Publications (58) View all
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Article: Urinary tract infections caused by multi-drug resistant Proteus mirabilis: Risk factors and clinical outcomes.
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ABSTRACT: Proteus mirabilis (PM) as well as other members of the Enterobacteriaceae family are a leading cause of infectious diseases in both the community and acute care settings. The prevalence of multi-drug resistant (MDR) bacterial isolates have increased in the last few years, affecting the prognosis and survival of hospitalized patients. The aim of our study was to determine the risk factors and clinical outcomes of urinary tract infections (UTIs) caused by MDR PM in patients hospitalized in our institution. This was a retrospective matched case-control study. Records of patients with PM-positive urine culture were reviewed, and data were included for analysis. Univariate analysis revealed that the variables significantly associated with acquisition of MDR PM vs non-MDR PM UTI were younger age ([in years] median 77.5, range 20-94 vs median 78, range 40-94, p = 0.04), other concomitant infectious diseases (57.1 vs 35.7%, p = 0.037),number of prior infectious diseases (mean 0.95 +/- 0.99 vs 0.57 +/- 0.85, p = 0.035), diagnosis of infection at hospital admission (67.9 vs 42.9%, p = 0.008), and prior therapy with antipseudomonal penicillin (17.9 vs 1.8%, p = 0.004),respectively. Mean length of hospitalization was 29.95 days for the MDR group and 30.04 days for the non-MDR group(p = non-significant [NS]). The crude mortality rate following hospital admission was 19/56 (33.9%) vs 14 (25%)in the MDR PM and non-MDR PM groups, respectively(p = 0.300, odds ratio [OR] 1.54, 95% confidence interval[CI] 0.63-3.82). The production of extended-spectrum beta lactamases(ESBL) was found in 100% of MDR-PM vs 31.5%of non-MDR-PM urine isolates (p < 0.001). All variables found to be significantly associated with MDR-PM UTI were included in a logistic regression model. Independent risk factors for MDR-PM UTI were empiric cephalosporin therapy(OR 4.694, 95% CI 1.76-12.516, p = 0.002) and prior antipseudomonal penicillin (piperacillin/tazobactam) therapy during the last year (OR 11.175, 95% CI 1.09-114.2,p = 0.04). Prior piperacillin/tazobactam and empiric cephalosporin use were the independent risk factors of MDR-PM strains. All MDR-PM urinary isolates at our institution were ESBL producers. Therefore, carbapenem use remains the only available treatment option for MDR-PM isolates in our institution.Infection 12/2009; 38(1):41-6. · 2.66 Impact Factor -
Article: Impact of 4% chlorhexidine whole-body washing on multidrug-resistant Acinetobacter baumannii skin colonisation among patients in a medical intensive care unit.
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ABSTRACT: The prevalence of skin colonisation with Acinetobacter baumannii (ACBA) on admission to the medical intensive care unit (MICU) was studied in an institution endemic for ACBA bloodstream infections (BSIs). The impact of 4% chlorhexidine gluconate (4% CG) whole-body washing on the patients' ACBA skin colonisation was also determined. A prospective cohort trial in a MICU during March 2002 to December 2003 was performed, with a comparison between the prevalence and incidence of ACBA-BSIs obtained after intervention and retrospectively. During the intervention period, ACBA skin-screening swabs were taken from all patients on admission and periodically until discharge. Patients underwent whole-body disinfection with 4% CG immediately after obtaining the initial cultures. Disinfection was carried out on a daily basis until discharge, regardless of colonisation status. Of the 320 patients at ward admission, 55 (17%) yielded ACBA. The prevalence of ACBA colonisation among the remaining MICU patients was 5.5% at 24h and 1% at 48h following the disinfection regimen (P=0.002, OR: 2.4). Following a second screen, 80% of colonised patients were decolonised. Prevalence of ACBA-BSIs decreased from 4.6 to 0.6 per 100 patients (P < or = 0.001; OR: 7.6) and incidence decreased from 7.8 to 1.25 (85% reduction). We conclude that daily whole-body disinfection with 4% CG significantly reduced ACBA skin colonisation. This regimen may be considered in addition to well-known infection control measures, particularly in institutions with endemic rates of multidrug-resistant ACBA-BSIs.Journal of Hospital Infection 11/2007; 67(2):149-55. · 3.39 Impact Factor -
Article: Conservative management of implantable cardioverter defibrillator-related endocarditis due to Bacillus spp.
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ABSTRACT: Endocarditis is a devastating complication of implantable cardioverter-defibrillator (ICD) therapy. Partial or complete device removal has been advocated for the treatment of this condition although controlled data are lacking. We present a case of ICD-related endocarditis caused by Bacillus spp. that occurred following coronary angiography. To the best of our knowledge, Bacillus spp. has not been previously described in such context. Moreover, conservative treatment with device retention was successful (no recurrence during a 6-year follow-up). Conservative management may be attempted in selected cases of ICD-related endocarditis, especially, those involving low-virulence organisms and rapid response to antibiotic therapy. This case also suggests that coronary angiography may be associated with transient bacteremia and subsequent infection of indwelling cardiac devices.Infection 04/2007; 35(2):114-7. · 2.66 Impact Factor -
Article: A randomized, double-blind, placebo-controlled trial of selective digestive decontamination using oral gentamicin and oral polymyxin E for eradication of carbapenem-resistant Klebsiella pneumoniae carriage.
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ABSTRACT: To assess the effectiveness of selective digestive decontamination (SDD) for eradicating carbapenem-resistant Klebsiella pneumoniae (CRKP) oropharyngeal and gastrointestinal carriage. A randomized, double-blind, placebo-controlled trial with 7 weeks of follow-up per patient. A 1,000-bed tertiary-care university hospital. Adults with CRKP-positive rectal swab cultures. Patients were blindly randomized (1 :1) over a 20-month period. The SDD arm received oral gentamicin and polymyxin E gel (0.5 g 4 times per day) and oral solutions of gentamicin (80 mg 4 times per day) and polymyxin E (1 x 10(6) units 4 times per day for 7 days). The placebo arm received oral placebo gel 4 times per day and 2 placebo oral solutions 4 times per day for 7 days. Strict contact precautions were applied. Samples obtained from the throat, groin, and urine were also cultured. Forty patients (mean age ± standard deviation, 71 ± 16 years; 65% male) were included. At screening, greater than or equal to 30% of oropharyngeal, greater than or equal to 60% of skin, and greater than or equal to 35% of urine cultures yielded CRKP isolates. All throat cultures became negative in the SDD arm after 3 days (P < .0001). The percentages of rectal cultures that were positive for CRKP were significantly reduced at 2 weeks. At that time, 16.1% of rectal cultures in the placebo arm and 61.1% in the SDD arm were negative (odds ratio, 0.13; 95% confidence interval, 0.02-0.74; P < .0016). A difference between the percentages in the 2 arms was still maintained at 6 weeks (33.3% vs 58.5%). Groin colonization prevalence did not change in either arm, and the prevalence of urine colonization increased in the placebo arm. This SDD regimen could be a suitable decolonization therapy for selected patients colonized with CRKP, such as transplant recipients or immunocompromised patients pending chemotherapy and patients who require major intestinal or oropharyngeal surgery. Moreover, in outbreaks caused by CRKP infections that are uncontrolled by routine infection control measures, SDD could provide additional infection containment.Infection Control and Hospital Epidemiology 01/2012; 33(1):14-9. · 3.67 Impact Factor -
Article: A multifaceted intervention strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae in Southern Israel.
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ABSTRACT: To devise a local strategy for eradication of a hospital-wide outbreak caused by carbapenem-resistant Klebsiella pneumoniae (CRKP). Quasi-experimental, before-and-after, interrupted time-series study. A 1,000-bed tertiary-care university teaching hospital. Retrospectively, all relevant data were collected from the medical records of patients with CRKP infections from May 2006 through April 2007, the preintervention period. From May 1, 2007, through May 1, 2010, the postintervention period, the intervention was applied and prospectively followed. The 5 key elements of this strategy were an emergency department flagging system, the building of a cohort ward, the eradication of clusters, environmental and personnel hand cultures, and a carbapenem-restriction policy. The demographic and clinical parameters of patients colonized by and/or infected with CRKP were collected from medical records. A total of 10,680 rectal cultures were performed for 8,376 patients; 433 (5.16%) and 370 (4.4%) were CRKP-colonized and CRKP-infected patients, respectively, and 789 (98%) of 803 patients were admitted to the CRKP cohort ward. The CRKP infection density was reduced from 5.26 to 0.18 per 10,000 patient-days (P ≤ .001), and no nosocomial CRKP infections were diagnosed. Twenty-three percent of environmental cultures were found to be positive. Meropenem use was reduced from 283 ± 70.92 to 118 ± 74.32 defined daily doses per 1,000 patient-days (P ≤ .001). This intervention produced an enormous impact on patient location, surveillance cultures, and antibiotic policies and a massive investment in infection control resources.Infection Control and Hospital Epidemiology 12/2011; 32(12):1158-65. · 3.67 Impact Factor
