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Ann Tammelin - One of the best experts on this subject based on the ideXlab platform.
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"Routes and sources of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of specia
2001Co-Authors: Ann Tammelin, Anna Hambraeus, E StahleAbstract:"Routes and sources of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of specia
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Source and route of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.
The Journal of hospital infection, 2001Co-Authors: Ann Tammelin, Anna Hambraeus, Elisabeth StahleAbstract:The objective of this study was to trace the source and route of transmission of Methicillin-Resistant Staphylococcus Epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly woven special scrub suits did not reduce air counts of MRSE or wound contamination with MRSE. The patients' sternal skin was the main source for wound contamination with MRSE
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dispersal of methicillin resistant Staphylococcus Epidermidis by staff in an operating suite for thoracic and cardiovascular surgery relation to skin carriage and clothing
Journal of Hospital Infection, 2000Co-Authors: Ann Tammelin, Anna Hambraeus, P Domicel, Elisabeth StahleAbstract:Methicillin-Resistant Staphylococcus Epidermidis (MRSE) is a common cause of deep sternal infections. The aim of the present investigation was to evaluate staff in an operating suite for thoracic and cardiovascular surgery as a possible source of MRSE and the possibility of reducing the amount of MRSE shed into the air by wearing tightly woven scrub suits. A second aim was to compare the results of dispersal obtained in a test chamber with those from an operating room. We studied carriage of MRSE in the nose and on different skin sites and made an experimental study of dispersal of MRSE during exercise in a test chamber and during operations, using two different types of scrub suits. Dispersal of MRSE [defined as > 1% of the total count of colony forming units (CFU) shed into the air] occurred in 25% of women and 43% of men. Nasal carriage was found among 28% in women and 33% in men. Among five skin-sampling sites, carriage of MRSE was most frequent on the cheek (50%) and in the axilla (24%) and least frequent in the perineum (5%). Dispersal of MRSE was however more strongly associated with carriage in the perineum (P = 0.097) than on the cheek (P = 0.5) and in the axilla (P = 0.21). With regard to shedding of bacteria into the air, there was a significant difference in favour of the tightly woven clothes regarding total counts of CFU both in the test chamber (P = 0.02) and the operating theatre (P = 0.002). Regarding MRSE, no such difference was found. We found there were too many dispersers of MRSE among operating department staff to exclude them from work. Although tightly woven scrub suits significantly reduced the amount of bacteria shed into the air, the amount of MRSE was not significantly reduced. Full-scale experiments in operating rooms are not needed when evaluating the protective capacity of different scrub suits as results from a test chamber give conclusive information.
Elisabeth Stahle - One of the best experts on this subject based on the ideXlab platform.
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Source and route of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.
The Journal of hospital infection, 2001Co-Authors: Ann Tammelin, Anna Hambraeus, Elisabeth StahleAbstract:The objective of this study was to trace the source and route of transmission of Methicillin-Resistant Staphylococcus Epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly woven special scrub suits did not reduce air counts of MRSE or wound contamination with MRSE. The patients' sternal skin was the main source for wound contamination with MRSE
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dispersal of methicillin resistant Staphylococcus Epidermidis by staff in an operating suite for thoracic and cardiovascular surgery relation to skin carriage and clothing
Journal of Hospital Infection, 2000Co-Authors: Ann Tammelin, Anna Hambraeus, P Domicel, Elisabeth StahleAbstract:Methicillin-Resistant Staphylococcus Epidermidis (MRSE) is a common cause of deep sternal infections. The aim of the present investigation was to evaluate staff in an operating suite for thoracic and cardiovascular surgery as a possible source of MRSE and the possibility of reducing the amount of MRSE shed into the air by wearing tightly woven scrub suits. A second aim was to compare the results of dispersal obtained in a test chamber with those from an operating room. We studied carriage of MRSE in the nose and on different skin sites and made an experimental study of dispersal of MRSE during exercise in a test chamber and during operations, using two different types of scrub suits. Dispersal of MRSE [defined as > 1% of the total count of colony forming units (CFU) shed into the air] occurred in 25% of women and 43% of men. Nasal carriage was found among 28% in women and 33% in men. Among five skin-sampling sites, carriage of MRSE was most frequent on the cheek (50%) and in the axilla (24%) and least frequent in the perineum (5%). Dispersal of MRSE was however more strongly associated with carriage in the perineum (P = 0.097) than on the cheek (P = 0.5) and in the axilla (P = 0.21). With regard to shedding of bacteria into the air, there was a significant difference in favour of the tightly woven clothes regarding total counts of CFU both in the test chamber (P = 0.02) and the operating theatre (P = 0.002). Regarding MRSE, no such difference was found. We found there were too many dispersers of MRSE among operating department staff to exclude them from work. Although tightly woven scrub suits significantly reduced the amount of bacteria shed into the air, the amount of MRSE was not significantly reduced. Full-scale experiments in operating rooms are not needed when evaluating the protective capacity of different scrub suits as results from a test chamber give conclusive information.
Anna Hambraeus - One of the best experts on this subject based on the ideXlab platform.
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"Routes and sources of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of specia
2001Co-Authors: Ann Tammelin, Anna Hambraeus, E StahleAbstract:"Routes and sources of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of specia
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Source and route of Methicillin-Resistant Staphylococcus Epidermidis transmitted to the surgical wound during cardio-thoracic surgery. Possibility of preventing wound contamination by use of special scrub suits.
The Journal of hospital infection, 2001Co-Authors: Ann Tammelin, Anna Hambraeus, Elisabeth StahleAbstract:The objective of this study was to trace the source and route of transmission of Methicillin-Resistant Staphylococcus Epidermidis (MRSE) in the surgical wound during cardio-thoracic surgery, and to investigate the possibility of reducing wound contamination by wearing special scrub suits. In total 65 elective operations for coronary artery bypass grafting (CABG) with or without concomitant valve replacement were investigated. All staff present in the operating room wore conventional scrub suits during 33 operations and special scrub suits during 32 operations. Samples were taken from the hands of the scrubbed team after surgical scrub but before putting on sterile gowns and gloves, and from patients' skin (incisional area of sternum and vein harvesting area of legs) after preoperative skin preparation with chlorhexidine gluconate. Air samples were taken during operations. Samples were also taken from the wound just before closure. Total counts of bacteria on sternal skin and from the wound (cfu/cm2) were calculated as well as total counts of bacteria in the air (cfu/m3). Strains of MRSE recovered from the different sampling sites were compared by pulsed field gel electrophoresis (PFGE). It was found that wearing special scrub suits did not reduce the number of air-samples where MRSE was found compared with conventional scrub suits. The risk factor most strongly associated with MRSE in the wound at the end of the operation was preoperative carriage of MRSE on sternal skin; RR 2.42 [95% CI 1.43-4.10], P= 0.021. By use of PFGE, it was possible to identify the probable source for four MRSE isolates recovered from the wound. In three cases the source was the patients own skin. Finding MRSE in air-samples, or on the hands of the scrubbed team, were not risk factors for the recovery of MRSE in the wound at the end of operation. In conclusion, with a total bacterial air count around 20 cfu/m3 and a low proportion of MRSE, the reduction of total air counts by use of tightly woven special scrub suits did not reduce air counts of MRSE or wound contamination with MRSE. The patients' sternal skin was the main source for wound contamination with MRSE
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dispersal of methicillin resistant Staphylococcus Epidermidis by staff in an operating suite for thoracic and cardiovascular surgery relation to skin carriage and clothing
Journal of Hospital Infection, 2000Co-Authors: Ann Tammelin, Anna Hambraeus, P Domicel, Elisabeth StahleAbstract:Methicillin-Resistant Staphylococcus Epidermidis (MRSE) is a common cause of deep sternal infections. The aim of the present investigation was to evaluate staff in an operating suite for thoracic and cardiovascular surgery as a possible source of MRSE and the possibility of reducing the amount of MRSE shed into the air by wearing tightly woven scrub suits. A second aim was to compare the results of dispersal obtained in a test chamber with those from an operating room. We studied carriage of MRSE in the nose and on different skin sites and made an experimental study of dispersal of MRSE during exercise in a test chamber and during operations, using two different types of scrub suits. Dispersal of MRSE [defined as > 1% of the total count of colony forming units (CFU) shed into the air] occurred in 25% of women and 43% of men. Nasal carriage was found among 28% in women and 33% in men. Among five skin-sampling sites, carriage of MRSE was most frequent on the cheek (50%) and in the axilla (24%) and least frequent in the perineum (5%). Dispersal of MRSE was however more strongly associated with carriage in the perineum (P = 0.097) than on the cheek (P = 0.5) and in the axilla (P = 0.21). With regard to shedding of bacteria into the air, there was a significant difference in favour of the tightly woven clothes regarding total counts of CFU both in the test chamber (P = 0.02) and the operating theatre (P = 0.002). Regarding MRSE, no such difference was found. We found there were too many dispersers of MRSE among operating department staff to exclude them from work. Although tightly woven scrub suits significantly reduced the amount of bacteria shed into the air, the amount of MRSE was not significantly reduced. Full-scale experiments in operating rooms are not needed when evaluating the protective capacity of different scrub suits as results from a test chamber give conclusive information.
Anna C Shore - One of the best experts on this subject based on the ideXlab platform.
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novel multiresistance cfr plasmids in linezolid resistant methicillin resistant Staphylococcus Epidermidis and vancomycin resistant enterococcus faecium vre from a hospital outbreak co location of cfr and optra in vre
Journal of Antimicrobial Chemotherapy, 2017Co-Authors: Alexandros Lazaris, David C Coleman, Angela Kearns, Bruno Pichon, Peter M Kinnevey, Megan R Earls, B Boyle, Brian Oconnell, Grainne I Brennan, Anna C ShoreAbstract:Background: Linezolid is often the drug of last resort to treat infections caused by Gram-positive cocci. Linezolid resistance can be mutational (23S rRNA or L-protein) or, less commonly, acquired [predominantly cfr, conferring resistance to phenicols, lincosamides, oxazolidinones, pleuromutilins and streptogramin A compounds (PhLOPSA) or optrA, encoding oxazolidinone and phenicol resistance]. Objectives: To investigate the clonality and genetic basis of linezolid resistance in 13 linezolid-resistant (LZDR) Methicillin-Resistant Staphylococcus Epidermidis (MRSE) isolates recovered during a 2013/14 outbreak in an ICU in an Irish hospital and an LZDR vancomycin-resistant Enterococcus faecium (VRE) isolate from an LZDR-MRSE-positive patient. Methods: All isolates underwent PhLOPSA susceptibility testing, 23S rRNA sequencing, DNA microarray profiling and WGS. Results: All isolates exhibited the PhLOPSA phenotype. The VRE harboured cfr and optrA on a novel 73 kb plasmid (pEF12-0805) also encoding erm(A), erm(B), lnu(B), lnu(E), aphA3 and aadE. One MRSE (M13/0451, from the same patient as the VRE) harboured cfr on a novel 8.5 kb plasmid (pSEM13-0451). The remaining 12 MRSE lacked cfr but exhibited linezolid resistance-associated mutations and were closely related to (1-52 SNPs) but distinct from M13/0451 (202-223 SNPs). Conclusions: Using WGS, novel and distinct cfr and cfr/optrA plasmids were identified in an MRSE and VRE isolate, respectively, as well as a cfr-negative LZDR-MRSE ICU outbreak and a distinct cfr-positive LZDR-MRSE from the same ICU. To our knowledge, this is the first report of cfr and optrA on a single VRE plasmid. Ongoing surveillance of linezolid resistance is essential to maintain its therapeutic efficacy.
Shigeru Kinoshita - One of the best experts on this subject based on the ideXlab platform.
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Vancomycin Ophthalmic Ointment 1% for Methicillin-Resistant Staphylococcus aureus or Methicillin-Resistant Staphylococcus Epidermidis infections: a case series.
BMJ open, 2013Co-Authors: Chie Sotozono, Masahiko Fukuda, Masao Ohishi, Keiko Yano, Hideki Origasa, Yoshinori Saiki, Yoshikazu Shimomura, Shigeru KinoshitaAbstract:Objectives To investigate the efficacy and safety of Vancomycin Ophthalmic Ointment 1% (Toa Pharmaceutical Co., Ltd, Toyama, Japan) in patients with external ocular infections caused by Methicillin-Resistant Staphylococcus aureus (MRSA) or Methicillin-Resistant Staphylococcus Epidermidis (MRSE). Design A case series. Setting This study was a multicentre, open-label, uncontrolled study in Japan approved as orphan drug status. Participants Patients with MRSA or MRSE external ocular infections unresponsive to the treatment of fluoroquinolone eye drops. Interventions Vancomycin Ophthalmic Ointment 1% was administered four times daily. Primary and secondary outcome measures The subjective and objective clinical scores and bacterial cultures were collected at days 0 (baseline), 3, 7 and 14. The primary outcome was clinical response evaluation (efficacy rate) determined as complete response , partial response , no response and worsening . Secondary outcome was the eradication of the bacteria. Safety was assessed by adverse events including cases in which neither MRSA nor MRSE was detected. Results Twenty-five cases with MRSA (20) or MRSE (5) infections were enrolled. Of these 25 cases, 4 discontinued the treatment due to the negative results for bacterial culture during screening or at baseline. Of the 21 cases with conjunctivitis (14), blepharitis (3), meibomitis (1), dacryocystitis (2) or keratitis (1), 14 (66.7%) cases were evaluated as being excellently ( complete response , 2 cases) or well ( partial response , 12 cases) treated. The eradication rates were 68.4% in MRSA (13 of 19 cases) and 100% in MRSE (2 of 2 cases). Ten adverse events occurred in 7 (28.0%) of 25 cases at the local administration site. Conclusions Vancomycin Ophthalmic Ointment 1% was considered to be useful for the treatment of intractable ocular MRSA/MRSE infections.
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Extreme Genetic Diversity of Methicillin-Resistant Staphylococcus Epidermidis Strains Disseminated among Healthy Japanese Children
Journal of clinical microbiology, 2008Co-Authors: Tengku Zetty Maztura Tengku Jamaluddin, Chie Sotozono, Shigeru Kinoshita, Kyoko Kuwahara-arai, Ken Hisata, Masahiko Terasawa, Longzhu Cui, Tadashi Baba, Teruyo Ito, Keiichi HiramatsuAbstract:For the past few years, we have been observing the dissemination of Methicillin-Resistant staphylococci in the community. From 2001 to 2003, an evaluation of nasal samples from 1,285 children in five day-care centers and two kindergartens in three districts in Japan revealed that Methicillin-Resistant coagulase-negative staphylococci (MRC-NS) have been widely disseminated in the Japanese community. Their prevalence is much greater than community-acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA). Forty-nine children (3.81%) were colonized with MRSA, whereas 390 children (30.35%) were colonized with MRC-NS. These MRC-NS strains predominantly harbored a pair of cassette chromosome recombinase types A2 and B2 (ccrAB2). Of these, 40.8% harbored type IVa staphylococcal cassette chromosome mec (SCCmec) elements, a distinct/characteristic type of SCCmec in pandemic clones of CA-MRSA. Interestingly, there was also a high frequency of nontypeable strains which possessed atypical structures compared to previous SCCmec types. Among the MRC-NS, the majority of strains (63.59%) were Methicillin-Resistant Staphylococcus Epidermidis (MRSE). Their genotypes, as judged from pulsed-field gel electrophoresis (PFGE), were highly diverse. They were so diverse that there was no sign of an immediate transmission of any MRSE clone among children in the same institutions. In a previous report, we expounded that a few CA-MRSA clones with distinct SCCmec types were disseminated among children in the same institutions. Au contraire, with the case of CA-MRSE, there was no single genotype of CA-MRSE disseminated among children even in the same institution or class.
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Methicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Staphylococcus Epidermidis infections in the cornea.
Cornea, 2002Co-Authors: Chie Sotozono, Kayoko Inagaki, Atsuko Fujita, Noriko Koizumi, Yoichiro Sano, Tsutomu Inatomi, Shigeru KinoshitaAbstract:Purpose To describe the incidence and clinical management of corneal infections with Methicillin-Resistant Staphylococcus aureus (MRSA) or Methicillin-Resistant Staphylococcus Epidermidis (MRSE). Methods The incidence of Methicillin-Resistant Staphylococcus (MRS) at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, was reviewed during the 5-year period from January 1996 to December 2000. Clinical aspects of MRS colonization or infection in the eye were investigated. Results Methicillin-Resistant S. aureus or MRSE was detected from 30 eyes with ocular diseases; post-keratoplasty (11 eyes), ocular surface disorders without operation (9 eyes), and others (10 eyes). Among the 30 eyes, 12 manifested keratitis. Eight cases (8 eyes) occurred after keratoplasty, including four postoperative cases in patients with Stevens-Johnson syndrome, and two bilateral cases (4 eyes) in patients with acute-phase Stevens-Johnson syndrome. The degree of MRS keratitis was classified into 4 groups: asymptomatic carrier or conjunctivitis, intraepithelial infiltrations, superficial keratitis, and severe keratitis leading to corneal perforation. All cases of keratitis were treated successfully with topical ofloxacin (OFLX), vancomycin (VCM), or arbekacin (ABK). Conclusion Factors associated with ocular MRS colonization were long-term use of antibiotics and/or steroids, and hospitalization. Patients who had undergone keratoplasty or who had Stevens-Johnson syndrome were at increased risk of MRS keratitis. Superficial stromal infiltrations, minimal melting, and minimal stromal scarring are characteristic of MRS keratitis. Therapy for MRS keratitis is summarized. Ofloxacin, VCM, and ABK are effective in the treatment of MRS keratitis. Vancomycin eye ointment is effective as the final choice in serious cases.
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Methicillin-Resistant Staphylococcus aureus and Methicillin-Resistant Staphylococcus Epidermidis infections in the cornea.
Cornea, 2002Co-Authors: Chie Sotozono, Kayoko Inagaki, Atsuko Fujita, Noriko Koizumi, Yoichiro Sano, Tsutomu Inatomi, Shigeru KinoshitaAbstract:To describe the incidence and clinical management of corneal infections with Methicillin-Resistant Staphylococcus aureus (MRSA) or Methicillin-Resistant Staphylococcus Epidermidis (MRSE). The incidence of Methicillin-Resistant Staphylococcus (MRS) at the Department of Ophthalmology, Kyoto Prefectural University of Medicine, was reviewed during the 5-year period from January 1996 to December 2000. Clinical aspects of MRS colonization or infection in the eye were investigated. Methicillin-Resistant S. aureus or MRSE was detected from 30 eyes with ocular diseases; post-keratoplasty (11 eyes), ocular surface disorders without operation (9 eyes), and others (10 eyes). Among the 30 eyes, 12 manifested keratitis. Eight cases (8 eyes) occurred after keratoplasty, including four postoperative cases in patients with Stevens-Johnson syndrome, and two bilateral cases (4 eyes) in patients with acute-phase Stevens-Johnson syndrome. The degree of MRS keratitis was classified into 4 groups: asymptomatic carrier or conjunctivitis, intraepithelial infiltrations, superficial keratitis, and severe keratitis leading to corneal perforation. All cases of keratitis were treated successfully with topical ofloxacin (OFLX), vancomycin (VCM), or arbekacin (ABK). Factors associated with ocular MRS colonization were long-term use of antibiotics and/or steroids, and hospitalization. Patients who had undergone keratoplasty or who had Stevens-Johnson syndrome were at increased risk of MRS keratitis. Superficial stromal infiltrations, minimal melting, and minimal stromal scarring are characteristic of MRS keratitis. Therapy for MRS keratitis is summarized. Ofloxacin, VCM, and ABK are effective in the treatment of MRS keratitis. Vancomycin eye ointment is effective as the final choice in serious cases.