Journal reviews: Bacterio-phage therapy for vancomycin-resistant Enterococcus; hospital-acquired infections and patient transfers
Journal reviews
Bug vs. bug: NIH puts its money on the virus
VRE-infected mice live to squeak another day
Biswas B, Adhya S, Washart P, et al. Bacterio-phage therapy rescues mice bacteremic from a clinical isolate of vancomycin-resistant Enterococcus. Infect Immun 2002; 70:204-210.
Pitting one microorganism against another, researchers at the National Institutes of Health are using viruses to attack antibiotic-resistant bacteria. Working with scientists from Exponential Biotherapies in Point Washington, NY, they have successfully used bacteriophage therapy to treat mice experimentally infected with a fatal vancomycin-resistant enterococci (VRE) infection. Bacteriophage are viruses that can attack and kill bacteria without causing disease in humans.
Renewed interest in old science
Researchers began exploring the potential of the viruses as antibacterial therapies in the early 20th century, but a combination of factors — not the least of which was the discovery of penicillin and the age of antibiotics — made that that interest short-lived. The rise of antibiotic resistance in the 1980s and 1990s has renewed scientific interest in the development of the alternative therapies.
In the study, the researchers experimentally infected mice with a strain of VRE and injected treated them with bacteriophage at varying times after initial infection. The mice that did not receive treatment died within 48 hours. All the mice that were treated within five hours of infection and half of those treated 24 hours after infection survived. "The emergence of antibiotic-resistant bacterial strains requires the exploration of alternative antibacterial therapies," the authors concluded. "In the present study, we report the isolation of bacteriophage that are safe and effective as bactericidal agents for animals with lethal VRE infections. The results warrant a re-examination of the potential application of bacteriophages in Western medicine."
Have bug, will travel: Risk rises for transfer patients
Risk similar for incoming and moving within
Eveillard M, Quenon JL, Rufat P, et al. Association between hospital-acquired infections and patients’ transfers. Infect Control Hosp Epidemiol 2001; 22:693-696.
Whether coming from another hospital or shifting wards within the same facility, the risk of having a nosocomial infection on a given day was more than four times higher in transferred patients. While clearly a risk marker, patient transfer also is independently associated with nosocomial infection, the authors found. "The origin of a transferred patient is readily known at admission. It would be useful to adopt specific measures for such patients, particularly if they have other risk factors of nosocomial infection, both to protect them and to prevent transmission of the infection to other hospitalized patients.
To assess the risk of nosocomial infection in transferred patients — and to determine whether transfer is only a risk marker or is independently associated with nosocomial infection — the researchers conducted a retrospective analysis at a 400-bed general hospital in the Paris area.
Of the 1,326 patients included in four surveys, 70 (5.3%) had been transferred from another hospital and 199 (15%) from another ward of the hospital. Transferred patients more frequently had known risk factors of nosocomial infection. Those included age more than 65 years, a length of hospital stay more than seven days, at least one invasive procedure, a recent surgical intervention, and immunosuppression.
The prevalence rate of infected patients was 6.7%. However, the risk was similar between patients transferred from another hospital (20%) and patients transferred within the hospital (17%). The multivariate analysis performed by logistic regression showed that intrahospital transfer, a length of hospital stay more than sever days, and having had at least one invasive procedure were independent risk factors of infection.
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