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L'indemnisation des dommages causés par les infections nosocomiales / Indemnification of the damages due to nosocomial infectionsMascrier, Isabelle 15 January 2014 (has links)
Les infections nosocomiales sont définies comme des infections contractées lors d’un séjour dans un établissement de soins. En matière de sécurité sanitaire, celles-ci sont déterminées par le principe de prévention et de précaution. En droit français, les infections nosocomiales ont longtemps été indemnisées en conséquences de solutions prétoriennes. Ce régime indemnitaire repose aujourd'hui sur le principe de la responsabilité sans faute qui a été consacré par la loi du 4 mars 2002. Toutefois la difficile prise en charge de cette indemnisation par les assureurs conduisit à l’adoption d’un nouveau régime découlant de la loi du 30 décembre 2002. Ces lois successives ont rendu complexe et ambigu le mécanisme de la réparation des dommages causés par les infections nosocomiales. Le constat résulte du fait qu’il manque une définition juridique de l’infection nosocomiale, outil essentiel à la pérennité du système indemnitaire mis en place pour la réparation des dommages causés par ces infections. / Nosocomial infections are infections acquired during a stay in a health care institution. From the sanitary safety point of view, they are defined by the prevention principle and the precautionary principle. According to the French law, the nosocomial infections have long been compensated by a case law. Nowadays, this compensation system is based on the principle of liability without fault laid down by the law of the 4th of March 2002. However, the reluctance of the insurers to assume this compensation led to the adoption of a new system resulting from the law of the 30th of December 2002. Because of these successive laws, the compensation mechanism for the damages due to nosocomial infections has been made more complex and ambiguous. This observation stems from the lack of a legal definition of the nosocomial infection, an essential tool for ensuring the sustainability of the compensation system for the damages caused by these infections
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Epidemiologie nosokomialer Infektionen und die Abhängigkeit krankenhausassoziierter Komplikationen von der Personalbesetzung in der NeonatologieLißner, Mareike 27 April 2011 (has links)
Nosokomiale Infektionen bei Früh- und Neugeborenen stellen aufgrund ihrer hohen Inzidenz und Mortalität eine große Herausforderung für die moderne Versorgung dar. Außerdem sind sie Indikatoren für die Pflegequalität, wie auch Verletzungen und Gefäßschädigungen. In dieser retrospektiven Querschnittsstudie wurden die epidemiologische Situation nosokomialer Infektionen auf den neonatologischen Stationen der Universitätskinderklinik Leipzig für das Jahr 2006 beleuchtet, die Abhängigkeit der genannten Komplikationen von Plegepersonalqualifikation und –quantität untersucht, sowie die Stationsauslastung und Personalbesetzung mit deutschen Empfehlungen verglichen. Die Inzidenz systemischer Infektionen lag sowohl auf der neonatologischen Intensiv- als auch auf der Nachsorgestation unter dem deutschlandweiten Durchschnitt. Dagegen traten Lokalinfekte wie Windel-/ Mundsoor und Konjunktivitiden häufig auf. Das beobachtete Keimspektrum zeigte das aus der Literatur bekannte Bild, multiresistente Keime traten nicht auf. Bei der Untersuchung der Abhängigkeiten zeigte sich für die Intensivstation eine signifikante Häufung von Candidainfektionen bei geringerer Stationsauslastung und höherer Personalbesetzung, unabhängig von der Qualifikation des Personals. Auf der Nachsorgestation wurde eine vermehrte Zahl systemischer Infektionen bei höherem Anteil von Schwestern am Gesamtpersonal festgestellt. Beide Stationen waren gegenüber den Empfehlungen fast das ganze Jahr überbelegt und unterbesetzt.
Gründe für die gefundenen Abhängigkeiten wurden vermutet in Informationsverlust und Trittbrettfahrerproblemen in größeren Kollektiven und verstärkter minimal-handling-Pflege und verstärkter Hygiene-Compliance in Stresssituationen. Die geringe Inzidenz systemischer Infektionen spricht für eine sichere Pflege und ist demnach sehr positiv zu bewerten, trotzdem sollten die Hintergründe für das Auftreten der Lokalinfekte, auch wenn sie meist einen milden Verlauf zeigten, überprüft werden.
Eine Gesamtbeurteilung der Pflege ist anhand der gemachten Untersuchungen nicht möglich, da aufgrund der Retrospektive keinerlei Faktoren wie Belastungseinschätzung der Schwestern, Lerneinschätzung der Schüler oder Betreuungseinschätzung der Eltern einfließen konnten.
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An Exploration of Bacterial Microbiome in E. TN AmbulancesSundin, Ashley, Babos, Mary Beth, PharmD, Slaven, Rick, MS EdD, Felts, Haley, Truitt, Gabrielle, Toma, Nicholas, Campbell, Teresa, MD, Weaver, Kali, PharmD, Kuzel, Aaron, DO 07 April 2022 (has links)
When patients develop new-onset infections after hospital admission, the origin of the infection is typically assumed to be nosocomial; however, ambulances are potentially unexplored reservoirs for emerging pathogens. This study seeks to identify the scope of bacterial contamination in rural East Tennessee ambulances. Though universal precautions and cleaning procedures aim to reduce the spread of infectious diseases to provider and patient, little is known about the bacterial microbiome of ambulances. To the best of our knowledge, this is the first study of its kind to be performed in the state of Tennessee and the first since the introduction of UVGI units as an ambulance-based COVID-19 infection control measure. Our dissemination of post-pandemic findings may impact ambulance sanitation measures and will add to the national and global knowledge pertaining to the microbiome of emergency medical patient transport systems. Ambulances in East Tennessee were sampled using environmental sampling contact plates. At least one active ambulance unit for each EMS service underwent sampling. Three samples were obtained from each of three areas: the floor of the ambulance transport area, the rear door panel inside the transport area and stretcher. The plates were then incubated at 30-35C for 48 hours. Colony counts were manually performed before the plates were shipped for species identification via MALDI-TOF DNA analysis by MIDI laboratories (Newark, DE). One plate from each ambulance door and stretcher was sent for bacterial identification. Only one sample returned free of growth. All floor samples, several stretcher samples, and three door samples presented vast growth with colonies too numerous to count. The results from bacterial identification showed all flora were human commensal flora or environmental flora. The flora found on ambulance doors with opportunistic capabilities are as follows: Staphylococcus hominis, Staphylococcus epidermidis, Enterobacter cloacae, Enterobacter xinagfangensis, Bacillus cereus, Klebsiella oxytoca, and Bacillus subtilis; and the flora found on the stretchers with opportunistic capabilities are as follows: Staphylococcus haemolyticus, Staphylococcus epidermidis, Staphylococcus cohnii ssp urealyticus, Bacillus cereus, Corynebaccterium mucifaciens, Staphylococcus pettenkoferi, Klebsiella oxytoca, Staphylococcus capitis, Bacillus subtillis, and Staphylococcus caprae. In this era of increasing antibiotic resistance, it is concerning that several microbes with pathogenicity were found, including species that often confer the spread of resistance such as Klebsiella oxytoca and Enterobacter cloacae. Overall, the finding of numerous diverse colonies does not support adequate sanitation of the ambulances. Further study is required to identify the most effective sanitation methods, and further metagenomic study is needed to explore the presence of genes that facilitate the spread of microbial resistance.
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Surveillance of antimicrobial susceptibility patterns among pathogens isolated in public sector hospitals associated with academic institutions in South AfricaNyasulu, Peter Suwirakwenda January 2015 (has links)
Background: Antimicrobial resistance (AMR) is a global public health challenge since infection with resistant organisms may cause death, can spread across the community, and increase health care costs at individual, community and government level as more expensive antimicrobials will have to be made available for the treatment of infections caused by resistant bacteria. This calls for urgent and consolidated efforts in order to effectively curb this growing crisis, to prevent the world from slipping back to the pre-antibiotic era. The World Health Organization made a call in 2011 advocating for strengthening of surveillance and laboratory capacity as one-way of detecting and monitoring trends and patterns of emerging AMR. Knowledge of AMR guides clinical decisions regarding choice of antimicrobial therapy, during an episode of bacteraemia and forms the basis of key strategies in containing the spread of resistant bacteria. The current study focused on Staphylococcus aureus (SA), Klebsiella pneumoniae (KP), and Pseudomonas aeruginosa (PA), as they are common hospital acquired infections which are prone to developing resistance to multiple antibiotics.
Aim: The aim of this project was to assess and utilize the laboratory information system (LIS) at the National Health Laboratory Services (NHLS), as a tool for reporting AMR and monitoring resistance patterns and trends over time of clinical isolates of SA, KP and PA, cultured from the blood of patients admitted to seven tertiary public hospitals in three provinces in South Africa.
Methods: A retrospective and prospective analysis was done on isolates of SA, KP, PA from blood specimens collected from patients with bacteraemia and submitted to diagnostic microbiology laboratories of the NHLS at seven tertiary public hospitals in three provinces in
South Africa. These hospitals comprised the Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Chris Hani Baragwanath Hospital (CBH), Helen Joseph Hospital (HJH), Steve Biko Pretoria Academic Hospital (SBPAH), Groote Schuur Hospital (GSH), Tygerberg Hospital (TH) and the Universitas Hospital of the Free State (UH). For retrospective analysis, data submitted during the period July 2005 to December 2009 were used and for prospective analysis, data relating to AMR in SA, KP, PA, collected by the Group for Enteric, Respiratory and Meningeal disease Surveillance in South Africa, (GERMS-SA) from July 2010 to June 2011 were used. AMR in these three pathogens to commonly used antimicrobial drugs was systematically investigated. Multivariate logistic regressions models were used to assess factors associated with AMR. In addition, a systematic review of research done to date on AMR in bacterial pathogens commonly associated with hospital-acquired infections was conducted in order to understand the existing antimicrobial surveillance systems and baseline resistance patterns in South Africa.
Results: A total of 9969 isolates were reported from the retrospective dataset. These were 3942 (39.5%) SA, 4466 (44.8%) KP and 1561 (15.7%) PA. From the prospective dataset, a total of 3026 isolates were reported, 1494 (49.4%) SA and 1532 (50.6%) KP isolates respectively. The proportion of invasive bacteraemia was higher in the <5 year old children. Nearly all strains of SA in South Africa were resistant to penicillin, and >30% up to as high as 80% were resistant to methicillin-related drugs among~560 invasive SA isolates over the two year period. Methicillin resistant Staphylococcus aureus (MRSA) rates significantly differed between hospitals (p=<0.001). The proportion of MRSA isolates in relation to methicillin-susceptible strains showed a declining trend from 22.2% in 2005 to 10.5% in 2009 (p=0.042). Emerging resistance was observed for vancomycin: 1 isolate was identified in 2006 and 9 isolates between July 2010-June 2011, and all except 1 were from Gauteng hospitals. The study found increasing rates of
carbapenem-resisant KP of 0.4% in 2005 to 4.0% in 2011 for imipenem. The mean rate of extended spectrum beta lactamase (ESBL-KP) producing KP was 74.2%, with the lowest rate of 62.4% in SBPAH and the highest rate of 81.3% in UH, showing a significant geographical variation in rates of resistance (p=0.021). PA showed a tendency for multi-drug resistance with resistance rates of >20% to extended spectrum cephalosporins, fluoroquinolones and aminoglycosides respectively. Emerging resistance in PA isolates was observed to colistin, showing a resistance rate of 1.9% over the 5 years period. In the multivariate model, age <5 years, male gender, and hospital location were factors significantly associated with MRSA, while ESBL-KP was significantly associated with age <5 years and hospital location.
Concluding remarks: The study has clearly demonstrated that AMR is relatively common in South Africa among children <5 years. Enhancement of continued surveillance of nosocomial infections through use of routine laboratory data should be reinforced as this will facilitate effective interpretation and mapping of trends and patterns of AMR. Therefore, the LIS as a tool for gathering such data should be strengthened to provide reliable AMR data for improved understanding of the extent of the AMR, and present evidence on which future policies and practices aimed at containing AMR could be based.
Key words: Laboratory information system, Trends, Patterns, Antimicrobial resistance, Bacterial pathogens, Nosocomial infections, Surveillance, Bacteraemia, Blood culture.
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SPECIES AND GENOTYPE DIVERSITIES OF YEASTS IN THE CLINICAL AND NATURAL ENVIRONMENTS IN HAMILTONMaganti, Harinad Babu 10 1900 (has links)
<p><strong><br /></strong></p> / <p><strong>In Canada the incidence of yeast infections have increased over the past decade, which in turn has resulted in the increased mortality and morbidity rates among the immuno-compromised patients. Yeasts are ubiquitous in nature and constitute a healthy portion of human skin and gut flora. Factors such as the urban settings and food have been previous shown to influence the yeast flora people harbour. This makes us believe that to effectively tackle the rising yeast infections in Canada we need to not only conduct epidemiological yeast studies in clinical settings but should also understand the diversity and distribution of them in the urban environment. This thesis constitutes of an epidemiological fungemia study and an urban environmental yeast profiling study conducted in the city of Hamilton.</strong></p> <p><strong> </strong></p> <p><strong>In the first chapter of the thesis I discuss the results of the epidemiological candidemia study. We noticed that over the past decade the mean age of the population with candidemia in hospitals within Hamilton has increased by 10 years. DNA fingerprinting analysis suggested that 33% of the blood stream</strong><strong><em>Candida</em></strong><strong> </strong><strong>isolates from January 2005 to February 2009 belonged to 18 clusters, some of which were shared between wards and hospitals. we found that for each of the four species, strains isolated closer to each other temporally were overall genetically more similar to each other as well, which suggested that nosocomial sources likely caused repeated candidemia infections. The study is the first of its sort in Canada and the results of this chapter are expected to aid infection control practitioners in the Hamilton hospitals and make the stay of patients in hospitals safer.</strong></p> <p><strong> </strong></p> <p><strong>In the second chapter, we discuss the diversity and distribution of yeasts prevalent on trees in and around Hamilton. We identified a total of 88 environmental yeasts belonging to 20 species (based on ITS sequence data). The yeast populations were highly heterogeneous in both species and genotype composition. Among the 14 tree species sampled, yeasts were frequently found on cedar, cottonwood and basswood. Interestingly all the</strong><strong> <em>Candida parapsilosis</em> </strong><strong>strains were found from pine tree only. Some of the potential environmental factors shaping the distribution of yeast populations in Hamilton are discussed.</strong></p> / Master of Science (MSc)
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Water-associated nosocomial infections.Wright, Claire Louise, Snelling, Anna M., Newton, L., Kerr, Kevin G. January 2008 (has links)
Yes / It is estimated that 5-10% of hospitalised patients in
developed countries contract hospital acquired infections
(HAI). Increasing levels of antimicrobial resistance manifested
by many HAI-causing pathogens such as Acinetobacter spp in
the intensive care unit (ICU) setting present a significant
challenge to those managing these infections. Consequently,
much attention has been focused on the prevention of HAIs.
Particular emphasis has been placed on interventions
intended to interrupt patient-to-patient transmission of pathogens,
such as enhanced hand hygiene and identification of
patients colonised with methicillin-resistant Staphylococcus
aureus (MRSA) using rapid DNA-based screening techniques.
However, comparatively little attention has been given to the
hospital environment, including water supplies, as a source of
nosocomial pathogens of importance for patients on the
critical care unit. This article reviews the role of hospital water
sources in the epidemiology of HAI and new technologies
which can be employed in the prevention and control of such
infections.
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Revisión crítica: beneficios del uso del apósito con clorhexidina en la prevención de infecciones por el catéter venoso central en el paciente críticoLingan Vega, Maribel January 2024 (has links)
La investigación “Beneficios del uso del apósito con clorhexidina en la prevención de infecciones por el catéter venoso central en el paciente crítico”, tuvo como objetivo determinar los beneficios del uso del apósito con clorhexidina para prevención de infecciones por catéter venoso central. Se desarrolló mediante una metodología de investigación secundaria bajo el enfoque de la enfermería basada en la evidencia, para lo cual se formuló la pregunta clínica ¿Cuáles son los beneficios del uso del apósito con
clorhexidina para prevención de infecciones por catéter venoso central en el paciente crítico?
Se realizó la búsqueda de la información en bases de datos como BVS, Scielo, Epistemonikos, Pubmed y Cochrane de donde se obtuvo un total de 761 artículos, de los cuales, finalmente solo quedaron 7 investigaciones que fueron validadas con la guía de Gálvez Toro, siendo la investigación sujeta a revisión “Apósito impregnado de clorhexidina para la profilaxis de complicaciones relacionadas con el catéter venoso central: una revisión sistemática y un metaanálisis”, a la cual se aplicó la guía CASPe, el cual tuvo un nivel de evidencia 1++ y grado recomendación A según guía SIGN. Finalmente para dar respuesta a
la pregunta se determinó que el apósito impregnado de clorhexidina es beneficioso en la reducción de riesgo de infecciones del torrente sanguíneo relacionados al uso de catéter venoso central en una unidad de cuidados intensivos. / The research “Benefits of the use of a dressing with chlorhexidine in the prevention of infections due to the central venous catheter in critically ill patients” aimed to determine the benefits of the use of a dressing with chlorhexidine for the prevention of infections due to a central venous catheter. It was developed through a secondary research methodology under the approach of evidence-based nursing, for which the clinical question was formulated: What are the benefits of using chlorhexidine dressing for the prevention of central venous catheter infections in critically ill patients? The information was searched in databases such as BVS, Scielo, Epistemonikos, Pubmed and Cochrane, from which a total of 761 articles
were obtained, of which, finally, only 7 investigations remained that were validated with the guide of Gálvez Toro. The research being subject to review “Chlorhexidine-impregnated dressing for the prophylaxis of complications related to the central venous catheter: a systematic review and meta-analysis”, to which the CASPe guideline was applied, which had a level of evidence 1++ and recommendation grade A according to SIGN guide. Finally, to answer the question, it was determined that the chlorhexidine-impregnated dressing is beneficial in reducing the risk of bloodstream infections related to the use of a central venous catheter in an intensive care unit.
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Adherence to infection control standards by nurses in a specific hospital in Manzini, SwazilandSimelane, Sibusiso Chalazela 01 1900 (has links)
The purpose of the study was to develop practice guidelines to promote adherence to infection control standards in a specific hospital in Manzini, Swaziland. It was a qualitative, descriptive and explanatory design which utilised an in-depth unstructured face to face interview data collection method done to nine (9) registered nurse participants. A qualitative content analysis was conducted to identify prominent themes and patterns, smaller units of data were named and coded according to the contents they represented. Four themes emerged from data analysis, they were; working environment for nurses, nurse’s descriptions of infection control standards, nurse’s challenges regarding adherence to infection control standards and nurses expressed needs. The findings revealed possible contributing factors to non-adherence to infection control standards by participants and therefore denoted to a serious need for development of general guidelines to promote adherence to infection control standards, these guidelines were presented. / Health Studies / M. A. (Health Studies)
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Adherence to infection control standards by nurses in a specific hospital in Manzini, SwazilandSimelane, Sibusiso Chalazela 01 1900 (has links)
The purpose of the study was to develop practice guidelines to promote adherence to infection control standards in a specific hospital in Manzini, Swaziland. It was a qualitative, descriptive and explanatory design which utilised an in-depth unstructured face to face interview data collection method done to nine (9) registered nurse participants. A qualitative content analysis was conducted to identify prominent themes and patterns, smaller units of data were named and coded according to the contents they represented. Four themes emerged from data analysis, they were; working environment for nurses, nurse’s descriptions of infection control standards, nurse’s challenges regarding adherence to infection control standards and nurses expressed needs. The findings revealed possible contributing factors to non-adherence to infection control standards by participants and therefore denoted to a serious need for development of general guidelines to promote adherence to infection control standards, these guidelines were presented. / Health Studies / M. A. (Health Studies)
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In Vitro antimicrobial synergy testing of Acinetobachter BaumanniiMartin, Siseko 12 1900 (has links)
Bibliography / Thesis (MMed (Pathology. Medical Microbiology))--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: Acinetobacter baumannii has emerged as one of the most troublesome nosocomial pathogens
globally. This organism causes infections that are often extremely difficult to treat because of the
widespread resistance to the major antibiotic groups. Colonization or infection with multidrugresistant
A. baumannii is associated with the following risk factors: prolonged hospital stay,
admission to an intensive care unit (ICU), mechanical ventilation, and exposure to broad spectrum
antibiotics, recent surgery, invasive procedures, and severe underlying disease.
A. baumannii has been isolated as part of the skin flora, mostly in moist regions such as axillae,
groin and toe webs. It has also been isolated from the oral cavity and respiratory tract of healthy
adults. Debilitated hospitalized patients have a high rate of colonization, especially during
nosocomial Acinetobacter outbreaks. This organism is an opportunistic pathogen as it contains
few virulence factors. Clinical manifestations of A. baumannii include nosocomial pneumonia,
nosocomial bloodstream infections, traumatic battlefield and other wound infections, urinary tract
infections, and post-neurological surgery meningitis. Fulminant community-acquired pneumonia
has recently been reported, indicating that this organism can be highly pathogenic.
The number of multidrug-resistant A. baumannii strains has been increasing worldwide in the past
few years. Therefore the selection of empirical antibiotic treatment is very challenging. Antibiotic
combinations are used mostly as empirical therapy in critically ill patients. One rationale for the
use of combination therapy is to achieve synergy between agents.
The checkerboard and time-kill methods are two traditional methods that have been used for
synergy testing. These methods are labor intensive, cumbersome, costly, and time consuming.
The E-test overlay method is a modification of the E-test method to determine synergy between
the different antibiotics. This method is easy to perform, flexible and time efficient.
The aim of this study was to assess the in vitro activity of different combinations of colistin,
rifampicin, imipenem, and tobramycin against selected clinical strains of A. baumannii using the
checkerboard and the E-test synergy methods. The MICs obtained with the E-test and broth
microdilution method were compared. The results of the disk diffusion for imipenem and
tobramycin as tested in the routine microbiology laboratory were presented for comparison. Overall good reproducibility was obtained with all three methods of sensitivity testing. The
agreement of MICs between the broth dilution and E-test methods was good with not more than
two dilution differences in MIC values for all isolates, except one in which the rifampicin E-test MIC
differed with three dilutions from the MIC obtained with the microdilution method. However, the
categorical agreement between the methods for rifampicin was poor. Although MICs did not differ
with more than two dilutions in most cases, many major errors occurred because the MICs
clustered around the breakpoints.
The combinations of colistin + rifampicin, colistin + imipenem, colistin + tobramycin, rifampicin +
tobramycin, and imipenem + tobramycin all showed indifferent or additive results by the E-test
method. No results indicating synergy were obtained for all the above-mentioned combinations.
There was one result indicating antagonistic effect for the combination of colistin + tobramycin.
The results of the checkerboard method showed results indicating synergy in four of the six
isolates for which the combination of colistin and rifampicin was tested. The other two isolates
showed indifferent/additive results. All the other combinations showed indifferent/additive results
for all isolates except isolate 30 (col + tob) and isolate 25 (rif + tob) which showed synergism. No
antagonistic results were observed by the checkerboard method.
When the results obtained with the E-test and checkerboard methods were compared, it was
noted that for most antibiotic combinations an indifferent/additive result was obtained. However,
for the colistin + rifampicin combination, the checkerboard method showed synergism for 4 of 6
isolates, whereas the E-test method showed indifference and an additive result in one. For the
rifampicin + tobramycin, and colistin + tobramycin combinations, synergism was also shown with
the checkerboard method in one isolate for each combination. The E-test method however
showed an indifferent and additive result respectively.
.
The E-test method was found to be a rapid, reproducible, easy-to-perform, and flexible method to
determine synergistic antibiotic activity. This study was however limited by low numbers of
isolates. This might explain why no synergistic results were obtained with the E-test method and
few synergistic results with the checkerboard method. Genotypic analysis using pulse-field gel
electrophoresis (PFGE) may be considered in future studies to determine relatedness of the isolates which will facilitate the selection of different strains for synergy testing. Furthermore,
clinical studies are needed to establish whether in vitro synergy testing is useful in the clinical
setting and whether the results of synergy testing will have any bearing on the clinical outcome of
patients infected with multidrug resistant A. baumannii. / AFRIKAANSE OPSOMMING: Acinetobacter baumannii het wêreldwyd as een van die mees problematiese nosokomiale
patogene verskyn. Hierdie organisme veroorsaak infeksies wat dikwels baie moeilik is om te
behandel weens wydverspreide weerstandigheid teen major antibiotikagroepe. Kolonisasie of
infeksie met multi-weerstandige A. baumannii word geassosieer met die volgende riskofaktore:
verlengde hospitaalverblyf, toelating tot ‘n intensiewe sorgeenheid (ICU), meganiese ventilasie,
blootstelling aan breëspektrum antibiotika, onlangse chirurgie, indringende prosedures en
ernstige onderliggende siekte.
A. baumannii kan deel vorm van die normale velflora, veral in die axillae, inguinale area en tussen
die tone. Dit is ook al vanuit die mondholte en die respiratoriese traktus van gesonde volwassenes
geïsoleer. Verswakte gehospitaliseerde pasiënte word veral gekoloniseer gedurende nosokomiale
Acinetobacter uitbrake. Hierdie organisme is ‘n opportunistiese patogeen en bevat min virulensie
faktore. Kliniese manifestasies van A. baumannii sluit nosokomiale pneumonie, nosokomiale
bloedstroom infeksies, troumatiese slagveld- en ander wondinfeksies, urienweginfeksies en
meningitis wat volg op neurologiese chirurgie in. Fulminerende gemeenskapsverworwe
pneumonie is onlangs beskryf en dui aan dat hierdie organisme hoogs patogenies kan wees.
Die aantal multi-weerstandige A. baumannii stamme het wêreldwyd toegeneem oor die laaste
paar jare. Daarom is die seleksie van empiriese antibiotiese behandeling ‘n uitdaging. Antibiotika
kombinasies word meestal as empiriese behandeling in ernstige siek pasiënte gebruik. Die
beginsel hiervan is om sinergistiese werking tussen agente te verkry.
Die “checkerboard” en “time-kill” metodes is twee tradisionele metodes van sinergisme toetsing.
Hierdie metodes is werksintensief, duur en tydrowend. Die E-toets sinergisme metode is gebaseer
op die E-toets metode. Hierdie metode is maklik, buigbaar en tydseffektief.
Die doel van hierdie studie was om die in vitro aktiwiteit tussen verskillende antibiotika
kombinasies van colistin, rifampisien, imipenem, en tobramisien teen geselekteerde kliniese A.
baumannii isolate te toets met die “checkerboard” en E-toets sinergisme toetsing metodes. Die
minimum inhibitoriese konsentrasies (MIKs) verkry met die E-toets en “broth microdilution” metode
is ook vergelyk. Die resultate van die skyfie diffusie metode (die metode wat in die roetiene mikrobiologie laboratorium gebruik word) vir imipenem en tobramisien word ook verskaf vir
vergelyking van die resultate van verskillende sensitiwiteitsmetodes.
In oorsig is goeie herhaalbaarheid van resultate verkry met al drie metodes van
sensitiwiteitstoetsing. Die ooreenstemming van MIKs tussen die “broth dilution” en E-toets
metodes was goed en resultate het met nie meer as twee verdunnings in MIK waardes verskil nie.
Daar is een uitsondering waar die rifampisien E-toets MIK waarde met drie verdunnings van die
MIK waarde verkry met die “microdilution” metode verskil. Die ooreenstemming tussen die
sensitiwiteitskategorie resultate tussen die twee metodes was egter swak vir rifampisien. Alhoewel
die MIKs in die meeste gevalle met nie meer as twee verdunnings in waarde verskil het nie, was
daar baie major foute aangetoon omdat die MIKs rondom die breekpunte geval het.
Die kombinasies van colistin + rifampisien, colistin + imipenem, colistin + tobramisien, rifampisien
+ tobramisien, en imipenem + tobramisien het oorwegend slegs matige interaksie met die E-toets
metode getoon. Geen sinergisme is verkry met enige van die antibiotika kombinasies met hierdie
metode nie. Daar was egter een resultaat wat antagonisme getoon het vir die kombinasie van
colistin + tobramycin.
Die resultate van die “checkerboard” metode het sinergisme getoon in vier van die ses isolate wat
vir die kombinasie van colistin en rifampisien getoets was. Die ander twee isolate het slegs matige
interaksie getoon. Al die ander kombinasies het ook slegs matige interaksie getoon, behalwe in
isolaat 30 (col + tob) en isolaat 25 (rif + tob) waar die spesifieke kombinasies sinergisme getoon
het. Geen antagonisme is waargeneem met die “checkerboard” metode nie.
Met vergelyking van die E-toets en “checkerboard” metodes, is dit opmerklik dat vir die meeste
van die antibiotika kombinasies slegs matige interaksie verkry is. Vir die colistin + rifampisien
kombinasie toon die “checkerboard” metode egter sinergisme vir 4 uit 6 isolate, terwyl die E-toets
metode slegs matige interaksie toon. Vir rifampisien + tobramisien, en colistin + tobramisien
kombinasies is sinergisme getoon met die “checkerboard” metode in een isolaat vir elke
kombinasie. Die E-toets metode het slegs matige interaksie getoon. Die E-toets sinergisme metode was vinnig, herhaalbaar en maklik om uit te voer. Hierdie studie
word egter beperk deur lae getalle van isolate. Dit mag verklaar waarom geen sinergistiese
resultate met die E-toets metode verkry is nie en die min sinergistiese resultate met die
“checkerboard” metode. Genotipiese analiese met “pulse-field gel electrophoresis” mag in
aanmerking geneem word in toekomstige studies om die verwantskap tussen isolate te bepaal wat
die seleksie van verskillende stamme vir sinergisme toetsing sal vergemaklik. Verder, kliniese
studies is nodig om te bepaal of in vitro sinergisme toetsing van waarde is en of die resultate van
sinergisme toetsing ‘n rol speel in die kliniese uitkoms van pasënte geïnfekteer met multiweerstandige
A. baumannii. / The National Health Laboratory Serivice
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