Temporal effects of antibiotic use and hand rub consumption on the incidence of MRSA and Clostridium difficile

Objectives The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. Methods An interventional time-series analysis was performed to evaluate the impact of two promotion campaigns on the consumption of ABHRs and to assess their effect on the incidence of non-duplicate clinical isolates of MRSA and C. difficile from February 2000 through September 2006. This analysis was combined with a transfer function model of aggregated data on antibiotic use. Results Consumption of ABHRs correlated with MRSA, but not with C. difficile. The final model demonstrated the immediate effect of the second hand hygiene promotion campaign and an additional temporal effect of fluoroquinolone (time lag, 1 month; i.e. antibiotic effect delayed for 1 month), macrolide (lag 1 and 4 months), broad-spectrum cephalosporins (lag 3, 4 and 5 months) and piperacillin/tazobactam (lag 3 months) use. The final model explained 57% of the MRSA variance over time. In contrast, the model for C. difficile showed only an effect for broad-spectrum cephalosporins (lag 1 month). Conclusions We observed an aggregate-level relation between the monthly MRSA incidence and the use of different antibiotic classes and increased consumption of ABHR after a successful hand hygiene campaign, while no association with ABHR use was detected for C. difficil

Impact of Combined Low-Level Mupirocin and Genotypic Chlorhexidine Resistance on Persistent Methicillin-Resistant Staphylococcus aureus Carriage After Decolonization Therapy: A Case-control Study

The clinical significance of low-level mupirocin and genotypic chlorhexidine resistance remains unclear. This case-control study demonstrates that combined low-level mupirocin and genotypic chlorhexidine resistance significantly increases the risk of persistent MRSA carriage after decolonization therapy (OR 3.4, 95% CI 1.5-7.8

Temporal effects of antibiotic use and Clostridium difficile infections

Objectives We tested a previously published model for the analysis of the temporal relationship between antibiotic use and the incidence of Clostridium difficile infection in a hospital with stable incidence of infection at >1 case per 1000 admissions per month. Methods The study period was from April 2004 to June 2008 and used data from Infection Control and Hospital Pharmacy. We first described the monthly variation in C. difficile infection and then constructed a multivariate transfer function model that included lag time (cases of C. difficile infection in previous months and delays between changes in antibiotic use and changes in C. difficile infection). Results The average incidence of C. difficile infection was 1.5 cases per 1000 patients per month with no significant increase over 3 years. The number of cases of C. difficile infection in 1 month was dependent on the average number of cases of C. difficile infection in the previous 2 months. The models with data from the whole hospital showed a statistically significant relationship between the number of both hospital-acquired C. difficile infections and total C. difficile infections and consumption of piperacillin/tazobactam, ciprofloxacin and cefuroxime. The association between C. difficile infection and consumption of co-amoxiclav was only significant for hospital-acquired C. difficile infection. The model for hospital-acquired C. difficile infections explained 61% of the variance in C. difficile infections. Conclusions These results provide support for antibiotic policies that minimize the use of broad-spectrum penicillins (co-amoxiclav and piperacillin/tazobactam), cephalosporins and fluoroquinolone

Fate and Transport of Mercury, Cadmium, Selenium, and Arsenic in the Presence of Growing Spirulina maxima

As the global population continues to increase, protein production must also, necessitating the development of new food production technologies. Microalgae have been studied for their benefits toward livestock health and production. Additionally, microalgae can be grown in wastewater, allowing the allocation of freshwater resources elsewhere. However, wastewater contains contaminants that may be transferred to livestock that consume the microalgae. To study potential contaminant transfer to consumers and cultivators, Spirulina maxima was grown in a growth medium containing 1.66 nM Hg, 0.27 µM Cd, 7.1 µM Se, and/or 0.80 µM As, and resulting biomass, liquid, and gaseous effluent were analyzed for metal(loid) content. Hg was recovered primarily in biomass, Cd was recovered primarily in liquid, and Se and As were recovered almost completely in liquid, likely due to the composition of the growth medium, and volatilization accounted for small fractions of total recoveries

Modelling the impact of antibiotic use on antibiotic-resistant Escherichia coli using population-based data from a large hospital and its surrounding community

Objectives To determine the temporal relationship between antibiotic use and incidence of antibiotic-resistant Escherichia coli in both the inpatient and outpatient setting of a large urban area. Methods A retrospective observational time-series analysis was performed to evaluate the incidence of non-duplicate clinical isolates of E. coli resistant to ciprofloxacin, trimethoprim/sulfamethoxazole and cefepime from January 2000 through December 2007, combined with a transfer function model of aggregated data on antibiotic use in both settings obtained from the hospital's pharmacy and outpatient billing offices. Results Ciprofloxacin resistance increased from 6.0% (2000) to 15.4% (2007; P  < 0.0001) and cefepime resistance from 0.9% (2002) to 3.2% (2007; P= 0.01). Trimethoprim/sulfamethoxazole resistance remained stable (23.7%-25.8%). Total antibiotic use increased in both settings, while fluoroquinolone use increased significantly only among outpatients. A temporal effect between fluoroquinolone resistance in community E. coli isolates and outpatient use of ciprofloxacin (immediate effect and time lag 1 month) and moxifloxacin (time lag 4 months) was observed, explaining 51% of the variance over time. The incidence of cefepime resistance in E. coli was correlated with ciprofloxacin use in the inpatient (lag 1 month) and outpatient (lag 4 months) settings and with the use of ceftriaxone (lag 0 month), piperacillin/tazobactam (3 months) and cefepime (3 months) in the hospital (R2  = 51%). Conclusions These results support efforts to reduce prescribing of fluoroquinolones for control of resistant E. coli including extended-spectrum β-lactamase producers and show the added value of time-series analysis to better understand the interaction between community and hospital antibiotic prescribing and its spill-over effect on antibiotic resistanc

Vaccination par le BCG : enquête auprès d'enfants de moins de 5 ans consultant dans un service d'urgences hospitalières

International audienceFrance is a country with a low incidence of tuberculosis. However, there are important local variations: some parts of the city of Marseilles (southern France) presented a yearly incidence greater than 30/100,000 in 2010. The main goal of this study was to evaluate the BCG vaccine coverage among at-risk children younger than 5 years consulting in one of the city's pediatric emergency departments. Material and methods. This descriptive study took place in February 2013 and used a semi-directive questionnaire distributed to parents. Results. One hundred and thirty-five children were included, 98 (72.6 %) were considered as being at risk of tuberculosis and among them 75 (76.5 %, 95 % CI [68.0–85.1]) were vaccinated with BCG. Parents' knowledge of tuberculosis was relevant in 48 % of the respondents. Only 19 % of the parents reported that BCG protects against tuberculosis, but 73 % were in favor of this vaccination. Two criteria significantly increased vaccine coverage among at-risk children: birth in Marseilles and age more than 6 months on the consultation day. The child living in a poor family and type of medical follow-up did not significantly influence BCG vaccine coverage. Conclusion. BCG coverage was high in at-risk children younger than 5 years born in Marseilles. Cooperation between private physicians , maternity hospitals and mothers, and children's public health services probably facilitates this high level of protection.Malgré une faible incidence de la tuberculose en France, il existe de grandes variations à l'échelle communale : certains quartiers de Marseille présentent ainsi une incidence annuelle supérieure à 30/ 100 000. Le but de notre étude etait d'évaluer la couverture vaccinale par le vaccin de Calmette et Guérin (BCG) des enfants à risque aâgés de moins de 5 ans consultant dans un service d'urgences pédiatriques. Matériel et méthodes : Cette étude descriptive a eété réalisée en février 2013 à l'aide d'un questionnaire semi-directif proposé aux parents. Résultats : Cent-trente-cinq enfants ont été inclus, 98 (72,6 %) étaient considérés àrisque de tuberculose et parmi ces derniers 75 (76,5 %, IC 95 % [68,0–85,1]) eétaient vaccinés par le BCG. Seuls 48 % des parents connaissaient la tuberculose et 19 % savaient que le BCG protégeait contre cette maladie, mais 73 % étaient favorables à ce vaccin. Deux paramètres étaient liés à la vaccination des enfants à risque : une naissance à Marseille et un âge supérieur à 6 mois le jour de la consultation. La précarité des conditions de vie et le type de suivi médical n' influençaient pas significativement la couverture vaccinale des enfants à risque. Conclusion : En 2013, la couverture vaccinale par le BCG des enfants de moins de 5 ans nés à Marseille et à risque de tuberculose était correcte mais perfectible. Une coopération entre médecins de ville, maternités et services de protection maternelle et infantile (PMI) permet probablement d'obtenir cette bonne couverture vaccinale

Interventions to improve hand hygiene compliance in patient care: Reflections on three systematic reviews for the Cochrane Collaboration 2007-2017

This article presents highlights from a recently updated systematic Cochrane review evaluating the effectiveness of interventions to improve hand hygiene compliance in patient care. It is an advance on the two earlier reviews we undertook on the same topic as it has, for the first time, provided very rigorous synthesis of evidence that such interventions can improve practice. In this article, we provide highlights from a recently updated Cochrane systematic review. We identify omissions in the information reported and point out important aspects of hand hygiene intervention studies that were beyond the scope of the review. A full report of the review is available free of charge on the Cochrane website