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Neuromodulation : Journal of the... Jul 2023Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Staphylococcus aureus (S aureus) is the foremost bacterial cause of surgical-site infection (SSI) and is a common source of neuromodulation SSI. Endogenous colonization is an independent risk factor for SSI; however, this risk has been shown to diminish with screening and decolonization.
MATERIALS AND METHODS
A systematic review was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines using the PubMed, Cochrane Library, and Embase data bases from inception to January 1, 2022, for the purposes of identifying all studies reporting on the use of S aureus swabbing and/or decolonization before neuromodulation procedures. A random-effects meta-analysis was performed using the metaphor package in R to calculate odds ratios (OR).
RESULTS
Five observational cohort studies were included after applying the inclusion and exclusion criteria. The average study duration was 6.6 ± 3.8 years. Three studies included nasal screening as a prerequisite for subsequent decolonization. Type of neuromodulation included spinal cord stimulation in two studies, deep brain stimulation in two studies, intrathecal baclofen in one study, and sacral neuromodulation in one study. Overall, 860 and 1054 patients were included in a control or intervention (ie, screening and/or decolonization) group, respectively. A combination of nasal mupirocin ointment and a body wash, most commonly chlorhexidine gluconate soap, was used to decolonize throughout. Overall infection rates were observed at 59 of 860 (6.86%) and ten of 1054 (0.95%) in the control and intervention groups, respectively. Four studies reported a significant difference. The OR for intervention (screen and/or decolonization) vs no intervention was 0.19 (95% CI, 0.09-0.37; p < 0.001). Heterogeneity between studies was nonsignificant (I = 0.43%, τ = 0.00).
CONCLUSIONS
Preoperative S aureus swabbing and decolonization resulted in significantly decreased odds of infection in neuromodulation procedures. This measure may represent a worthwhile tool to reduce neuromodulation SSI, warranting further investigation.
Topics: Humans; Staphylococcus aureus; Mupirocin; Staphylococcal Infections; Surgical Wound Infection; Anti-Bacterial Agents
PubMed: 36198512
DOI: 10.1016/j.neurom.2022.07.013 -
Cureus May 2022To determine incidence trends of bacteremia (SAB) from population-based studies from multiple countries. (Review)
Review
OBJECTIVES
To determine incidence trends of bacteremia (SAB) from population-based studies from multiple countries.
METHODS
A contemporary systematic review was conducted using Ovid Cochrane Central Register of Controlled Trials (1991+), Ovid Embase (1974+), Ovid Medical Literature Analysis and Retrieval System Online (MEDLINE) (1946+ including epub ahead of print, in-process & other non-indexed citations), and Web of Science Core Collection (Science Citation Index Expanded 1975+ and Emerging Sources Citation Index 2015+). Two authors (J.R.H. and J.A.Q.M.) independently reviewed all studies and included those that reported population-based incidence of SAB in patients aged 18 years and older.
RESULTS
Twenty-six studies met inclusion criteria with the highest number (n=6) of studies conducted in Canada. The incidence of SAB ranged from 9.3 to 65 cases/100,000/year. The median age of patients with SAB ranged from 62 to 72 years and SAB cases were more commonly observed in men than in women. The most common infection sources were intravascular catheters and skin and soft tissue infections. SAB incidence trends demonstrated high variability for geographic regions and calendar years. Overall, there was no change in the incidence trend across all studies during the past two decades.
CONCLUSION
Multiple factors, both pros, and cons are likely responsible for the overall stable SAB incidence in countries included in this systematic review. Some of these factors vary in geographic location and prompt additional investigations from countries not included in the current review so that a more global characterization is defined.
PubMed: 35774691
DOI: 10.7759/cureus.25460 -
International Journal of Infectious... Feb 2021Methicillin-resistant Staphylococcus aureus (MRSA) is a significant health threat and public burden worldwide, particularly in developing countries, including Nepal, due... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) is a significant health threat and public burden worldwide, particularly in developing countries, including Nepal, due to its low healthcare standards and irrational use of antibiotics. It is evident that MRSA strains are frequently detected in Nepalese hospitals; however, they remain underreported. Therefore, to provide a comprehensive and clear understanding of MRSA infection at the national level, this systematic review and meta-analysis evaluated the prevalence and antimicrobial susceptibility patterns of MRSA in Nepal.
METHODS
PubMed, EMBASE, Cochrane CENTRAL, Google scholar, and Nepalese databases were searched for studies published between 1st January 2008 and 31st August 2020. A total of 26 original articles were selected for quantitative analysis. Data extraction was accomplished by three authors independently and meta-analysis was performed using MedCalc Version 19.5.1 and Comprehensive Meta-Analysis (CMA) software v.3.0.
RESULT
The pooled prevalence of MRSA infections among 5951 confirmed S. aureus isolates was 38.2% (95% CI, 31.4%-45.2%). We found a significant heterogeneity (I = 96.7% for resistance proportion), and no evidence of publication bias (p = 0.256) among studies. MRSA strains showed a high level of resistance to beta-lactam antibiotics and the highest susceptibility profile was noted in vancomycin 98.0% followed by chloramphenicol 91.0%.
CONCLUSION
The analysis revealed that the overall MRSA burden in Nepal is considerably high and the prevalence of MRSA infections is in the increasing trend. Sound legislation, definite antibiotic policy, and implementations of control interventions are indispensable for tackling MRSA infection and antimicrobial resistance as a whole.
Topics: Anti-Bacterial Agents; Chloramphenicol; Drug Resistance, Bacterial; Humans; Methicillin-Resistant Staphylococcus aureus; Nepal; Prevalence; Staphylococcal Infections; Vancomycin
PubMed: 33217574
DOI: 10.1016/j.ijid.2020.11.152 -
Journal of Cardiovascular Development... Mar 2022In the expanding era of antibiotic resistance, new strains of have emerged which possess resistance to traditionally used antibiotics (MRSA). Our review aimed to... (Review)
Review
In the expanding era of antibiotic resistance, new strains of have emerged which possess resistance to traditionally used antibiotics (MRSA). Our review aimed to systematically synthesize information on previously described MRSA pericarditis cases. The only criterion for inclusion was the isolation of MRSA from the pericardial space. Our review included 30 adult and 9 pediatric patients (aged: 7 months to 78 years). Comorbid conditions were seen in most adult patients, whereas no comorbidities were noted amongst the pediatric patients. Pericardial effusion was found in 94.9% of cases, with evidence of tamponade in 83.8%. All cases isolated MRSA from pericardial fluid and 25 cases (64.1%) had positive blood cultures for MRSA. Pericardiocentesis and antibiotics were used in all patients. The mortality rate amongst adults was 20.5%, with a mean survival of 21.8 days, and attributed to multi-organ failure associated with septic shock. No mortality was observed in the pediatric population. In adult patients, there was no statistical difference in symptom duration, antibiotic duration, presence of tamponade, age, and sex in relation to survival. Conclusion: MRSA pericarditis often presents with sepsis and is associated with significant mortality. As such, a high clinical suspicion is needed to proceed with proper tests such as echocardiography and pericardiocentesis. In more than one third of the cases, MRSA pericarditis occurs even in the absence of documented bacteremia.
PubMed: 35448079
DOI: 10.3390/jcdd9040103 -
Oman Medical Journal Jul 2022The emergence of methicillin-resistant (MRSA) has increased and become a serious concern worldwide, including India. Additionally, MRSA isolates are showing resistance... (Review)
Review
The emergence of methicillin-resistant (MRSA) has increased and become a serious concern worldwide, including India. Additionally, MRSA isolates are showing resistance to other chemotherapeutic agents. Isolated and valuable reports on the prevalence of MRSA are available in India. There is no systematic review on the prevalence of MRSA in one place; hence, this study was planned. The overall prevalence of MRSA in humans in India was evaluated state-wise, zone-wise, and year-wise. A systematic search from PubMed, Indian journals, Google Scholar, and J-Gate Plus was carried out and retrieved 98 eligible articles published from 2015 to 2020 in India. The statistical analysis of data was conducted using R software. The overall prevalence of MRSA was 37% (95% CI: 32-41) from 2015 to 2019. The pooled prevalence of MRSA zone-wise was 41% (95% CI: 33-50), 43% (95% CI: 20-68), 33% (95% CI: 24-43), 34% (95% CI: 26-42), 36% (95% CI: 25-47), and 40% (95% CI: 23-58) for north, east, west, south, central, and northeast region-zones, respectively. The state-wise stratified results showed a predominance of MRSA in Jammu and Kashmir with 55% (95% CI: 42-67) prevalence, and the lowest was 21% (95% CI: 11-34) in Maharashtra. The study indicated that the prevalence data would help in formulating and strict implementation of control measures in hospital areas to prevent the outbreak of MRSA infection and management of antibiotic usage.
PubMed: 35949712
DOI: 10.5001/omj.2022.22 -
The Cochrane Database of Systematic... Sep 2019Trachoma is the world's leading infectious cause of blindness. In 1996, WHO launched the Alliance for the Global Elimination of Trachoma by the year 2020, based on the...
BACKGROUND
Trachoma is the world's leading infectious cause of blindness. In 1996, WHO launched the Alliance for the Global Elimination of Trachoma by the year 2020, based on the 'SAFE' strategy (surgery, antibiotics, facial cleanliness, and environmental improvement).
OBJECTIVES
To assess the evidence supporting the antibiotic arm of the SAFE strategy by assessing the effects of antibiotics on both active trachoma (primary objective), Chlamydia trachomatis infection of the conjunctiva, antibiotic resistance, and adverse effects (secondary objectives).
SEARCH METHODS
We searched relevant electronic databases and trials registers. The date of the last search was 4 January 2019.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) that satisfied either of two criteria: (a) trials in which topical or oral administration of an antibiotic was compared to placebo or no treatment in people or communities with trachoma, (b) trials in which a topical antibiotic was compared with an oral antibiotic in people or communities with trachoma. We also included studies addressing different dosing strategies in the population. DATA COLLECTION AND ANALYSIS: We used standard methods expected by Cochrane. We assessed the certainty of the evidence using the GRADE approach.
MAIN RESULTS
We identified 14 studies where individuals with trachoma were randomised and 12 cluster-randomised studies. Any antibiotic versus control (individuals)Nine studies (1961 participants) randomised individuals with trachoma to antibiotic or control (no treatment or placebo). All of these studies enrolled children and young people with active trachoma. The antibiotics used in these studies included topical (oxy)tetracycline (5 studies), doxycycline (2 studies), and sulfonamides (4 studies). Four studies had more than two study arms. In general these studies were poorly reported, and it was difficult to judge risk of bias.These studies provided low-certainty evidence that people with active trachoma treated with antibiotics experienced a reduction in active trachoma at three months (risk ratio (RR) 0.78, 95% confidence interval (CI) 0.69 to 0.89; 1961 people; 9 RCTs; I = 73%) and 12 months (RR 0.74, 95% CI 0.55 to 1.00; 1035 people; 4 RCTs; I = 90%). Low-certainty evidence was available for ocular infection at three months (RR 0.81, 95% CI 0.63 to 1.04; 297 people; 4 RCTs; I = 0%) and 12 months (RR 0.25, 95% CI 0.08 to 0.78; 129 people; 1 RCT). None of these studies assessed antimicrobial resistance. In those studies that reported harms, no serious adverse effects were reported (low-certainty evidence).Oral versus topical antibiotics (individuals)Eight studies (1583 participants) compared oral and topical antibiotics. Only one study included people older than 21 years of age. Oral antibiotics included azithromycin (5 studies), sulfonamides (2 studies), and doxycycline (1 study). Topical antibiotics included (oxy)tetracycline (6 studies), azithromycin (1 study), and sulfonamide (1 study). These studies were poorly reported, and it was difficult to judge risk of bias.There was low-certainty evidence of little or no difference in effect between oral and topical antibiotics on active trachoma at three months (RR 0.97, 95% CI 0.81 to 1.16; 953 people; 6 RCTs; I = 63%) and 12 months (RR 0.93, 95% CI 0.75 to 1.15; 886 people; 5 RCTs; I = 56%). There was very low-certainty evidence for ocular infection at three or 12 months. Antimicrobial resistance was not assessed. In those studies that reported adverse effects, no serious adverse effects were reported; one study reported abdominal pain with azithromycin; one study reported a couple of cases of nausea with azithromycin; and one study reported three cases of reaction to sulfonamides (low-certainty evidence).Oral azithromycin versus control (communities)Four cluster-randomised studies compared antibiotic with no or delayed treatment. Data were available on active trachoma at 12 months from two studies but could not be pooled because of reporting differences. One study at low risk of bias found a reduced prevalence of active trachoma 12 months after a single dose of azithromycin in communities with a high prevalence of infection (RR 0.58, 95% CI 0.52 to 0.65; 1247 people). The other, lower quality, study in low-prevalence communities reported similar median prevalences of infection at 12 months: 9.3% in communities treated with azithromycin and 8.2% in untreated communities. We judged this moderate-certainty evidence for a reduction in active trachoma with treatment, downgrading one level for inconsistency between the two studies. Two studies reported ocular infection at 12 months and data could be pooled. There was a reduction in ocular infection (RR 0.36, 0.31 to 0.43; 2139 people) 12 months after mass treatment with a single dose compared with no treatment (moderate-certainty evidence). There was high-certainty evidence of an increased risk of resistance of Streptococcus pneumoniae, Staphylococcus aureus, and Escherichia coli to azithromycin, tetracycline, and clindamycin in communities treated with azithromycin, with approximately 5-fold risk ratios at 12 months. The evidence did not support increased resistance to penicillin or trimethoprim-sulfamethoxazole. None of the studies measured resistance to C trachomatis. No serious adverse events were reported. The main adverse effect noted for azithromycin (˜10%) was abdominal pain, vomiting, and nausea.Oral azithromycin versus topical tetracycline (communities)Three cluster-randomised studies compared oral azithromycin with topical tetracycline. The evidence was inconsistent for active trachoma and ocular infection at three and 12 months (low-certainty evidence) and was not pooled due to considerable heterogeneity. Antimicrobial resistance and adverse effects were not reported.Different dosing strategiesSix studies compared different strategies for dosing. There were: mass treatment at different dosing intervals; applying cessation or stopping rules to mass treatment; strategies to increase mass treatment coverage. There was no strong evidence to support any variation in the recommended annual mass treatment.
AUTHORS' CONCLUSIONS
Antibiotic treatment may reduce the risk of active trachoma and ocular infection in people infected with C trachomatis, compared to no treatment/placebo, but the size of the treatment effect in individuals is uncertain. Mass antibiotic treatment with single dose oral azithromycin reduces the prevalence of active trachoma and ocular infection in communities. There is no strong evidence to support any variation in the recommended periodicity of annual mass treatment. There is evidence of an increased risk of antibiotic resistance at 12 months in communities treated with antibiotics.
Topics: Administration, Oral; Administration, Topical; Anti-Bacterial Agents; Chlamydia trachomatis; Drug Resistance, Bacterial; Humans; Randomized Controlled Trials as Topic; Trachoma; Treatment Outcome
PubMed: 31554017
DOI: 10.1002/14651858.CD001860.pub4 -
Antibiotics (Basel, Switzerland) Feb 2020is a common bacterial colonizer of humans and a variety of animal species. Many strains have zoonotic potential, moving between humans and animals, including livestock,... (Review)
Review
is a common bacterial colonizer of humans and a variety of animal species. Many strains have zoonotic potential, moving between humans and animals, including livestock, pets, and wildlife. We examined publications reporting on presence in a variety of wildlife species in order to more cohesively review distribution of strains and antibiotic resistance in wildlife. Fifty-one studies were included in the final qualitative synthesis. The most common types documented included ST398, ST425, ST1, ST133, ST130, and ST15. A mix of methicillin-resistant and methicillin-susceptible strains were noted. A number of molecular types were identified that were likely to be found in wildlife species, including those that are commonly found in humans or other animal species (including livestock). Additional research should include follow-up in geographic areas that are under-sampled in this study, which is dominated by European studies.
PubMed: 32085586
DOI: 10.3390/antibiotics9020089 -
Antimicrobial Resistance and Infection... Jun 2021Vancomycin‑resistant Staphylococcus aureus (VRSA) is a serious public health challenging concern worldwide. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Vancomycin‑resistant Staphylococcus aureus (VRSA) is a serious public health challenging concern worldwide.
OBJECTIVES
Therefore, the objective of present study of 62 published studies was to evaluate the prevalence of VRSA based on different years, areas, isolate source, antimicrobial susceptibility testing, and the genetic determinants.
METHODS
We searched the relevant articles that focused on the prevalence rates of VRSA in PubMed, Scopus, Embase, and Web of Science from 2000 to 2019. Statistical analyses were conducted using STATA software (version 14.0).
RESULTS
The prevalence of VRSA was 2% before 2006, 5% in 2006-2014, and 7% in 2015-2020 that showed a 3.5-fold increase in the frequency of VRSA between before 2006 and 2020 years. The prevalence of VRSA was 5% in Asia, 1% in Europe, 4% in America, 3% in South America, and 16% in Africa. The frequencies of VRSA isolated from clinical, non-clinical, and mixed samples were 6%, 7%, and 14%, respectively. The prevalence of VRSA was 12% using disk diffusion agar method, 7% using MIC-base methods, and 4% using mixed-methods. The prevalence of vanA, vanB, and vanC1 positive were 71%, 26%, and 4% among VRSA strains. The most prevalent genotype was staphylococcal cassette chromosomemec (SCCmec) II, which accounted for 57% of VRSA. The most prevalent staphylococcal protein A (spa) types were t002, t030, and t037.
CONCLUSION
The prevalence of VRSA has been increasing in recent years particularly in Africa/Asia than Europe/America. The most prevalent of genetic determinants associated with VRSA were vanA and SCCmec II. This study clarifies that the rigorous monitoring of definite antibiotic policy, regular surveillance/control of nosocomial-associated infections and intensive surveillance of vancomycin-resistance are required for preventing emergence and further spreading of VRSA.
Topics: Africa; Asia; Europe; Humans; Methicillin-Resistant Staphylococcus aureus; North America; Prevalence; South America; Staphylococcal Infections; Vancomycin-Resistant Staphylococcus aureus
PubMed: 34193295
DOI: 10.1186/s13756-021-00967-y -
International Journal of Molecular... Feb 2023Many studies have been published assessing the association between the presence of genes and outcomes in patients with bone and joint infections (BJI), but it is not... (Review)
Review
Many studies have been published assessing the association between the presence of genes and outcomes in patients with bone and joint infections (BJI), but it is not known if they have had similar findings. A systematic literature review was performed. All available data on studies in Pubmed between January 2000 to October 2022 reporting the genetic characteristics of and the outcomes of BJIs were analyzed. BJI included prosthetic joint infection (PJI), osteomyelitis (OM), diabetic foot infection (DFI), and septic arthritis. Because of the heterogeneity of studies and outcomes, no meta-analysis was performed. With the search strategy, 34 articles were included: 15 articles on children and 19 articles on adults. In children, most BJI studied were OM ( = 13) and septic arthritis ( 9). Panton Valentine leucocidin (PVL) genes were associated with higher biological inflammatory markers at presentation ( 4 studies), more febrile days ( 3), and more complicated/severe infection ( 4). Other genes were reported anecdotally associated with poor outcomes. In adults, six studies reported outcomes in patients with PJI, 2 with DFI, 3 with OM, and 3 with various BJI. Several genes were associated with a variety of poor outcomes in adults, but studies found contradictory results. Whereas PVL genes were associated with poor outcomes in children, no specific genes were reported similarly in adults. Additional studies with homogenous BJI and larger sample sizes are needed.
Topics: Child; Adult; Humans; Staphylococcus aureus; Arthritis, Infectious; Staphylococcal Infections; Osteomyelitis; Communicable Diseases; Genomics
PubMed: 36834650
DOI: 10.3390/ijms24043234 -
Biomaterials Mar 2016Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative... (Review)
Review
Orthopaedic devices are the most common surgical devices associated with implant-related infections and Staphylococcus aureus (S. aureus) is the most common causative pathogen in chronic bone infections (osteomyelitis). Treatment of these chronic bone infections often involves combinations of antibiotics given systemically and locally to the affected site via a biomaterial spacer. The gold standard biomaterial for local antibiotic delivery against osteomyelitis, poly(methyl methacrylate) (PMMA) bone cement, bears many limitations. Such shortcomings include limited antibiotic release, incompatibility with many antimicrobial agents, and the need for follow-up surgeries to remove the non-biodegradable cement before surgical reconstruction of the lost bone. Therefore, extensive research pursuits are targeting alternative, biodegradable materials to replace PMMA in osteomyelitis applications. Herein, we provide an overview of the primary clinical treatment strategies and emerging biodegradable materials that may be employed for management of implant-related osteomyelitis. We performed a systematic review of experimental biomaterials systems that have been evaluated for treating established S. aureus osteomyelitis in an animal model. Many experimental biomaterials were not decisively more efficacious for infection management than PMMA when delivering the same antibiotic. However, alternative biomaterials have reduced the number of follow-up surgeries, enhanced the antimicrobial efficacy by delivering agents that are incompatible with PMMA, and regenerated bone in an infected defect. Understanding the advantages, limitations, and potential for clinical translation of each biomaterial, along with the conditions under which it was evaluated (e.g. animal model), is critical for surgeons and researchers to navigate the plethora of options for local antibiotic delivery.
Topics: Animals; Anti-Bacterial Agents; Biocompatible Materials; Disease Models, Animal; Humans; Osteomyelitis; Prostheses and Implants; Staphylococcal Infections
PubMed: 26724454
DOI: 10.1016/j.biomaterials.2015.12.012