During the period from April 2012 to May 2013, 13 newborns (1 to 4 weeks of age) and 1 child in a pediatric hospital ward in Germany were colonized with
producing an extended-spectrum beta-lactamase ...(ESBL) (CTX-M-15). A microbiological source-tracking analysis with human and environmental samples was carried out to identify the source and transmission pathways of the
clone. In addition, different hygienic intervention methods were evaluated.
isolates were detected in the detergent drawer and on the rubber door seal of a domestic washer-extractor machine that was used in the same ward to wash laundry for the newborns, as well as in two sinks. These strains were typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The environmental findings were compared with those for the human strains and the isolates detected on clothing. The results from both techniques showed that the strains were identical (sequence type 201 and PFGE type 00531, a clone specific to this hospital and not previously isolated in Germany), emphasizing the washing machine as a reservoir and fomite for the transmission of these multidrug-resistant bacteria. After the washing machine was taken out of use, no further colonizations were detected during the subsequent 4-year period.
Washing machines should be further investigated as possible sites for horizontal gene transfer (ESBL genes) and cross-contamination with clinically important Gram-negative strains. Particularly in the health care sector, the knowledge of possible (re-)contamination of laundry (patients' clothes and staff uniforms) with multidrug-resistant Gram-negative bacteria could help to prevent and to control nosocomial infections. This report describes an outbreak with a single strain of a multidrug-resistant bacterium (
sequence type 201) in a neonatal intensive care unit that was terminated only when the washing machine was removed. In addition, the study implies that changes in washing machine design and processing are required to prevent accumulation of residual water where microbial growth can occur and contaminate clothes.
Nosocomial infections and multidrug-resistant organisms are an increasing problem in nursing homes worldwide; therefore, new approaches for infection control need to be developed.
This article gives ...an overview of infections in nursing homes, their medical treatment and previous measures for infection prevention.
The article is based on a selective literature search including the literature database PubMed. In particular, scientific studies on the prevalence of nosocomial infections in German nursing homes, publications for medical care in long-term care facilities in Europe and international studies for infection prevention were evaluated.
The basis for an effective reduction of infections is the establishment of a surveillance system. All participating medical professionals provide feedback about local infections and resistance situations and the presence of risk factors, such as urinary catheters or chronic wounds. Only then can targeted antibiotic strategies be adapted and the effectiveness of preventive measures, such as hand disinfection is continuously reviewed. So far, in particular multimodal, multidisciplinary prevention projects were successful. These included frequent staff training, reduction of urinary catheters and a rational use of antibiotics.
Most prevention models have been previously tested in hospitals. A possible applicability of the results to the infection prevention in long-term care facilities has so far hardly been studied. Accordingly, further studies on infection control in nursing homes are absolutely necessary.
Problemkeime im Altenheim Klaschik, Manuela; Rösing, Claudia
MMW Fortschritte der Medizin,
10/2015, Letnik:
157, Številka:
18
Journal Article
Recenzirano
Mit multiresistenten Keimen werden zunehmend auch Hausärzte, die Alten- und Pflegeheimbewohner betreuen, konfrontiert. Welche Erreger kommen hier besonders häufig vor? Was müssen Sie bei der ...Sanierung und der Hygiene beachten?
Zusammenfassung
Hintergrund
Nosokomiale Infektionen und multiresistente Erreger sind weltweit eine zunehmende Problematik in Altenpflegeheimen. Daher müssen neue Konzepte zur Infektkontrolle ...entwickelt werden.
Ziel der Arbeit
Dieser Artikel zeigt einen Überblick über Infektionen in Altenpflegeheimen, deren medizinische Versorgung und bisherige Maßnahmen zur Infektionsprävention.
Material und Methoden
Die Arbeit basiert auf einer selektiven Literaturrecherche unter Einbeziehung der Literaturdatenbank
PubMed
. Dabei wurden insbesondere wissenschaftliche Untersuchungen zur Prävalenz von nosokomialen Infektionen in deutschen Altenpflegeheimen, Publikationen zur medizinischen Versorgung von Langzeitpflegeeinrichtungen und internationale Studien zur Infektionsprävention ausgewertet.
Ergebnisse
Die Grundlage für eine effektive Reduzierung von Infektionen ist die Einführung eines Surveillance-Systems. Dabei geben alle beteiligten medizinischen Fachkräfte regelmäßig eine Rückmeldung zur lokalen Infektions- und Resistenzlage und dem Vorhandensein von Risikofaktoren wie z. B. Harnwegskatheter oder chronische Wunden. Nur so können gezielt Antibiotikastrategien angepasst und die Effektivität von Präventionsmaßnahmen wie Händedesinfektion kontinuierlich überprüft werden. Bisher waren insbesondere multimodale, interdisziplinäre Präventionsvorhaben erfolgreich. Dazu gehörten regelmäßige Personalschulungen, Reduzierung von Harnwegskathetern sowie ein rationaler Einsatz von Antibiotika.
Diskussion
Die meisten Präventionsmodelle wurden bisher in Krankenhäusern getestet. Eine mögliche Übertragbarkeit der Ergebnisse auf die Infektionsprävention in Langzeitpflegeeinrichtungen ist bisher kaum untersucht. Daher sind unbedingt weitere Studien zur Infektkontrolle in Altenpflegeheimen notwendig.
Zusammenfassung
Hintergrund
Nosokomiale Infektionen und multiresistente Erreger sind weltweit eine zunehmende Problematik in Altenpflegeheimen. Daher müssen neue Konzepte zur Infektkontrolle ...entwickelt werden.
Ziel der Arbeit
Dieser Artikel zeigt einen Überblick über Infektionen in Alten pflegeheimen, deren medizinische Versorgung und bisherige Maßnahmen zur Infektionsprävention.
Material und Methoden
Die Arbeit basiert auf einer selektiven Literaturrecherche unter Einbeziehung der Literaturdatenbank PubMed. Dabei wurden insbesondere wissenschaftliche Untersuchungen zur Prävalenz von nosokomialen Infektionen in deutschen Altenpflegeheimen, Publikationen zur medizinischen Versorgung von Langzeitpflegeeinrichtungen und internationale Studien zur Infektionsprävention ausgewertet.
Ergebnisse
Die Grundlage für eine effektive Reduzierung von Infektionen ist die Einführung eines Surveillance-Systems. Dabei geben alle beteiligten medizinischen Fachkräfte regelmäßig eine Rückmeldung zur lokalen Infektions- und Resistenzlage und dem Vorhandensein von Risikofaktoren wie z. B. Harnwegskatheter oder chronische Wunden. Nur so können gezielt Antibiotikastrategien angepasst und die Effektivität von Präventionsmaßnahmen wie Händedesinfektion kontinuierlich überprüft werden. Bisher waren insbesondere multimodale, interdisziplinäre Präventionsvorhaben erfolgreich. Dazu gehörten regelmäßige Personalschulungen, Reduzierung von Harnwegskathetern sowie ein rationaler Einsatz von Antibiotika.
Diskussion.
Die meisten Präventionsmodelle wurden bisher in Krankenhäusern getestet. Eine mögliche Übertragbarkeit der Ergebnisse auf die Infektionsprävention in Langzeitpflegeeinrichtungen ist bisher kaum untersucht. Daher sind unbedingt weitere Studien zur Infektkontrolle in Altenpflegeheimen notwendig.
Cutaneous lupus erythematosus (CLE), the main manifestation of systemic lupus erythematosus (SLE), is driven by type I interferons (IFNs) and often only partially responds to conventional therapies. ...Treatment of seven SLE patients with the monoclonal antibody anifrolumab induced fast and sustained remission of previously refractory CLE lesions, beginning within the first weeks of treatment. Decline in CLASI-A score was paralleled by a reduction in IFN score determined by mRNA expression of seven IFN-stimulated genes (ISGs) in blood. These data suggest that a subset of ISGs could be a valuable biomarker in CLE.
Myotonic dystrophy type 2 (DM2) is a tetranucleotide CCTG repeat expansion disease associated with an increased prevalence of autoimmunity. Here, we identified an elevated type I interferon (IFN) ...signature in peripheral blood mononuclear cells and primary fibroblasts of DM2 patients as a trigger of chronic immune stimulation. Although RNA-repeat accumulation was prevalent in the cytosol of DM2-patient fibroblasts, type-I IFN release did not depend on innate RNA immune sensors but rather the DNA sensor cGAS and the prevalence of mitochondrial DNA (mtDNA) in the cytoplasm. Sublethal mtDNA release was promoted by a chronic activation of the ATF6 branch of the unfolded protein response (UPR) in reaction to RNA-repeat accumulation and non-AUG translated tetrapeptide expansion proteins. ATF6-dependent mtDNA release and resulting cGAS/STING activation could also be recapitulated in human THP-1 monocytes exposed to chronic endoplasmic reticulum (ER) stress. Altogether, our study demonstrates a novel mechanism by which large repeat expansions cause chronic endoplasmic reticulum stress and associated mtDNA leakage. This mtDNA is, in turn, sensed by the cGAS/STING pathway and induces a type-I IFN response predisposing to autoimmunity. Elucidating this pathway reveals new potential therapeutic targets for autoimmune disorders associated with repeat expansion diseases.
This article aims to analyze how corporate social innovation contributes to the creation of shared value. The research presents a unique case study of a company in southern Brazil that is recognized ...for its strategic repositioning, based on a redefinition of its purpose and the inclusion of social and environmental values in its business model. We questioned how a for‐profit organization could create shared value based not only on economic considerations but also on social values? To this end, and based on Den Ouden's (2012) framework, we use multiple‐level analysis, considering the value created for users, organizations, society, and the ecosystem. To collect the data, we use in‐depth semi‐structured interviews and documentary research, followed by qualitative content analysis aided by Nvivo. We highlight the fact that for a company to create value considering diverse stakeholders at multiple levels of analysis, it must develop a capacity for collaboration, especially the ability to communicate and learn collectively. As a practical contribution, the results indicate that in creating shared value from corporate social innovation, it is important for organizational changes to be systemic, and for the development of solutions to focus on needs that emerge from the community. The study signals the importance of the community, especially the user, in developing solutions that focus on social challenges and encourage for‐profit organizations to rethink their role in society.
Psoriasis is frequently associated with the metabolic syndrome and occurs more often in obese individuals. In order to understand innate immune mechanisms mediating this inflammatory pattern we ...investigated expression of the chemokine and lipid scavenger receptor CXCL16 in patients with psoriasis and associated comorbidities. CXCL16 expression was enhanced on all monocyte subsets in psoriatic patients compared with healthy controls and positively correlated with psoriasis activity and severity index, body mass index and the risk for cardiovascular disease indicated by PROCAM score. The intensity of CXCL16 expression on monocytes further correlated with their capability to phagocytose oxidized LDL indicating the possibility to transform into foam cells in atherosclerotic plaques. Patients with psoriasis and atherosclerosis or obesity displayed elevated numbers of innate lymphoid cells in blood with specific increase of the IFN-γ or IL-17 producing ILC1 and ILC3 subpopulations. The expression of the CXCL16 receptor, CXCR6, was increased in ILCs and co-expressed with CCR6 but not CCR7 indicating their migratory potential to psoriatic skin or adipose tissue that is characterized by strong CXCL16 and CCL20 expression. This hypothesis was supported by the finding that the percentage of CXCR6 expressing ILCs was alleviated in blood of psoriatic patients. Together these data link a strong expression of CXCL16 to metabolic syndrome in psoriasis and indicate a possible link to ILC activation and tissue distribution in obese psoriatic patients. These data contribute to the understanding of the complex interaction of innate immunity and metabolic state in psoriasis.
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