Meticillin-resistant (MRSA) infections are of increasing importance to clinicians, public health ... more Meticillin-resistant (MRSA) infections are of increasing importance to clinicians, public health agencies and governments. Prevention and control strategies must address sources in healthcare settings, the community and livestock. This document presents the conclusions of a European Consensus Conference on the role of screening and decolonisation in the control of MRSA infection. The conference was held in Rome on 5-6 March 2010 and was organised jointly by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC). In an environment where MRSA is endemic, universal or targeted screening of patients to detect colonisation was considered to be an essential pillar of any MRSA control programme, along with the option of decolonising carriers dependent on relative risk of infection, either to self or others, in a specific setting. Staff screening may be useful but is problematic as it needs to distinguish between transient carriage and longer-term colonisation. The consequences of identification of MRSA-positive staff may have important effects on morale and the ability to maintain staffing levels. The role of environmental contamination in MRSA infection is unclear, but screening may be helpful as an audit of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of which requires careful evaluation. European initiatives designed to provide further information on the cost/benefit value of particular strategies in the control of infection, including those involving MRSA, are in progress.
The global threat of antimicrobial resistance and potentially untreatable infections is a serious... more The global threat of antimicrobial resistance and potentially untreatable infections is a serious matter under review currently by the WHO and many countries throughout the world. I consider the optimal surveillance scheme and point out the various biases in the systems that we have been using in the UK over the last decade. MRSA are used as an example where similar trends have been identified in these systems and the information has, once again, proved to be of value to the MRSA control working party.
Infection Control and Hospital Epidemiology, Jun 1, 2000
Methicillin-resistantStaphylococcus aureus(MRSA) is an important cause of nosocomial infections w... more Methicillin-resistantStaphylococcus aureus(MRSA) is an important cause of nosocomial infections worldwide. Interpretation of community MRSA trends is problematical, in that the term is ill-defined, and related data are difficult to put into context. There are four relevant battlefronts, all of interest to risk assessment and prevention. These comprise the following: the issues relating to an increasing pool of patients with MRSA discharged from hospitals into the community; MRSA spreading to patients in nursing and residential homes; and MRSA spreading from patients and healthcare workers to others in the community. There are often difficulties in determining whether the fourth issue, MRSA arising apparently de novo in the community, is in fact due to one of these other fronts. All these battlefronts are important and not yet lost. However, we must agree on definitions and design-appropriate surveillance strategies, so that we can best inform prevention and control activities to contain these emerged or emerging problems.
reported an isolation of a glycopeptide resistant methicillin resistant Staphylococcus aureus (MR... more reported an isolation of a glycopeptide resistant methicillin resistant Staphylococcus aureus (MRSA) (1). The organism was isolated from a patient with endocarditis who had failed to respond to treatment with this antibiotic used in combination with gentamicin and rifampicin. The strain was resistant to vancomycin (minimum inhibitory concentration (MIC) 8-16 mg/L, depending on the testing conditions). Such strains have been termed glycopeptide intermediately resistant Staphylococcus aureus or GISAs, and were first described by Hiramatsu and colleagues in Japan in 1997 (2,3). Since then, they have been identified in France, Scotland, and the United States (US).
practices and implementation varied. Essential aspects such as compliance measurement and audits ... more practices and implementation varied. Essential aspects such as compliance measurement and audits to assess guideline effectiveness were neglected in most documents. In conclusion, there is a need for a more consistent approach leading to recommendations based on a thorough evaluation of evidence and applicable worldwide. Aspects related to implementation and impact monitoring deserve greater attention.
Methicillin-resistant Staphylococcus aureus (MRSA) is a world-wide public health problem, causing... more Methicillin-resistant Staphylococcus aureus (MRSA) is a world-wide public health problem, causing nosocomial and community-acquired infections. Furthermore, MRSA is increasingly resistant to many conventional antimicrobials, so there is a real need to develop alternative approaches for MRSA decolonization and treatment. Previously, we have demonstrated that MRSA can be killed with an immunoglobulin G (IgG)-SnCe6 conjugate and red light, but effectiveness was dependent on the particular strain and the growth phase. In this investigation, we used an antibody raised against MRSA to make an Ab-SnCe6 conjugate capable of targeting many MRSA strains in all growth phases. To suspensions of important epidemic MRSA, each grown to stationary, lag, or exponential phase, the Ab-SnCe6 conjugate was added and samples exposed to red light. Survivors were then enumerated. This treatment was very effective at killing all the different MRSA strains tested, in all growth phases. The Ab-SnCe6 conjugate was able to kill EMRSA-16 selectively in a mixed suspension of EMRSA-16 and Escherichia coli, and was much better at killing EMRSA-16 than a coagulase-negative staphylococcus, S. epidermidis. These results demonstrate that photodynamic therapy of MRSA is very effective when the photosensitizer is targeted to the pathogen using a suitable antibody and may be a good candidate for a novel treatment of MRSA infections.
We describe bacterial contamination of a 'Cialit'-preserved cartilage bank which ... more We describe bacterial contamination of a 'Cialit'-preserved cartilage bank which continued after a variety of changes to the harvesting and preservation protocols during a 3-year prospective study. Our results emphasize the importance of adequate tissue bank microbiological screening. Alternative methods of tissue preservation should be considered.
staff are untrained, levels of agency staff are high, and management fails to provide the constan... more staff are untrained, levels of agency staff are high, and management fails to provide the constant support and encouragement required. This results in burnt out staff who have neither the energy nor the drive to provide more than basic physical care. This picture is paralleled in nursing homes. Many buildings are new but have failed to take advantage of the latest thinking in design, which can help both staff and patients with dementia. Dementia specific design features include high levels of visual access, highly visible and signed toilet doors, increased lighting, age appropriate fixtures and fittings, and individualised personal space. 3 Like the inspectors, staff are often unaware of recent thinking about dementia care. They too often have neither the time nor the energy to provide more than basic physical care. Providing good quality care for people with dementia is not easy. These patients often have communication difficulties, which makes interaction difficult. They often communicate through their behaviour, which can thereby be very challenging. We do not know the level of sedation in the population in this study but it is likely to be high. The cycle of challenging behaviour, overuse of sedatives, 4 and diminished capacity to interact is commonplace. Many of these patients will also have high levels of incontinence, problems with eating, and impaired abilities in many activities of daily living. It is all too easy to blame the dementia for the extent to which patients spend their time sleeping or sitting apathetically around the walls of the communal areas. In a sense dementia lets staff at all levels, and those responsible for quality of care, off the hook. This makes the issue of quality of care one of wider concern. People with dementia are very vulnerable. They cannot usually complain about their care, and if they try to communicate through their behaviour the response is often to see it as a symptom to be
Meticillin-resistant (MRSA) infections are of increasing importance to clinicians, public health ... more Meticillin-resistant (MRSA) infections are of increasing importance to clinicians, public health agencies and governments. Prevention and control strategies must address sources in healthcare settings, the community and livestock. This document presents the conclusions of a European Consensus Conference on the role of screening and decolonisation in the control of MRSA infection. The conference was held in Rome on 5-6 March 2010 and was organised jointly by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC). In an environment where MRSA is endemic, universal or targeted screening of patients to detect colonisation was considered to be an essential pillar of any MRSA control programme, along with the option of decolonising carriers dependent on relative risk of infection, either to self or others, in a specific setting. Staff screening may be useful but is problematic as it needs to distinguish between transient carriage and longer-term colonisation. The consequences of identification of MRSA-positive staff may have important effects on morale and the ability to maintain staffing levels. The role of environmental contamination in MRSA infection is unclear, but screening may be helpful as an audit of hygiene procedures. In all situations, screening procedures and decolonisation carry a significant cost burden, the clinical value of which requires careful evaluation. European initiatives designed to provide further information on the cost/benefit value of particular strategies in the control of infection, including those involving MRSA, are in progress.
The global threat of antimicrobial resistance and potentially untreatable infections is a serious... more The global threat of antimicrobial resistance and potentially untreatable infections is a serious matter under review currently by the WHO and many countries throughout the world. I consider the optimal surveillance scheme and point out the various biases in the systems that we have been using in the UK over the last decade. MRSA are used as an example where similar trends have been identified in these systems and the information has, once again, proved to be of value to the MRSA control working party.
Infection Control and Hospital Epidemiology, Jun 1, 2000
Methicillin-resistantStaphylococcus aureus(MRSA) is an important cause of nosocomial infections w... more Methicillin-resistantStaphylococcus aureus(MRSA) is an important cause of nosocomial infections worldwide. Interpretation of community MRSA trends is problematical, in that the term is ill-defined, and related data are difficult to put into context. There are four relevant battlefronts, all of interest to risk assessment and prevention. These comprise the following: the issues relating to an increasing pool of patients with MRSA discharged from hospitals into the community; MRSA spreading to patients in nursing and residential homes; and MRSA spreading from patients and healthcare workers to others in the community. There are often difficulties in determining whether the fourth issue, MRSA arising apparently de novo in the community, is in fact due to one of these other fronts. All these battlefronts are important and not yet lost. However, we must agree on definitions and design-appropriate surveillance strategies, so that we can best inform prevention and control activities to contain these emerged or emerging problems.
reported an isolation of a glycopeptide resistant methicillin resistant Staphylococcus aureus (MR... more reported an isolation of a glycopeptide resistant methicillin resistant Staphylococcus aureus (MRSA) (1). The organism was isolated from a patient with endocarditis who had failed to respond to treatment with this antibiotic used in combination with gentamicin and rifampicin. The strain was resistant to vancomycin (minimum inhibitory concentration (MIC) 8-16 mg/L, depending on the testing conditions). Such strains have been termed glycopeptide intermediately resistant Staphylococcus aureus or GISAs, and were first described by Hiramatsu and colleagues in Japan in 1997 (2,3). Since then, they have been identified in France, Scotland, and the United States (US).
practices and implementation varied. Essential aspects such as compliance measurement and audits ... more practices and implementation varied. Essential aspects such as compliance measurement and audits to assess guideline effectiveness were neglected in most documents. In conclusion, there is a need for a more consistent approach leading to recommendations based on a thorough evaluation of evidence and applicable worldwide. Aspects related to implementation and impact monitoring deserve greater attention.
Methicillin-resistant Staphylococcus aureus (MRSA) is a world-wide public health problem, causing... more Methicillin-resistant Staphylococcus aureus (MRSA) is a world-wide public health problem, causing nosocomial and community-acquired infections. Furthermore, MRSA is increasingly resistant to many conventional antimicrobials, so there is a real need to develop alternative approaches for MRSA decolonization and treatment. Previously, we have demonstrated that MRSA can be killed with an immunoglobulin G (IgG)-SnCe6 conjugate and red light, but effectiveness was dependent on the particular strain and the growth phase. In this investigation, we used an antibody raised against MRSA to make an Ab-SnCe6 conjugate capable of targeting many MRSA strains in all growth phases. To suspensions of important epidemic MRSA, each grown to stationary, lag, or exponential phase, the Ab-SnCe6 conjugate was added and samples exposed to red light. Survivors were then enumerated. This treatment was very effective at killing all the different MRSA strains tested, in all growth phases. The Ab-SnCe6 conjugate was able to kill EMRSA-16 selectively in a mixed suspension of EMRSA-16 and Escherichia coli, and was much better at killing EMRSA-16 than a coagulase-negative staphylococcus, S. epidermidis. These results demonstrate that photodynamic therapy of MRSA is very effective when the photosensitizer is targeted to the pathogen using a suitable antibody and may be a good candidate for a novel treatment of MRSA infections.
We describe bacterial contamination of a 'Cialit'-preserved cartilage bank which ... more We describe bacterial contamination of a 'Cialit'-preserved cartilage bank which continued after a variety of changes to the harvesting and preservation protocols during a 3-year prospective study. Our results emphasize the importance of adequate tissue bank microbiological screening. Alternative methods of tissue preservation should be considered.
staff are untrained, levels of agency staff are high, and management fails to provide the constan... more staff are untrained, levels of agency staff are high, and management fails to provide the constant support and encouragement required. This results in burnt out staff who have neither the energy nor the drive to provide more than basic physical care. This picture is paralleled in nursing homes. Many buildings are new but have failed to take advantage of the latest thinking in design, which can help both staff and patients with dementia. Dementia specific design features include high levels of visual access, highly visible and signed toilet doors, increased lighting, age appropriate fixtures and fittings, and individualised personal space. 3 Like the inspectors, staff are often unaware of recent thinking about dementia care. They too often have neither the time nor the energy to provide more than basic physical care. Providing good quality care for people with dementia is not easy. These patients often have communication difficulties, which makes interaction difficult. They often communicate through their behaviour, which can thereby be very challenging. We do not know the level of sedation in the population in this study but it is likely to be high. The cycle of challenging behaviour, overuse of sedatives, 4 and diminished capacity to interact is commonplace. Many of these patients will also have high levels of incontinence, problems with eating, and impaired abilities in many activities of daily living. It is all too easy to blame the dementia for the extent to which patients spend their time sleeping or sitting apathetically around the walls of the communal areas. In a sense dementia lets staff at all levels, and those responsible for quality of care, off the hook. This makes the issue of quality of care one of wider concern. People with dementia are very vulnerable. They cannot usually complain about their care, and if they try to communicate through their behaviour the response is often to see it as a symptom to be
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