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2 results on '"oropharynx -- microbiology"'

1. Antimicrobial susceptibility of commensal Neisseria in a general population and men who have sex with men in Belgium

Author

Laumen, Jolein J.G.E., Van Dijck, Christophe, Abdellati, Said, De Baetselier, Irith, Serrano, Gabriela, Manoharan-Basil, Sheeba Santhini, Bottieau, Emmanuel, Martiny, Delphine, Kenyon, Christopher, Laumen, Jolein J.G.E., Van Dijck, Christophe, Abdellati, Said, De Baetselier, Irith, Serrano, Gabriela, Manoharan-Basil, Sheeba Santhini, Bottieau, Emmanuel, Martiny, Delphine, and Kenyon, Christopher

Abstract

Non-pathogenic Neisseria are a reservoir of antimicrobial resistance genes for pathogenic Neisseria meningitidis and Neisseria gonorrhoeae. Men who have sex with men (MSM) are at risk of co-colonization with resistant non-pathogenic and pathogenic Neisseria. We assessed if the antimicrobial susceptibility of non-pathogenic Neisseria among MSM differs from a general population and if antimicrobial exposure impacts susceptibility. We recruited 96 participants at our center in Belgium: 32 employees, 32 MSM who did not use antibiotics in the previous 6 months, and 32 MSM who did. Oropharyngeal Neisseria were cultured and identified with MALDI-TOF–MS. Minimum inhibitory concentrations for azithromycin, ceftriaxone and ciprofloxacin were determined using E-tests® and compared between groups with non-parametric tests. Non-pathogenic Neisseria from employees as well as MSM were remarkably resistant. Those from MSM were significantly less susceptible than employees to azithromycin and ciprofloxacin (p < 0.0001, p < 0.001), but not ceftriaxone (p = 0.3). Susceptibility did not differ significantly according to recent antimicrobial exposure in MSM. Surveilling antimicrobial susceptibility of non-pathogenic Neisseria may be a sensitive way to assess impact of antimicrobial exposure in a population. The high levels of antimicrobial resistance in this survey indicate that novel resistance determinants may be readily available for future transfer from non-pathogenic to pathogenic Neisseria., SCOPUS: ar.j, info:eu-repo/semantics/published

Published
2022

2. Decontamination Strategies and Bloodstream Infections With Antibiotic-Resistant Microorganisms in Ventilated Patients: A Randomized Clinical Trial

Author

Irene Aragao, Patrizia Coppadoro, Pere Coll, Pieter Depuydt, Pierre Damas, Jordi Mancebo, Andrea Vergara Gomez, Valérie Verbelen, Giuseppe Nardi, Kris Leleu, Nienke L. Plantinga, Philippe G. Jorens, Surbhi Malhotra-Kumar, Esther Villarreal Tello, T. Dugernier, Matt P. Wise, C. Brun-Buisson, Sara Fernández Méndez, Matt Morgan, Anne-Marie Van Den Abeele, Ana Filipa Gomes Pimenta de Matos, Claudia C. dos Santos, Marc J. M. Bonten, Joaquín López-Contreras, Franc Šifrer, Jerina Boelens, Roberta H. M. Sperning, Jesús Ruiz Ramos, Viktorija Tomic, Bastiaan H J Wittekamp, Cécile Meex, Ben S. Cooper, and Walter Verbrugghe

Subjects
Male, intensive care units, medicine.medical_treatment, Mouthwashes, naključni nadzorovani poskus, Oropharynx, Bacteremia, Drug resistance, law.invention, 0302 clinical medicine, anti-infective agents -- therapeutic use, Randomized controlled trial, Anti-Infective Agents, law, Tobramycin, bacteremia -- prevention and control, Medicine, 030212 general & internal medicine, Hospital Mortality, Aged, 80 and over, Cross Infection, Hazard ratio, Chlorhexidine, ustne vode -- terapevtska raba, General Medicine, Middle Aged, Intensive care unit, 3. Good health, Intensive Care Units, bolnišnična umrljivost, Female, bakterijska odpornost na zdravila, enote za intenzivno oskrbo, bakteriemija -- preprečevanje in nadzor, oropharynx -- microbiology, medicine.drug, Adult, cross infection -- prevention and control, medicine.medical_specialty, Gramnegativne bakterijske okužbe -- preprečevanje in nadzor, Gram-negative bacterial infections -- prevention and control, sredstva proti okužbam -- terapevtska raba, 03 medical and health sciences, Young Adult, navzkrižne okužbe -- preprečevanje in nadzor, Internal medicine, Drug Resistance, Bacterial, mouthwashes -- therapeutic use, Humans, artificial respiration, multicentrična študija, bacterial drug resistance, Aged, hospital mortality, gastrointestinalni trakt -- mikrobiologija, Mechanical ventilation, umetna respiracija, razkuževanje -- metode, business.industry, disinfection -- methods, gastrointestinal tract -- microbiology, klorheksidin -- terapevtska raba, 030208 emergency & critical care medicine, Odds ratio, udc:616-084, orofarinks -- mikrobiologija, Respiration, Artificial, Disinfection, Gastrointestinal Tract, multicenter study, chlorhexidine -- therapeutic use, randomized controlled trial, Human medicine, business, Gram-Negative Bacterial Infections
Abstract

Importance: The effects of chlorhexidine (CHX) mouthwash, selective oropharyngeal decontamination (SOD), and selective digestive tract decontamination (SDD) on patient outcomes in ICUs with moderate to high levels of antibiotic resistance are unknown. Objective: To determine associations between CHX 2%, SOD, and SDD and the occurrence of ICU-acquired bloodstream infections with multidrug-resistant gram-negative bacteria (MDRGNB) and 28-day mortality in ICUs with moderate to high levels of antibiotic resistance. Design, Setting, and Participants: Randomized trial conducted from December 1, 2013, to May 31, 2017, in 13 European ICUs where at least 5% of bloodstream infections are caused by extended-spectrum β-lactamase–producing Enterobacteriaceae. Patients with anticipated mechanical ventilation of more than 24 hours were eligible. The final date of follow-up was September 20, 2017. Interventions: Standard care was daily CHX 2% body washings and a hand hygiene improvement program. Following a baseline period from 6 to 14 months, each ICU was assigned in random order to 3 separate 6-month intervention periods with either CHX 2% mouthwash, SOD (mouthpaste with colistin, tobramycin, and nystatin), or SDD (the same mouthpaste and gastrointestinal suspension with the same antibiotics), all applied 4 times daily. Main Outcomes and Measures: The occurrence of ICU-acquired bloodstream infection with MDRGNB (primary outcome) and 28-day mortality (secondary outcome) during each intervention period compared with the baseline period. Results: A total of 8665 patients (median age, 64.1 years; 5561 men [64.2%]) were included in the study (2251, 2108, 2224, and 2082 in the baseline, CHX, SOD, and SDD periods, respectively). ICU-acquired bloodstream infection with MDRGNB occurred among 144 patients (154 episodes) in 2.1%, 1.8%, 1.5%, and 1.2% of included patients during the baseline, CHX, SOD, and SDD periods, respectively. Absolute risk reductions were 0.3% (95% CI, −0.6% to 1.1%), 0.6% (95% CI, −0.2% to 1.4%), and 0.8% (95% CI, 0.1% to 1.6%) for CHX, SOD, and SDD, respectively, compared with baseline. Adjusted hazard ratios were 1.13 (95% CI, 0.68-1.88), 0.89 (95% CI, 0.55-1.45), and 0.70 (95% CI, 0.43-1.14) during the CHX, SOD, and SDD periods, respectively, vs baseline. Crude mortality risks on day 28 were 31.9%, 32.9%, 32.4%, and 34.1% during the baseline, CHX, SOD, and SDD periods, respectively. Adjusted odds ratios for 28-day mortality were 1.07 (95% CI, 0.86-1.32), 1.05 (95% CI, 0.85-1.29), and 1.03 (95% CI, 0.80-1.32) for CHX, SOD, and SDD, respectively, vs baseline. Conclusions and Relevance: Among patients receiving mechanical ventilation in ICUs with moderate to high antibiotic resistance prevalence, use of CHX mouthwash, SOD, or SDD was not associated with reductions in ICU-acquired bloodstream infections caused by MDRGNB compared with standard care. Trial Registration: ClinicalTrials.gov NCT02208154

Published
2018

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