Day: October 13, 2023

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.”

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.”

Irish holidaymakers are returning from trips abroad with infections of nasty parasites, the HSE has confirmed in an urgent warning to anyone travelling to or from Spain. The health authority has issued hygiene advice to tackle an increase in cases of a condition called cryptosporidiosis, also known as crypto, with a number of holidaymakers coming home with symptoms including vomiting and diarrhoea. Travellers returning from Spain, especially from Salou in Catalonia, have been reported as having intestinal issues. The most common symptom is ‘watery diarrhoea,’ but the illness can also cause dehydration, weight loss, stomach cramps, fever, and nausea. Read More Related Articles Read More Related Articles The HSE has warned that the infection can come about through careless hygiene practices and is urging holidaymakers to wash their hands after handling food, especially raw meat, or live animals. They’ve also advised travellers to take care when drinking tap water, even going so far as to say not to use ice in drinks, as ice cubes can often be contaminated with dangerous bacteria. Precautions should also be taken around food preparation and consumption, with the HSE telling tourists to avoid undercooked shellfish and dodgy street vendors, and to keep an eye on the cleanliness of restaurants. Those who have had the illness have been asked not to go swimming in shared pools for at least a fortnight after the symptoms have cleared up, as the bug is resistant to chlorine. In a healthy person, the symptoms caused by cryptosporidiosis should clear up in a week or two, but the infection can be much more serious for people with compromised immune systems. And as part of the HSE’s official advice, beer and wine are deemed ‘generally safe’ for consumption as well as bottled mineral water and hot drinks. It’s the latest warning to those travelling out of Ireland and onto the continent, with another warning for Irish holidaymakers urged to avoid bringing bedbugs home from their travels as France deals with a scourge of the creepy crawlies – which now look to be becoming resistant to pesticides.

CINCINNATI (WKRC) – The next time your healthcare providers listens to your breathing or heart, you might want to ask about stethoscope hygiene. While stethoscopes can be used to listen to your heart or breathing over clothing, it’s sometimes placed on unprotected skin. In certain settings then, this can raise the risk for transferring germs if the stethoscope isn’t disinfected between patients. “You’re exactly right. We walk in the room, we wash our hands, and yet we take something on other people and lay it on your chest,” said Dr. Steve Feagins. Feagins said while most providers know to wipe down a stethoscope with alcohol between patients, observational studies of healthcare providers now show that as few as one in five providers actually do that. The stethoscope has now been associated with more healthcare associated infections, as well as spores, drug resistant bacteria, viruses and even an emerging resistant fungi such as candida auris. The alcohol wipe down gets rid of some of these but not others, such as norovirus or a common hospital infection known as C. diff. “We have these devices that look like ovens, many of you have these for your cell phones, and you put your stethoscopes in their prior to rounds and sometimes after rounds. That kills everything,” said Dr. Feagins. Researchers are also looking into adding barrier protections for a stethoscope as part of standard infection control practice. That means, just like we protect hands and bodies with gloves or gowns, these barriers would protect against germs.

Acinetobacter baumannii sign (Adobe Stock 76664998 by fotohansel) (This article first appeared on our sister brand ContagionLive.) Treatment with the combination antibiotic sulbactam-durlobactam (SUL-DUR; Xacduro; Entasis Therapeutics) resulted in lower mortality and higher clinical cure and microbiological eradication compared with colistin in individuals with hospital-acquired Acinetobacter baumannii-calcoaceticus complex (ABC) infections. Data from the phase 3 ATTACK clinical trial (NCT03894046) were presented at IDWeek 2023, held October 11 to 14, in Boston, Massachusetts. SUL-DUR, which is an intravenous drug combining sulbactam, a beta-lactam antibacterial, and durlobactam, a beta-lactamase inhibitor, was recently approved by the FDA for the treatment of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia caused by Acinetobacter baumannii. The phase 3, randomized, controlled, noninferiority trial compared SUL-DUR versus colistin in individuals with monomicrobial and polymicrobial ABC infections, randomly assigned to receive either 1.0 g sulbactam/1.0 g durlobactam IV infused over 3 hours every 6 hours plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour every 6 hours, or 2.5 mg/kg colistin IV infused over 30 minutes every 12 hours (after an initial loading dose of colistin 2.5 to 5 mg/kg) plus 1.0 g imipenem/1.0 g cilastatin IV infused over 1 hour every 6 hours, with a treatment duration of 7 to 14 days. Overall, treatment with SUL-DUR reduced 28-day all-cause mortality, the primary endpoint, by 13.2% compared with colistin (19%, 12/63 vs 32.3%, 20/62, respectively). Outcomes for individuals in the treatment arm were similar regardless of monomicrobial or polymicrobial ABC infections; however, individuals in the control arm with monomicrobial infections had higher mortality rates and worse clinical and microbiological outcomes than those with polymicrobial infections. Among the 12 participants in the SUL-DUR arm who died, 4 were attributed to the index infection (33.3% each for mono- vs. polymicrobial infection) compared with 10 in the control arm (46.7% monomicrobial vs 60% polymicrobial infection). Notably, 35% of patients treated with colistin who had monomicrobial ABC infection died compared with 17% in the SUL-DUR group. A greater portion of those in the SUL-DUR arm reached clinical cure and favorable microbiological outcome at the time of cure (7+2 days) compared with the colistin group (SUL-DUR: 64% clinical cure [mono] vs. 59% [poly]; Colistin: 35% [mono] vs. 53% [poly]; SUL-DUR: 67% favorable microbiological outcome [mono] vs 70% [poly]; Colistin: 33% [mono] vs 63% [poly]). Further, 57% of co-infecting Gram-negative pathogens in the SUL-DUR arm at baseline were non-susceptible to imipenem; however, adding durlobactam restored susceptibility to 85% of those pathogens, including those with multi-drug resistance. “These results suggest that SUL-DUR plus a carbapenem could be an effective treatment for polymicrobial infections that include ABC,” the authors concluded, noting that “additional clinical data are needed to demonstrate efficacy.” Click here for more coverage of IDWeek 2023. Reference McLeod S, Miller A, Shapiro AB, Rana K, Altarac D. Efficacy of Sulbactam-Durlobactam (SUL-DUR) Compared to Colistin (COL) against Acinetobacter baumannii-calcoaceticus Complex (ABC) Monomicrobial and Polymicrobial Infections in a Phase 3 Trial. Presented at: IDWeek 2023. October 11-14, 2023; Boston, MA. Abstract 85.

<div data-thumb="https://scx1.b-cdn.net/csz/news/tmb/2023/collating-data-on-drop.jpg" data-src="https://scx2.b-cdn.net/gfx/news/2023/collating-data-on-drop.jpg" data-sub-html="Conceptual scheme of the aerosol and droplet pathogen transmission routes along with relevant physicochemical properties of respiratory particles. Credit: Reviews of Modern Physics (2023). DOI: 10.1103/RevModPhys.95.045001″> Conceptual scheme of the aerosol and droplet pathogen transmission routes along with relevant physicochemical properties of respiratory particles. Credit: Reviews of Modern Physics (2023). DOI: 10.1103/RevModPhys.95.045001 A team of atmospheric scientists, chemists and infectious disease specialists at the Max Planck Institute for Chemistry, working with colleagues from the Max Planck Institute for Dynamical Systems, the University of Denver, Georg August University and St. Petersburg State University, has embarked on an effort to collate publicly available information on droplet properties, such as the way they are distributed by size, their composition, and the ways they are emitted, as a means of helping to develop mitigation strategies for fighting infectious agents. In their paper published in the journal Reviews of Modern Physics, the group describes their collating process and why they believe it could help fight non-contact infectious diseases. In the early days of the pandemic, as people around the world locked themselves inside their residences, scientists, including those not in the medical field, looked for ways to help. One such pair of researchers, Christopher Pöhlker, an atmospheric scientist, and his wife, Mira, a cloud scientist, began to wonder about the nature of droplet size—something related to both their fields of work. After getting online and doing some searching, they found little research had been done regarding respiratory droplet size as it relates to airborne disease transmission. That led them to begin a research effort of their own that involved gathering known information and collating it in a way that might prove useful to traditional medical researchers. To that end, they joined up with specialists in other fields to form a team with the goal of parameterizing droplets involved in respiratory infections such as COVID-19. The team first searched for available information regarding infectious droplet size. They then embarked on a mission to create a parameterization scheme that would collate the data. To that end, they created a classification system based on what they describe as modes, where different modes are based on the size of droplets created in various parts of the body. They ultimately defined five types in all, each described by its size (from less than 0.2 µm to 130 µm), rather than a name. Each was also classified by the location where it was created: in the lungs, the mouth, tongue or lips and the larynx–trachea. The researchers also left space for data that correlates droplet size with infection potential—specifics that are still not known. The team concluded by suggesting that human studies will have to be conducted to fully complete their collating process, which they suggest should, when complete, provide medical researchers with a valuable resource as they continue to look for ways to develop anti-transmission measures to combat infectious diseases. More information: Mira L. Pöhlker et al, Respiratory aerosols and droplets in the transmission of infectious diseases, Reviews of Modern Physics (2023). DOI: 10.1103/RevModPhys.95.045001 © 2023 Science X Network Citation: Collating data on droplet properties to trace and localize the sources of infectious particles (2023, October 13) retrieved 13 October 2023 from https://phys.org/news/2023-10-collating-droplet-properties-localize-sources.html This document is subject to copyright. Apart from any fair dealing for the purpose of private study or research, no part may be reproduced without the written permission. The content is provided for information purposes only.