ABSTRACT
OBJECTIVE: To assess the impact of active surveillance and decolonization strategies on methicillin-resistant Staphylococcus aureus (MRSA) infection rates in a NICU. STUDY DESIGN: MRSA infection rates were compared before (2014-2016) and during (2017-2022) an active surveillance program. Eligible infants were decolonized with chlorohexidine gluconate (CHG) bathing and/or topical mupirocin. Successful decolonization and rates of recolonization were assessed. RESULTS: Fifty-two (0.57%) of 9 100 hospitalized infants had invasive MRSA infections from 2014 to 2022; infection rates declined non-significantly. During the 6-year surveillance program, the risk of infection was 16.9-times [CI95 8.4, 34.1] higher in colonized infants than uncolonized infants. Those colonized with mupirocin-susceptible MRSA were more likely successfully decolonized (aOR 9.7 [CI95 4.2, 22.5]). Of 57 infants successfully decolonized who remained hospitalized, 34 (60%) became recolonized. CONCLUSIONS: MRSA infection rates did not significantly decline in association with an active surveillance and decolonization program. Alternatives to mupirocin and CHG are needed to facilitate decolonization.
Subject(s)
Anti-Bacterial Agents , Chlorhexidine , Cross Infection , Intensive Care Units, Neonatal , Methicillin-Resistant Staphylococcus aureus , Mupirocin , Staphylococcal Infections , Humans , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/prevention & control , Staphylococcal Infections/drug therapy , Infant, Newborn , Mupirocin/administration & dosage , Mupirocin/therapeutic use , Chlorhexidine/analogs & derivatives , Chlorhexidine/administration & dosage , Chlorhexidine/therapeutic use , Female , Male , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/administration & dosage , Cross Infection/prevention & control , Cross Infection/epidemiology , Cross Infection/microbiology , Anti-Infective Agents, Local/administration & dosage , Anti-Infective Agents, Local/therapeutic use , BathsABSTRACT
Specimens of Sparus aurata were exposed to sub-lethal concentrations of Hg and Cd for 25 days and the levels of both metals were investigated in organs and tissues. Bioaccumulation of Hg decreased as follow: gills > kidney > liver > skin > muscle, while the order of Cd bioaccumulation was: liver > kidney > gills > skin > muscle. Immediately after exposure, both metals showed the highest bioaccumulation in gills and skin indicating that these organs are reliable targets for biomonitoring studies after short term exposure. Metals introduction caused a significant time-dependent concentrations increase in kidney and liver, while in the muscle a significant increase of Hg was recorded only at the end of the experimentation. The effects of exposure were also investigated, at biochemical level, in the liver, which represents the main target of xenobiotics biotransformation and metabolism in fish. Exposed fishes exhibited a reduction of total lipid level, a decrease of polyunsaturated fatty acids (PUFA), together with a MDA increase. This suggests a direct effect of contaminants on oxidative stress induction that, through the MDA increase, altered the membrane fatty acids composition decreasing the PUFA content. As it regards molecular markers related to oxidative stress and lipid metanolism, a significant increase of Nrf2, Hif-1α and Ampk and a decrease of Fas were observed after exposure to both metals, while an Nf-kB increase was recorded in specimens exposed to Hg, docuemnting a correlation with oxidative stress and consequent metabolism adaptation. Finally, these results suggest the possibility to adopt these biomarkers to explore fish metabolic responses to environmental pollution.
