Umsetzung krankenhaushygienischer Primärpräventionsmaßnahmen verhindert die Übertragung von P. aeruginosa bei Patienten mit cystischer Fibrose im Krankenhaus

Background: The aim of this study was to characterise the epidemiology of P. aeruginosa isolated from cystic fibrosis (CF) patients at the Vienna General Hospital (VGH) by molecular genetic fingerprinting in order to understand transmission ways and to evaluate the established infection control protocols.Methods: The outpatient clinic for CF patients at the VGH cares for children and adolescents up to the age of 18 years. Among an average of 139 patients cared for at the clinic, 41 were tested positive for P. aeruginosa during the study period. Fifty P. aeruginosa isolates, obtained between August 2010 and March 2012 from routine examinations of CF patients, were subject to molecular characterization using the DiversiLab® method.Results: 42 distinguishable molecular-biological patterns were identified, 7 of which were found multiple times. 40 out of 42 genotypes were retrieved from single patients only, while two patterns were present in two patients each.Nine patients presented with two or more phenotypically diverse P. aeruginosa isolates. In five of these cases the retrieved isolates belonged to the same genotype.Conclusion: The broad genetic heterogeneity of P. aeruginosa in the studied patient population suggests that the majority of CF patients cared for at the VGH acquire P. aeruginosa from environmental sources. It may be concluded that implemented infection control guidelines have been successful in preventing nosocomial transmission of P. aeruginosa among CF patients within the VGH and patient-to-patient transmission outside the hospital. Chronic polyclonal infection/colonization was rare in the study population.Hintergrund: Ziel dieser Studie war es, die Übertragungsepidemiologie von Pseudomonas aeruginosa -Isolaten von stationärer Patienten mit cystischer Fibrose (CF) am Allgemeinen Krankenhaus der Stadt Wien (AKH Wien) anhand ihres molekularbiologischen Fingerabdrucks zu untersuchen, um die Mechanismen der Übertragung zwischen CF-Patienten zu identifizieren und gezielte infektionspräventive Maßnahmen zu implementieren. Methoden: Am AKH Wien werden Kinder und Jugendliche mit CF bis zum vollendeten 18. Lebensalter betreut. Zum Studienzeitpunkt befanden sich 139 Patienten in Behandlung, von denen bei 41 Patienten P. aeruginosa im Sputum und/oder Rachenabstrich nachweisbar war. Insgesamt wurden 50 P. aeruginosa- Isolate von den 41 P. aeruginosa -positiven CF-Patienten, die zwischen August 2010 und März 2012 im Rahmen von Routineuntersuchungen isoliert worden waren, hinsichtlich ihrer molekulargenetischen Eigenschaften mittels DiversiLab® untersucht.Ergebnisse: Es konnten 42 nicht weiter unterscheidbare molekular-biologische Muster identifiziert werden, wobei sich 7 Muster häufiger als die anderen fanden. 40 der insgesamt 42 Genotypen wurden nur von einzelnen Patienten isoliert, 2 Genotypen waren jeweils bei 2 unterschiedlichen Patienten nachweisbar. Neun Patienten wiesen 2 oder mehr phänotypisch unterschiedlicher Isolate aus, bei 5 dieser Patienten gehörten die Isolate zum selben Genotyp.Schlussfolgerung: Die breite genetische Heterogenität der P. aeruginosa- Isolate in den untersuchten CF-Patienten weist darauf hin, dass die Mehrzahl an CF-Patienten in stationärer Behandlung am AKH Wien diese Isolate von anderen Quellen als von zur selben Zeit in Betreuung stehenden Patienten oder von einer gemeinsamen internen Umgebungsquelle erworben haben müsste. Das legt die Schlussfolgerung nahe, dass sich die an der CF-Klinik implementierten krankenhaushygienischen Maßnahmen hinsichtlich der Verhinderung einer Übertragung von CF-Patienten erfolgreich erwiesen haben. Chronische polyklonale Infektionen bzw. Kolonisationen waren innerhalb der untersuchten CF-Patienten selten

Efficacy of five alcohol-based skin antiseptics on sebaceous skin used at shorter application times than the current recommendation of 10 minutes

International audienceAlcohol-based skin antiseptics are recommended with a minimum application time of 10 min on skin containing high numbers of sebaceous glands. In clinical practice, a 10-min application time is often too long. Therefore, we determined the efficacy of skin antiseptics on the forehead and lower back using shorter application times. Five alcoholic solutions were tested in a double-blind trial for their colony-forming units (cfu) reduction after 3, 4, 5 and 10 min on the forehead of 20 healthy volunteers and the lower back of 10 healthy volunteers and 10 patients against the reference alcohol 70% propan-2-ol, 10 min. After an application time of 3 min, 3/5 (forehead) and 5/5 (lower back) preparations were at least equally as effective compared to the reference alcohol and an application time of 10 min. Alcohol-based skin antiseptics do not require a 10-min application time. For all of the tested antiseptics, a minimum application time of 3 min on sebaceous skin can be recommended

Microsatellite genotyping clarified conspicuous accumulation of Candida parapsilosis at a cardiothoracic surgery intensive care unit.

Contains fulltext : 124291.pdf (publisher's version ) (Open Access)Candida parapsilosis has become a significant cause of invasive fungal infections in seriously ill patients. Nosocomial outbreaks through direct and indirect contact have been described. The aim of this study was the molecular characterization of what appeared to be an ongoing C. parapsilosis outbreak at the cardiothoracic intensive care unit of the University Hospital of Vienna between January 2007 and December 2008. Using two different molecular typing methods-automated repetitive sequence-based PCR (DiversiLab; bioMerieux) and microsatellite genotyping-we investigated the genetic relationship of 99 C. parapsilosis isolates. Eighty-three isolates originated from the cardiothoracic intensive care unit, while 16 isolates were random control isolates from other intensive care units and a different Austrian hospital. The 99 C. parapsilosis isolates analyzed by repetitive-element PCR all showed identical genotypes, suggesting an ongoing outbreak. In contrast, microsatellite genotyping showed a total of 56 different genotypes. Two major genotypes were observed in 10 and 15 isolates, respectively, whereas another 13 genotypes were observed in 2 to 4 isolates each. Forty-one genotypes were observed only once. Closely related genotypes that differed in only a single microsatellite marker were grouped into clonal complexes. When it comes to C. parapsilosis, microsatellite genotyping is a more discriminative method than repetitive-element PCR genotyping to investigate outbreaks.1 november 201