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MeSH: Staphylococcal Infections-prevention & control

60 záznamů v Medvik Filtry

Článek

Postoperative Staphylococcus aureus Infections in Patients With and Without Preoperative Colonization

Troeman, Darren P R
Autor Troeman, Darren P R Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Hazard, Derek
Autor Hazard, Derek Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
Timbermont, Leen
Autor Timbermont, Leen Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
Malhotra-Kumar, Surbhi
Autor Malhotra-Kumar, Surbhi Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
van Werkhoven, Cornelis H
Autor van Werkhoven, Cornelis H Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Wolkewitz, Martin
Autor Wolkewitz, Martin Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
Ruzin, Alexey
Autor Ruzin, Alexey Microbial Sciences, R&D BioPharmaceuticals, AstraZeneca Plc, Gaithersburg, Maryland
Goossens, Herman
Autor Goossens, Herman Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
Bonten, Marc J M
Autor Bonten, Marc J M Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
Harbarth, Stephan
Autor Harbarth, Stephan Infection Control Programme and World Health Organization Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland

JAMA network open. 2023 ; 6 (10) : e2339793. [pub] 20231002

JAMA Netw Open
ISSN 2574-3805
Medvik
Zdroj

IMPORTANCE: Staphylococcus aureus surgical site infections (SSIs) and bloodstream infections (BSIs) are important complications of surgical procedures for which prevention remains suboptimal. Contemporary data on the incidence of and etiologic factors for these infections are needed to support the development of improved preventive strategies. OBJECTIVES: To assess the occurrence of postoperative S aureus SSIs and BSIs and quantify its association with patient-related and contextual factors. DESIGN, SETTING, AND PARTICIPANTS: This multicenter cohort study assessed surgical patients at 33 hospitals in 10 European countries who were recruited between December 16, 2016, and September 30, 2019 (follow-up through December 30, 2019). Enrolled patients were actively followed up for up to 90 days after surgery to assess the occurrence of S aureus SSIs and BSIs. Data analysis was performed between November 20, 2020, and April 21, 2022. All patients were 18 years or older and had undergone 11 different types of surgical procedures. They were screened for S aureus colonization in the nose, throat, and perineum within 30 days before surgery (source population). Both S aureus carriers and noncarriers were subsequently enrolled in a 2:1 ratio. EXPOSURE: Preoperative S aureus colonization. MAIN OUTCOMES AND MEASURES: The main outcome was cumulative incidence of S aureus SSIs and BSIs estimated for the source population, using weighted incidence calculation. The independent association of candidate variables was estimated using multivariable Cox proportional hazards regression models. RESULTS: In total, 5004 patients (median [IQR] age, 66 [56-72] years; 2510 [50.2%] female) were enrolled in the study cohort; 3369 (67.3%) were S aureus carriers. One hundred patients developed S aureus SSIs or BSIs within 90 days after surgery. The weighted cumulative incidence of S aureus SSIs or BSIs was 2.55% (95% CI, 2.05%-3.12%) for carriers and 0.52% (95% CI, 0.22%-0.91%) for noncarriers. Preoperative S aureus colonization (adjusted hazard ratio [AHR], 4.38; 95% CI, 2.19-8.76), having nonremovable implants (AHR, 2.00; 95% CI, 1.15-3.49), undergoing mastectomy (AHR, 5.13; 95% CI, 1.87-14.08) or neurosurgery (AHR, 2.47; 95% CI, 1.09-5.61) (compared with orthopedic surgery), and body mass index (AHR, 1.05; 95% CI, 1.01-1.08 per unit increase) were independently associated with S aureus SSIs and BSIs. CONCLUSIONS AND RELEVANCE: In this cohort study of surgical patients, S aureus carriage was associated with an increased risk of developing S aureus SSIs and BSIs. Both modifiable and nonmodifiable etiologic factors were associated with this risk and should be addressed in those at increased S aureus SSI and BSI risk.

MeSH
infekce chirurgické rány prevence a kontrola MeSH
kohortové studie MeSH
lidé MeSH
mastektomie MeSH
nádory prsu * komplikace MeSH
senioři MeSH
stafylokokové infekce * prevence a kontrola MeSH
Staphylococcus aureus MeSH
Check Tag
lidé MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
multicentrická studie MeSH

Článek

Laboratorní diagnostika v NRL pro stafylokoky CEM SZÚ v roce 2021
[Laboratory diagnostics in the National Reference Laboratory for staphylococci CEM NIPH in 2021]

Zprávy Centra epidemiologie a mikrobiologie (2011, Print). 2022 ; 31 (5) : 181-185.

ISSN 1804-8668
Medvik
Zdroj

Národní referenční laboratoř pro stafylokoky CEM SZÚ se i v roce 2021, v rámci zajištění surveillance stafylokokových infekcí, věnovala podrobnému vyšetřování kmenů stafylokoků z humánního klinického materiálu. Celkem to bylo 659 kmenů, převážně druhu Staphylococcus aureus, které byly zaslány asi z 90 bakteriologických pracovišť z celé České republiky. Metodou PCR byla zjišťována přítomnost genů kódujících především Pantonův - Valentinův leukocidin, toxin Syndromu toxického šoku, exfoliatiny A, B, D a enterotoxiny A–D. Informace o produkci faktorů virulence jsou důležité pro ošetřující lékaře ke správnému stanovení klinické diagnózy a tedy i vhodné terapie. V roce 2021 jsme zaregistrovali 13 případů závažného onemocnění - syndrom toxického šoku, kdy jsme mohli potvrdit původce – toxinogenní kmen S. aureus. Pomohli jsme řešit i hromadný výskyt puchýřnatého onemocnění novorozenců v jedné porodnici, kdy byl příčinou kmen S. aureus s produkcí exfoliatinu A. V celém souboru bylo i 45 (5,9 %) kmenů koaguláza negativních stafylokoků. U těchto podmíněných patogenů jsme fenotypizací a metodou hmotnostní spektrometrie kmeny identifikovali, resp. konfirmovali identifikaci zjištěnou již v terénních laboratořích.

The main focus of the National Reference Laboratory for Staphylococci (NRL) in 2020 was again on the investigation of staphylococcal strains from human clinical specimens within the surveillance of staphylococcal infections. In total, 659 strains mostly of the species Staphylococcus aureus referred to the NRL by 90 bacteriological laboratories from all over the Czech Republic were analysed. The strains were screened by PCR for the genes encoding Panton-Valentine leukocidin, toxic shock syndrome toxin, exfoliative toxins A, B, and D, and enterotoxins A–D. Data on the production of virulence factors are helpful for attending physicians in determining the right diagnosis and effective treatment. In 2021, 13 cases of severe toxic shock syndrome were reported, with toxigenic strain of S. aureus being confirmed as the causative agent. The NRL also participated in the investigation of an outbreak of blistering skin condition in newborns in one maternity hospital where the cause of infection was an exfoliative toxin A producing strain of S. aureus. Fifty-eight strains (5.9%) referred to the NRL were coagulase-negative staphylococci. These opportunistic pathogens were identified or confirmed, after previous identification by field laboratories, by phenotyping and mass spectrometry.

Článek

Efficacy and safety of suvratoxumab for prevention of Staphylococcus aureus ventilator-associated pneumonia (SAATELLITE): a multicentre, randomised, double-blind, placebo-controlled, parallel-group, phase 2 pilot trial

Lancet. Infectious diseases. 2021 ; 21 (9) : 1313-1323. [pub] 20210421

Lancet Infect Dis
ISSN 1474-4457
Medvik
Zdroj

BACKGROUND: Staphylococcus aureus remains a common cause of ventilator-associated pneumonia, with little change in incidence over the past 15 years. We aimed to evaluate the efficacy of suvratoxumab, a monoclonal antibody targeting the α toxin, in reducing the incidence of S aureus pneumonia in patients in the intensive care unit (ICU) who are on mechanical ventilation. METHODS: We did a multicentre, randomised, double-blind, placebo-controlled, parallel-group, phase 2 pilot trial at 31 hospitals in Belgium, the Czech Republic, France, Germany, Greece, Hungary, Portugal, Spain, and Switzerland. Eligible patients were in the ICU, aged ≥18 years, were intubated and on mechanical ventilation, were positive for S aureus colonisation of the lower respiratory tract, as assessed by quantitative PCR (qPCR) analysis of endotracheal aspirate, and had not been diagnosed with new-onset pneumonia. Patients were excluded if they had confirmed or suspected acute ongoing staphylococcal disease; had received antibiotics for S aureus infection for more than 48 h within 72 h of randomisation; had a Clinical Pulmonary Infection Score of 6 or higher; had an acute physiology and chronic health evaluation II score of 25 or higher with a Glasgow coma scale (GCS) score of more than 5, or an acute physiology and chronic health evaluation II score of at least 30 with a GCS score of 5 or less; had a Sequential Organ Failure Assessment score of 9 or higher; or had active pulmonary disease that would impair the ability to diagnose pneumonia. Colonised patients were randomly assigned (1:1:1), by use of an interactive voice or web response system, to receive either a single intravenous infusion of suvratoxumab 2000 mg, suvratoxumab 5000 mg, or placebo. Randomisation was done in blocks of size four, stratified by country and by whether patients had received systemic antibiotics for S aureus infection. Patients, investigators, and study staff involved in the treatment or clinical evaluation of patients were masked to patient assignment. The primary efficacy endpoint was the incidence of S aureus pneumonia at 30 days, as determined by a masked independent endpoint adjudication committee, in all patients who received their assigned treatment (modified intention-to-treat [ITT] population). Primary safety endpoints were the incidence of treatment-emergent adverse events at 30 days, 90 days, and 190 days after treatment, and the incidence of treatment-emergent serious adverse events, adverse events of special interest, and new-onset chronic disease at 190 days after treatment. All primary safety endpoints were assessed in the modified ITT population. This trial is registered with ClinicalTrials.gov (NCT02296320) and the EudraCT database (2014-001097-34). FINDINGS: Between Oct 10, 2014, and April 1, 2018, 767 patients were screened, of whom 213 patients with confirmed S aureus colonisation of the lower respiratory tract were randomly assigned to the suvratoxumab 2000 mg group (n=15), the suvratoxumab 5000 mg group (n=96), or the placebo group (n=102). Two patients in the placebo group did not receive treatment after randomisation because their clinical conditions changed and they no longer met the eligibility criteria for dosing. As adjudicated by the data monitoring committee at an interim analysis, the suvratoxumab 2000 mg group was discontinued on the basis of predefined pharmacokinetic criteria. At 30 days after treatment, 17 (18%) of 96 patients in the suvratoxumab 5000 mg group and 26 (26%) of 100 patients in the placebo group had developed S aureus pneumonia (relative risk reduction 31·9% [90% CI -7·5 to 56·8], p=0·17). The incidence of treatment-emergent adverse events at 30 days were similar between the suvratoxumab 5000 mg group (87 [91%]) and the placebo group (90 [90%]). The incidence of treatment-emergent serious adverse events at 30 days were also similar between the suvratoxumab 5000 mg group (36 [38%]) and the placebo group (32 [32%]). No significant difference in the incidence of treatment-emergent adverse events between the two groups at 90 days (89 [93%] in the suvratoxumab 5000 mg group vs 92 [92%] in the placebo group) and at 190 days (93 [94%] vs 93 [93%]) was observed. 40 (40%) patients in the placebo group and 50 (52%) in the suvratoxumab 5000 mg group had a serious adverse event at 190 days. In the suvratoxumab 5000 mg group, one (1%) patient reported at least one treatment-emergent serious adverse event related to treatment, two (2%) patients reported an adverse event of special interest, and two (2%) reported a new-onset chronic disease. INTERPRETATION: In patients in the ICU receiving mechanical ventilation with qPCR-confirmed S aureus colonisation of the lower respiratory tract, the incidence of S aureus pneumonia at 30 days was not significantly lower following treatment with 5000 mg suvratoxumab than with placebo. Despite these negative results, monoclonal antibodies still represent one promising therapeutic option to reduce antibiotic consumption that require further exploration and studies. FUNDING: AstraZeneca, with support from the Innovative Medicines Initiative Joint Undertaking.

MeSH
dospělí MeSH
dvojitá slepá metoda MeSH
humanizované monoklonální protilátky aplikace a dávkování terapeutické užití MeSH
lidé středního věku MeSH
lidé MeSH
mladiství MeSH
mladý dospělý MeSH
pilotní projekty MeSH
plíce MeSH
senioři MeSH
široce neutralizující protilátky aplikace a dávkování terapeutické užití MeSH
stafylokokové infekce prevence a kontrola MeSH
Staphylococcus aureus účinky léků MeSH
umělé dýchání MeSH
ventilátorová pneumonie prevence a kontrola MeSH
výsledek terapie MeSH
Check Tag
dospělí MeSH
lidé středního věku MeSH
lidé MeSH
mladiství MeSH
mladý dospělý MeSH
mužské pohlaví MeSH
senioři MeSH
ženské pohlaví MeSH
Publikační typ
časopisecké články MeSH
klinické zkoušky, fáze II MeSH
multicentrická studie MeSH
práce podpořená grantem MeSH
randomizované kontrolované studie MeSH
Geografické názvy
Belgie MeSH
Česká republika MeSH
Francie MeSH
Maďarsko MeSH
Německo MeSH
Portugalsko MeSH
Řecko MeSH
Španělsko MeSH
Švýcarsko MeSH

Článek

Hračka - bezpečný předmět na dětských odděleních?
[Toy - the safe subject on the children‘s departments?]

Zelenková, Jaroslava
Autor Autorita Hygienická stanice hlavního města Prahy

Československá pediatrie. 2020 ; 75 (2) : 71-76.

ISSN 0069-2328
Medvik
Zdroj

Stafylokoky jsou ubikvitérní mikroorganismy vyskytující se běžně na předmětech denního užívání. Pouze některé ze 40 druhů a poddruhů se uplatňují v humánní medicíně. Největší význam pro člověka mají Staphylococcus aureus, S. epidermidis a S. saprophyticus. Výskyt stafylokoků na dětských hračkách u hospitalizovaných dětí není rutinně sledován. Zahraniční studie naznačují, že by mohly být zdrojem nákaz spojených se zdravotní péčí. Proto byla v letech 2016 a 2017 provedena šetření v pražských nemocnicích. Z výsledků šetření vyplývá, že záchyt stafylokoků na hračkách je ovlivněn zejména materiálem, ze kterého jsou hračky vyrobeny, a dále i prostředím, ve kterém jsou umístěny.

Staphylococci are ubiquitous microorganisms commonly found in daily use articles. Only some of the 40 species and subspecies are used in human medicine. The most important for humans are Staphylococcus aureus, S. epidermidis and S. saprophyticus.Information on the presence of staphylococci on children's toys in hospitalized children is not available on routine basis. Foreign studies conducted abroad suggest that the toys could be sources of healthcare-associated infections. Consequently a survey was carried out in Prague hospitals in 2016 and 2017. The results of the study show that capture of staphylococci on toys is influenced, in particular, by the material from which the toys are produced and also by the environment.