Day: October 13, 2023

Nineteen new cases of leptospirosis have been confirmed in the areas affected by last month’s flooding in Thessaly, nine of them in the last 24 hours. At the same time, in the last 24 hours, 1,466 citizens attended hospital emergency departments in the region. Of these admissions, 26 were for gastroenteritis and 194 for respiratory infections.

For some older women, recurring urinary tract infections — and the antibiotics typically prescribed for them — become a fact of life, but a new study offers a novel treatment that may deliver relief. Called electrofulguration, the minimally invasive procedure essentially zaps and eliminates inflamed, infected bladder tissue. In the study, it was found to be effective for a number of women plagued by the issue. Advertisement Study corresponding author Dr. Philippe Zimmern, director of the John and Felecia Cain Center for Bladder Health at UT Southwestern Medical Center in Dallas, said he was interested in finding solutions because he saw so many patients who had taken antibiotics for bladder infections repeatedly before they were referred to him. “It was kind of a puzzle. I was saying, ‘Where are these infections coming from?’” Zimmern said. Zimmern was inspired to try electrofulguration after reading the work of another researcher who had discovered in animal studies that the infections had attacked the surface of the bladder, allowing bacteria to attach to a deeper layer. After that, those bacteria were able to persist in the bladder because they were protected by a biofilm, he explained. Advertisement “Once we had proven the bacteria were there, then it kind of opened the idea that fulguration in fact could be a definitive treatment for these patients,” Zimmern said. Fulguration has been used in the past to burn away bladder tumors, according to the U.S. National Institutes of Health. In this study, the researchers reviewed the medical records of 96 postmenopausal women treated with electrofulguration for recurrent urinary tract infections (UTIs) between 2006 and 2012. About 72% of the women were considered to have a successful treatment. That meant they had no more than one UTI per year during follow-up. Another 22% had fewer than three UTIs annually. About 6% were unchanged. Only about 5% of women were on continuous antibiotics after their last follow-up, compared to 74% before electrofulguration, according to the report. The concern about continuously or repeatedly taking antibiotics for the infections is that resistant strains of bacteria can build up over time, which can make UTIs even harder to treat. Sometimes that can lead to the dangerous blood infection known as sepsis. Sometimes, it requires surgical removal of the bladder, the researchers said. “It’s a complicated story between the type of bacteria that invade the bladder. And that’s something we have to figure out. There are different bacteria, they have different abilities to stick to tissues,” Zimmern said. “The fascinating part of this story is that half of women don’t have infection.” Advertisement Another study Zimmern is involved in is looking at what happens with women who do not have these chronic infections, how they’re protected, but that’s ongoing. After electrofulguration, doctors have a variety of tools to help prevent germs from re-entering the bladder, which can include hormone cream and probiotics, Zimmern said. The findings were published in the October issue of The Journal of Urology. Dr. Louis Kavoussi, chair of urology at Northwell Health in New Hyde Park, N.Y., had reservations about whether this type of procedure should be recommended to women over standard care. “Does it merit further study? Yes, it does, but it’s by no means a panacea or standard of care,” Kavoussi said. Postmenopausal women can struggle with recurrent UTIs because of changes in levels of estrogen, which helps keep tissues strong in the pelvis, vagina and urethra, Kavoussi explained. The tissue gets thinner with less estrogen, he said. A person may be prescribed antibiotics for a UTI, but it can take longer than a course of antibiotics for a natural barrier to infection to repopulate and keep bacteria from sticking to the surface of the bladder. “What happens if bacteria gets in, in the meantime while the coating is even weaker, then they get another infection, something called cluster infection,” Kavoussi said. Advertisement Kavoussi noted the study volunteers were also prescribed a long course of antibiotics after electrofulguration and wondered if that may have played an outsized role in the cure. He suggested some alternatives for women with recurrent UTIs. “Some of them are very simple. One is just drinking a lot of fluids,” Kavoussi said. Research studies have looked at cranberry products, including drinking cranberry juice. Estrogen cream placed at the opening of the urinary tract three times a week can help build tissue and doesn’t get absorbed systemically, he added. “And then the fourth is just go on a longer low-dose period of antibiotics, for about four to six weeks,” Kavoussi said. “All those things have been shown to be helpful. This is, I think, of academic interest,” Kavoussi said about electrofulguration. More information The U.S. Centers for Disease Control and Prevention has more on urinary tract infections. Copyright © 2023 HealthDay. All rights reserved.

Weekly Rounds with Infection Control Today Here are 5 highlights from Infection Control Today®‘s (ICT®’s) wide-ranging coverage of the infection prevention and control world. Everything from interviews with known opinion leaders to the news that infection preventionists and other health care professionals can use on their jobs. Mosquito-Borne Pathogens and Climate Change: The Case of West Nile Virus The article discusses the increased risk of mosquito-borne diseases, such as West Nile Virus (WNV), in the US due to climate change. It explores the transmission, clinical aspects, and prevention measures of WNV, emphasizing the importance of public awareness and action in mitigating the impact of these diseases. Promising Advances in Preventing Staphylococcus Infections: The Efficacy of Mupirocin Nasal Ointment in ICU Care An 18-month trial with 801,668 ICU admissions showed that mupirocin nasal ointment effectively reduces Staphylococcus aureus and MRSA infections by 18% and 15%, respectively, offering hope in ICU infection prevention. Infection Intel, IDWeek 2023 Edition This edition of Infection Intel from Infection Control Today covers infection control and prevention company news out of IDWeek, being held in Boston, Massachusetts, from October 11 to 15, 2023. Wastewater-Based Surveillance Accurately Monitoring Influenza A, B, and RSV Wastewater-based surveillance can accurately monitor influenza A and B and RSV at the population level. This makes it an objective tool to inform public response to common seasonal illnesses. One School System’s Innovative Approach to Student Safety With CASPR Technology Meriwether County School District prioritizes student safety by implementing CASPR Technology, enhancing air and surface disinfection for a healthier learning environment.

NIAID / NIH / Flickr cc A randomized clinical trial found that nasal mupirocin is more effective than nasal iodophor for reducing Staphylococcus aureus and methicillin-resistant S aureus (MRSA) in intensive care unit (ICU) patients, researchers reported this week in JAMA. In the cluster-randomized noninferiority trial, investigators randomized 801,668 ICU patients at 137 US hospitals to receive universal decolonization with nasal mupirocin (an antibiotic ointment) plus chlorhexidine gluconate (CHG) bathing or nasal iodophore (an antiseptic) plus CHG bathing. While a trial conducted from 2009 to 2011 found that universal decolonization with mupirocin and CHG reduced MRSA clinical cultures by 37% and bloodstream infections by 44% in ICU patients, and CHG bathing has been broadly adopted in ICUs, there have been concerns that widespread use of mupirocin could promote resistance in S aureus. Iodophore is considered a potential alternative. The investigators compared ICU-attributable S aureus cultures, MRSA clinical cultures, and all-cause bloodstream infections in the baseline period—when all hospitals used mupirocin-CHG for universal decolonization—and the intervention period. The noninferiority margin was 10%. Iodophore inferior to mupirocin When comparing the two periods, the relative hazard of S aureus clinical cultures was significantly higher by 18.4% for the iodophor-CHG group (hazard ratio [HR], 1.17; 95% confidence interval [CI], 1.12 to 1.23) compared with the mupirocin-CHG group (HR, 0.99; 95% CI, 0.94 to 1.04). Similarly, MRSA clinical cultures were significantly higher by 14.1% for iodophor-CHG compared with mupirocin-CHG (HR, 1.13 vs 0.99, respectively). For all-cause bloodstream infections, iodophore-CHG was not inferior to mupirocin-CHG (HR, 1.00 vs 1.01, respectively). This large study confirms that clearing the nose of bacteria prevents infection, and that the choice of product matters. In addition, when the investigators compared the results from the current trial to the 2009-2011 trial, they found that mupirocin-CHG decolonization remained as effective at reducing S aureus in ICU patients. “This large study confirms that clearing the nose of bacteria prevents infection, and that the choice of product matters,” lead trial investigator Susan Huang, MD, MPH, of the University of California Irvine (UCI), said in a UCI Health press release. “Mupirocin antibiotic ointment remains the best treatment, and serious ICU infections can be avoided by simply giving patients mupirocin for the first five days of an ICU stay along with daily chlorhexidine bathing.”