形成的实际发生频率以及对儿科 SAB 疾病严重程度和预后可能产生的影响仍不得而知。此外，有关儿科 SAB 管理的影像学指导也不明确：我们报告了 SNOOPY（金黄色葡萄球菌网络；儿科和青少年血管内疾病超声诊断）研究的方案。SNOOPY 是一项试验性前瞻性单臂介入研究，旨在调查使用全身多普勒超声检测到静脉血栓形成的 SAB 患儿比例。
{"title":"Optimising detection of thrombosis in paediatric Staphylococcus aureus bacteraemia: A prospective interventional sub-study protocol","authors":"Keerthi Anpalagan , Asha C. Bowen , Leanne Lamborn , Derek Roebuck , Tina Carter , Jeffrey W. Cannon , Caitlin Symons , Jane McNally , Gillian Woods , Brendan McMullan , Amanda Gwee , Steven Y.C. Tong , Joshua S. Davis , Anita J. Campbell","doi":"10.1016/j.idnow.2024.105010","DOIUrl":"10.1016/j.idnow.2024.105010","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Staphylococcus aureus</em> bacteraemia (SAB) is the most common cause of sepsis, contributing to paediatric intensive care unit admission in Australia and New Zealand. While deep venous thrombosis (DVT) has been reported in children with invasive <em>S. aureus</em> infections, the actual frequency and possible effects of thrombosis on disease severity and outcome in paediatric SAB remain unknown. Moreover, guidance regarding imaging for paediatric SAB management are poorly defined.</div></div><div><h3>Methods and analysis</h3><div>We report the protocol for the SNOOPY (<em>Staphylococcus aureus</em> Network; ultrasOund for diagnOsis of endovascular disease in Paediatrics and Youth) study. SNOOPY is a pilot prospective single-arm interventional study that aims to investigate the proportion of children with SAB that have venous thrombosis detected using whole body doppler ultrasound.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"55 1","pages":"Article 105010"},"PeriodicalIF":2.9,"publicationDate":"2024-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-10DOI: 10.1016/j.idnow.2024.105009
Wenjing Zhang , Kaiyu Qin , Ran Miao , Canglin Song , Xiaoyang Ma , Cheng Kou , Dongmei Xu
Background
While Parkinsonism plus syndrome (PPS) is one of several atypical manifestations in neurosyphilis patients, its clinical features and brain-related manifestations are inadequately documented. In this cross-sectional study, we endeavored to indicate some key clinical and imaging features of neurosyphilis patients, particularly those specific to PPS.
Methods
We retrospectively included all syphilis patients enrolled in the study from January 2021 to February 2024. All in all, 54 neurosyphilis patients with PPS were recruited. Their socio-demographical features, clinical status, presentations, laboratory manifestations and neuroimaging were analyzed retrospectively.
Results
The predominant phenotype was general paresis (GP). Median age at onset was 50 years, and 87.0 % of the patients were male. Bradykinesia (53.7 %) was the most common manifestation of PPS in neurosyphilis patients. The most frequent physical sign was orofacial dyskinesia (the Candy sign), which accounted for 51.9 % of cases.
In nearly three quarters (71.1 %), magnetic resonance imagery revealed temporal, hippocampal lobe, or whole brain atrophy, while 13.3 % exhibited basal ganglia lacunar infarction, and 22.2 % cases had focal demyelination in the cerebral peduncle, cerebellum, frontal lobe, parietal lobe, hippocampus and/or lateral vertical.
Conclusions
Neurosyphilis patients exhibited PPS in involving bradykinesia, tremor rigidity and, in most cases, GP. Brain atrophy and basal ganglia lesion were the most common imaging findings in neurosyphilis patients with PPS. Our results should help to elucidate PPS characteristics PPS and neuroimaging mechanisms in neurosyphilis patients with PPS.
{"title":"Parkinsonism plus syndrome in neurosyphilis: Clinical insights and brain imaging","authors":"Wenjing Zhang , Kaiyu Qin , Ran Miao , Canglin Song , Xiaoyang Ma , Cheng Kou , Dongmei Xu","doi":"10.1016/j.idnow.2024.105009","DOIUrl":"10.1016/j.idnow.2024.105009","url":null,"abstract":"<div><h3>Background</h3><div>While Parkinsonism plus syndrome (PPS) is one of several atypical manifestations in neurosyphilis patients, its clinical features and brain-related manifestations are inadequately documented. In this cross-sectional study, we endeavored to indicate some key clinical and imaging features of neurosyphilis patients, particularly those specific to PPS.</div></div><div><h3>Methods</h3><div>We retrospectively included all syphilis patients enrolled in the study from January 2021 to February 2024. All in all, 54 neurosyphilis patients with PPS were recruited. Their socio-demographical features, clinical status, presentations, laboratory manifestations and neuroimaging were analyzed retrospectively.</div></div><div><h3>Results</h3><div>The predominant phenotype was general paresis (GP). Median age at onset was 50 years, and 87.0 % of the patients were male. Bradykinesia (53.7 %) was the most common manifestation of PPS in neurosyphilis patients. The most frequent physical sign was orofacial dyskinesia (the Candy sign), which accounted for 51.9 % of cases.</div><div>In nearly three quarters (71.1 %), magnetic resonance imagery revealed temporal, hippocampal lobe, or whole brain atrophy, while 13.3 % exhibited basal ganglia lacunar infarction, and 22.2 % cases had focal demyelination in the cerebral peduncle, cerebellum, frontal lobe, parietal lobe, hippocampus and/or lateral vertical.</div></div><div><h3>Conclusions</h3><div>Neurosyphilis patients exhibited PPS in involving bradykinesia, tremor rigidity and, in most cases, GP. Brain atrophy and basal ganglia lesion were the most common imaging findings in neurosyphilis patients with PPS. Our results should help to elucidate PPS characteristics PPS and neuroimaging mechanisms in neurosyphilis patients with PPS.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"54 8","pages":"Article 105009"},"PeriodicalIF":2.9,"publicationDate":"2024-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619576","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-29DOI: 10.1016/j.idnow.2024.105008
Leonor Moreno Núñez , Cristina Garmendia Fernández , Manuel Ruiz Muñoz , Jesús Collado Álvarez , Carmen Jimeno Griño , Álvaro Prieto Callejero , Elia Pérez Fernández , Isabel González Anglada , Juan Emilio Losa García
Objective
To evaluate the adequacy of empirical antibiotic prescription and the duration of antibiotic therapy for infected patients admitted for conventional hospitalization (CH) and Hospitalization at Home (HaH) after implementation of an antibiotic stewardship programs (ASP) in HaH.
Design
Retrospective cohort study.
Patients
Patients admitted for infection to Emergency Department between October and December 2023. “CH-ASP cohort” was admitted to CH with ASP intervention, “CH cohort” was admitted to CH without ASP intervention, “HaH cohort” was admitted to HaH (integrated daily ASP intervention).
Results
Ninety-one patients were analyzed in CH-ASP, 60 in CH, and 101 in HaH. The ASP made recommendations on empirical antibiotic therapy for 175 patients (92 %) with a 98 % acceptance rate. For 111 patients (44 %) the ASP made recommendations on antibiotic duration (24 % CH-ASP vs 89 % HaH, p < 0.001), with a 73 % acceptance rate (41 % CH-ASP vs 81 % HaH, p < 0.001). Empirical antibiotic adequacy was 94 % (93 % CH-ASP vs 87 % CH vs 100 % HaH, p = 0.006). Median duration of antibiotic therapy was nine days in CH-ASP and CH vs seven in HaH (p < 0.001). There were no differences in mortality and readmissions. In the multivariate analysis, patients in CH-ASP and CH had total duration of antibiotic therapy of 2.2 (95 % CI: 0.2–4.2) and 3 days more (95 % CI: 0.8–5.3) respectively as compared to HaH.
Conclusions
ASP improves empirical antibiotic adequacy in patients admitted for infection. ASP in HaH, because of high acceptance of intervention regarding antibiotic duration, achieves shorter treatment durations without increased mortality or readmission.
目的评估在哈医大一院实施抗生素管理计划（ASP）后，常规住院（CH）和居家住院（HaH）感染患者经验性抗生素处方的充分性和抗生素治疗的持续时间：设计：回顾性队列研究：患者：2023年10月至12月期间急诊科收治的感染患者。"CH-ASP队列 "为接受ASP干预的CH患者，"CH队列 "为未接受ASP干预的CH患者，"HaH队列 "为接受HaH（日常ASP综合干预）的患者：结果：分析了91名CH-ASP患者、60名CH患者和101名HaH患者。ASP为175名患者（92%）提出了经验性抗生素治疗建议，接受率为98%。ASP 对 111 名患者（44%）提出了抗生素疗程建议（CH-ASP 24% vs HaH 89%，P 结论：ASP 提高了经验性抗生素的疗效：ASP 提高了因感染入院的患者使用经验性抗生素的充分性。哈医大的 ASP 由于对抗生素疗程干预的接受度高，因此可缩短治疗时间，同时不会增加死亡率或再入院率。
{"title":"A step further: Antibiotic stewardship programme in home hospital","authors":"Leonor Moreno Núñez , Cristina Garmendia Fernández , Manuel Ruiz Muñoz , Jesús Collado Álvarez , Carmen Jimeno Griño , Álvaro Prieto Callejero , Elia Pérez Fernández , Isabel González Anglada , Juan Emilio Losa García","doi":"10.1016/j.idnow.2024.105008","DOIUrl":"10.1016/j.idnow.2024.105008","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the adequacy of empirical antibiotic prescription and the duration of antibiotic therapy for infected patients admitted for conventional hospitalization (CH) and Hospitalization at Home (HaH) after implementation of an antibiotic stewardship programs (ASP) in HaH.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Patients</h3><div>Patients admitted for infection to Emergency Department between October and December 2023. “CH-ASP cohort” was admitted to CH with ASP intervention, “CH cohort” was admitted to CH without ASP intervention, “HaH cohort” was admitted to HaH (integrated daily ASP intervention).</div></div><div><h3>Results</h3><div>Ninety-one patients were analyzed in CH-ASP, 60 in CH, and 101 in HaH. The ASP made recommendations on empirical antibiotic therapy for 175 patients (92 %) with a 98 % acceptance rate. For 111 patients (44 %) the ASP made recommendations on antibiotic duration (24 % CH-ASP vs 89 % HaH, p < 0.001), with a 73 % acceptance rate (41 % CH-ASP vs 81 % HaH, p < 0.001). Empirical antibiotic adequacy was 94 % (93 % CH-ASP vs 87 % CH vs 100 % HaH, p = 0.006). Median duration of antibiotic therapy was nine days in CH-ASP and CH vs seven in HaH (p < 0.001). There were no differences in mortality and readmissions. In the multivariate analysis, patients in CH-ASP and CH had total duration of antibiotic therapy of 2.2 (95 % CI: 0.2–4.2) and 3 days more (95 % CI: 0.8–5.3) respectively as compared to HaH.</div></div><div><h3>Conclusions</h3><div>ASP improves empirical antibiotic adequacy in patients admitted for infection. ASP in HaH, because of high acceptance of intervention regarding antibiotic duration, achieves shorter treatment durations without increased mortality or readmission.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"54 8","pages":"Article 105008"},"PeriodicalIF":2.9,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142557749","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.idnow.2024.105007
Özge Özgen Top , Beyza Çifci , Merve Büyükkörük , Handan Can , Pınar Aysert Yıldız , Halil Furkan Martlı , Elif Ayça Şahin , Kayhan Çağlar , Hasan Selçuk Özger
Objectives
To evaluate the possible impact of RAST on optimal antimicrobial therapy via de-escalation or escalation, and to determine the reduction in antibiotic susceptibility reporting time with RAST.
Methods
In this single-center, prospective descriptive study, RAST was performed on clinical blood cultures containing E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter baumannii isolates. Very major error, major error, and categorical agreements with VITEK 2 were analyzed.
Results
One hundred and three isolates were included in the study, out of which 29.1 % were carbapenem-resistant and 36.9 % were multidrug-resistant according to VITEK 2. Categorical agreement of the RAST method with standard antimicrobial susceptibility test (AST) was > 90 % at 6 h, except for piperacillin/tazobactam. Antibiotic revision could be carried out in 79.6 % of the patients either by de-escalation (61.2 %) or escalation (18.4 %) for optimal therapy based on the RAST 6 h result. RAST could provide carbapenem-sparing therapy in 24 % of patients. Reduction in antibiotic susceptibility reporting time was 41.5 h (38.8 to 63.2, median (IQR)).
Conclusions
RAST can provide early antibiotic revision in a majority of patients with significantly reduced antibiotic susceptibility reporting time. Six hours is the shortest optimal time for antibiotic revision with RAST. In countries where empirical broad-spectrum antibiotics are prevalent due to high antibiotic resistance pressure, RAST should be proposed primarily in de-escalation and carbapenem-sparing strategies.
目的评估 RAST 通过降级或升级对最佳抗菌治疗可能产生的影响，并确定 RAST 可缩短抗生素药敏报告时间：在这项单中心前瞻性描述性研究中，对含有大肠杆菌、肺炎克雷伯氏菌、铜绿假单胞菌和鲍曼不动杆菌的临床血液培养物进行了 RAST 检测。分析了与 VITEK 2 的极重大误差、重大误差和分类一致性：除哌拉西林/他唑巴坦外，RAST 法与标准抗菌药物药敏试验 (AST) 在 6 小时内的分类一致率大于 90%。根据 RAST 6 小时的结果，79.6% 的患者可以通过降级（61.2%）或升级（18.4%）抗生素以获得最佳治疗。RAST 可为 24% 的患者提供碳青霉烯类药物治疗。抗生素药敏报告时间缩短了41.5小时（38.8至63.2小时，中位数（IQR））：结论：RAST 可为大多数患者提供早期抗生素修订，并显著缩短抗生素药敏报告时间。六小时是使用 RAST 进行抗生素修订的最短时间。在因抗生素耐药性压力大而普遍使用经验性广谱抗生素的国家，RAST应主要用于降级和碳青霉烯类疏通策略。
{"title":"Impact of EUCAST Rapid Antimicrobial Susceptibility Testing (RAST) on optimal antimicrobial therapy in gram-negative bloodstream infections","authors":"Özge Özgen Top , Beyza Çifci , Merve Büyükkörük , Handan Can , Pınar Aysert Yıldız , Halil Furkan Martlı , Elif Ayça Şahin , Kayhan Çağlar , Hasan Selçuk Özger","doi":"10.1016/j.idnow.2024.105007","DOIUrl":"10.1016/j.idnow.2024.105007","url":null,"abstract":"<div><h3>Objectives</h3><div>To evaluate the possible impact of RAST on optimal antimicrobial therapy via de-escalation or escalation, and to determine the reduction in antibiotic susceptibility reporting time with RAST.</div></div><div><h3>Methods</h3><div>In this single-center, prospective descriptive study, RAST was performed on clinical blood cultures containing <em>E. coli</em>, <em>Klebsiella pneumoniae, Pseudomonas aeruginosa</em>, and <em>Acinetobacter baumannii</em> isolates. Very major error, major error, and categorical agreements with VITEK 2 were analyzed.</div></div><div><h3>Results</h3><div>One hundred and three isolates were included in the study, out of which 29.1 % were carbapenem-resistant and 36.9 % were multidrug-resistant according to VITEK 2. Categorical agreement of the RAST method with standard antimicrobial susceptibility test (AST) was > 90 % at 6 h, except for piperacillin/tazobactam. Antibiotic revision could be carried out in 79.6 % of the patients either by de-escalation (61.2 %) or escalation (18.4 %) for optimal therapy based on the RAST 6 h result. RAST could provide carbapenem-sparing therapy in 24 % of patients. Reduction in antibiotic susceptibility reporting time was 41.5 h (38.8 to 63.2, median (IQR)).</div></div><div><h3>Conclusions</h3><div>RAST can provide early antibiotic revision in a majority of patients with significantly reduced antibiotic susceptibility reporting time. Six hours is the shortest optimal time for antibiotic revision with RAST. In countries where empirical broad-spectrum antibiotics are prevalent due to high antibiotic resistance pressure, RAST should be proposed primarily in de-escalation and carbapenem-sparing strategies.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"54 8","pages":"Article 105007"},"PeriodicalIF":2.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-28DOI: 10.1016/j.idnow.2024.104998
Léna Sleiman , Cédric Dananché , Sophie Gardes , Isabelle Fredenucci , Camille Duval , Isabelle Durieu , Fabien Zoulim , Philippe Vanhems , Pierre Cassier , Christelle Elias
Objectives
Wet hospital environments have been documented as potential reservoirs for Carbapenemase-producing Enterobacteriaceae (CPE), possibly contributing to outbreaks among inpatients. Our objectives were to assess the prevalence of CPE reservoirs in a hospital’s wet environments and to investigate the contamination of adjacent dry surfaces.
Methods
From March to August 2023, we conducted a cross-sectional study in two hospital wards experiencing ongoing large outbreaks. Sampling of the environment was undertaken in two distinct phases. During phase 1, 38 shower drains and 38 toilet bowls, defined as the wet environment, were sampled using swabs. Phase 2 consisted in sampling adjacent dry surfaces, using wipes in rooms that had tested positive during phase 1. Samples were plated on a selective medium (chromID®CARBASMART, bioMérieux). Species were identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technique. Carbapenemases were detected by OKNVI RESIST-5® (CORIS BioConcept).
Results
From the 38 patient rooms, 76 samples were taken during phase 1. All in all, 33 (86.8%) rooms presented at least one CPE reservoir in the wet environment; there were 32 (84.2%) contaminated shower drains and six (15.8%) contaminated toilet bowls. Among 57 identified CPEs, the most frequent strain was Enterobacter cloacae VIM (13, 22.8%). During phase 2, 11 (8.3%) out of 132 samples tested positive for CPE. Enterobacter cloacae complex VIM accounted for six (54.5%) of the CPE strains.
Conclusion
These findings suggest that the wet hospital environments were broadly contaminated with CPE, mostly Enterobacter cloacae VIM. The spread of CPE from wet environments to dry surfaces seemed limited.
{"title":"Identification of carbapenemase-producing Enterobacteriaceae reservoirs in wet hospital environments as a potential factor in patient acquisition: A cross-sectional study in a French university hospital in 2023","authors":"Léna Sleiman , Cédric Dananché , Sophie Gardes , Isabelle Fredenucci , Camille Duval , Isabelle Durieu , Fabien Zoulim , Philippe Vanhems , Pierre Cassier , Christelle Elias","doi":"10.1016/j.idnow.2024.104998","DOIUrl":"10.1016/j.idnow.2024.104998","url":null,"abstract":"<div><h3>Objectives</h3><div>Wet hospital environments have been documented as potential reservoirs for Carbapenemase-producing Enterobacteriaceae (CPE), possibly contributing to outbreaks among inpatients. Our objectives were to assess the prevalence of CPE reservoirs in a hospital’s wet environments and to investigate the contamination of adjacent dry surfaces.</div></div><div><h3>Methods</h3><div>From March to August 2023, we conducted a cross-sectional study in two hospital wards experiencing ongoing large outbreaks. Sampling of the environment was undertaken in two distinct phases. During phase 1, 38 shower drains and 38 toilet bowls, defined as the wet environment, were sampled using swabs. Phase 2 consisted in sampling adjacent dry surfaces, using wipes in rooms that had tested positive during phase 1. Samples were plated on a selective medium (chromID®CARBASMART, bioMérieux). Species were identified using the matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) technique. Carbapenemases were detected by OKNVI RESIST-5® (CORIS BioConcept).</div></div><div><h3>Results</h3><div>From the 38 patient rooms, 76 samples were taken during phase 1. All in all, 33 (86.8%) rooms presented at least one CPE reservoir in the wet environment; there were 32 (84.2%) contaminated shower drains and six (15.8%) contaminated toilet bowls. Among 57 identified CPEs, the most frequent strain was <em>Enterobacter cloacae</em> VIM (13, 22.8%). During phase 2, 11 (8.3%) out of 132 samples tested positive for CPE. <em>Enterobacter cloacae complex</em> VIM accounted for six (54.5%) of the CPE strains.</div></div><div><h3>Conclusion</h3><div>These findings suggest that the wet hospital environments were broadly contaminated with CPE, mostly <em>Enterobacter cloacae</em> VIM. The spread of CPE from wet environments to dry surfaces seemed limited.</div></div>","PeriodicalId":13539,"journal":{"name":"Infectious diseases now","volume":"54 8","pages":"Article 104998"},"PeriodicalIF":2.9,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142561084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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