Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis.

BACKGROUND Chronic haemodialysis patients are a high-risk population for meticillin-resistant Staphylococcus aureus (MRSA) colonization, which is a precursor of infection. AIM To summarize the effect of nasal (± whole-body wash) MRSA decolonization in haemodialysis patients by means of a systematic review and meta-analysis. METHODS We identified eligible studies using Medline, Embase, the Cochrane database, clinicaltrials.org, and conference abstracts investigating the success of MRSA decolonization in haemodialysis patients. For the statistical analysis, we used Stata 13 to express study-specific proportions with 95% confidence intervals. A likelihood ratio test was used to assess inter-study heterogeneity. FINDINGS Six published prospective cohort studies and one study described in a conference abstract met our inclusion criteria. From 1150 haemodialysis patients enrolled in these studies, MRSA was isolated from nasal swabs of 147 (12.8%) patients. Six of the trials used mupirocin nasal ointment and combined it with chlorhexidine body washes for decolonization. The most widely used protocol was a five-day course of mupirocin nasal ointment application three times a day, and chlorhexidine body wash once daily. The pooled success rate of decolonization was 0.88 (95% confidence interval: 0.75-0.95). A likelihood ratio test of the fixed versus the random-effects model showed significant inter-study heterogeneity (P = 0.047). Four of seven studies determined subsequent MRSA infections in 94 carriers overall, two (2%) of which experienced infection. CONCLUSION The use of mupirocin together with whole-body decolonization is highly effective in eradicating MRSA carriage in haemodialysis patients. The current literature, however, is characterized by a lack of comparative effectiveness studies for this intervention.

[Pilot Project: Improved Lung Deposition via a New Nasal Inhalation Procedure].

INTRODUCTION Inhaled drugs can only be effective if they reach the middle and small airways. This study introduces a system that combines a trans-nasal application of aerosols with noninvasive pressure support ventilation. METHODS In a pilot study, 7 COPD patients with GOLD stages II and III inhaled a radiolabeled marker dissolved in water via a trans-nasal route. The mean aerosol particle size was 5.5 µm. Each patient took part in two inhalation sessions that included two application methods and were at least 70 hours apart. During the first session ("passive method"), the patient inhaled the aerosol through an open tube system. The second session ("active method") included pressure support ventilation during the inhalation process. A gamma camera and planar scintigraphy was used to determine the distribution of aerosol particles in the patient's body and lung. RESULTS The pressure supported inhalation ("active method") results in an increased aerosol lung deposition compared to the passive method. Above all, we could demonstrate deposition in the lung periphery with relatively large aerosol particles (5.5 µm). DISCUSSION The results prove that the combination of trans-nasal inhalation with noninvasive pressure support ventilation leads to significantly increased particle deposition in the lung.

Comparison of innate immune responses towards rhinovirus infection of primary nasal and bronchial epithelial cells.

BACKGROUND AND OBJECTIVE Rhinoviruses (RV) replicate in both upper and lower airway epithelial cells. We evaluated the possibility of using nasal epithelial cells (NEC) as surrogate of bronchial epithelial cells (BEC) for RV pathogenesis cell culture studies. METHODS We used primary paired NEC and BEC cultures established from healthy subjects and compared the replication of RV belonging to the major (RV16) and minor (RV1B) group, and the cellular antiviral and proinflammatory cytokine responses towards these viruses. We related antiviral and pro-inflammatory responses of NEC isolated from CF and COPD patients with those of BEC. RESULTS RV16 replication and major group surface receptor (ICAM-1) expression were higher in healthy NEC compared with BEC (P < 0.05); RV1B replication and minor group surface receptor (LDLR) expression were similar. Healthy NEC and BEC produced similar levels of IFN-β and IFN-λ2/3 upon RV infection or after simulation with poly(IC). IL-8 production was similar between healthy NEC and BEC. IL-6 release at baseline (P < 0.01) and upon infection with RV16 (P < 0.05) and poly(IC) stimulation (P < 0.05) was higher in NEC. RV1B viral load in NEC was related to RV1B viral load in BEC (r = 0.49, P = 0.01). There was a good correlation of IFN levels between NEC and BEC (r = 0.66, P = 0.0004 after RV1B infection). IL-8 production in NEC was related to IL-8 production in BEC (r = 0.48, P = 0.02 after RV1B infection). CONCLUSION NEC are a suitable alternative cellular system to BEC to study the pathophysiology of RV infections and particularly to investigate IFN responses induced by RV infection.

Characterization of Staphylococcus aureus isolates associated with pediatric carriage in Houston, Texas

Infections caused by Methicillin-resistant Staphylococcus aureus (MRSA) have been of great concern in hospitals due the difficulty in treating virulent, antibiotic resistant microorganisms in sensitive populations including children, the elderly, and immunocomprimised individuals. Since the late 1990's, MRSA infections have become a problem in the general community, and the strains of S. aureus that cause infections in the community are known to be genetically different than the hospital acquired strains. Community-acquired strains tend to be more virulent, affecting even relatively healthy individuals, and disease presentation tends to be more diverse than diseases observed in patients suffering from hospital-acquired strains. From the year 2000 to the present, there has been a significant increase in community-acquired infections in children, a population already particularly sensitive to S. aureus infection. Genotyping the strains of CA-MRSA circulating in the pediatric population is an important step in developing better antibiotic treatment strategies. Additionally, determining the carriage status of individuals in this population and comparing these data with strain genotypes will also be valuable in establishing prevention and control practices. ^

Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization among dental professionals

Background. MRSA (methicillin-resistant Staphylococcus aureus) is a multi-drug resistant bacterium that is quite prevalent in social environments where close person-to-person contact and crowding are an issue. In dental settings, the likelihood of transmission of MRSA may be higher than among other healthcare practitioners because of the close proximity between a patient's nose (where MRSA colonizes) and the field of procedure (the mouth) to the dental professional. Objective. To estimate the prevalence of MRSA nasal colonization among dental professionals (dentists and dental hygienists) in the Greater Houston Metropolitan Area, Texas, and analyze its associations with demographic, professional and personal protective equipment-related variables. Methods. 800 dental professionals (400 dentists and 400 dental hygienists) were randomly selected in the Greater Houston Metropolitan Area. Multiple waves of nasal swab kits and a self-administered questionnaire were mailed to increase the response rate of the study population. The swabs were cultured on chromagenic agar growth medium and bacterial growth results were evaluated after 18 hours. Positively selected bacterial colonies were confirmed as MRSA by further culturing these isolated bacteria on blood agar plates. Associations between positive nasal swabs and self-reported professional practice patterns, personal protective equipment use and demographics were analyzed using multiple logistic regression. Main Results. Completed questionnaires and nasal swabs were received from 496 study participants (68%). Fourteen cultures were positive for MRSA (4.2% among dentists and 1.6% among dental hygienists, p=0.07). After adjusting for gender, dental hygienists had a significantly lower prevalence of nasal colonization of MRSA as compared to dentists (OR: 0.20, 95% CI: 0.05–0.75). No other significant associations or interactions were found. Conclusion. The prevalence of nasal colonization with MRSA among dentists is similar to that reported for health care workers in general, whereas prevalence among dental hygienists is only slightly above that of the general population (1%). Differences in practice patterns and use of personal protective equipment did not explain this difference in this study, and was possibly due either to residual confounding or unexplored risk factors. Increased prevalence of MRSA among dentists warrants further investigation as to the reason for the increased rate and to allow implementation of measures to avoid transmission and progression to disease. ^

Significance of some previously unrecognized apomorphies in the nasal region of Homo neanderthalensis.

For many years, the Neanderthals have been recognized as a distinctive extinct hominid group that occupied Europe and western Asia between about 200,000 and 30,000 years ago. It is still debated, however, whether these hominids belong in their own species, Homo neanderthalensis, or represent an extinct variant of Homo sapiens. Our ongoing studies indicate that the Neanderthals differ from modern humans in their skeletal anatomy in more ways than have been recognized up to now. The purpose of this contribution is to describe specializations of the Neanderthal internal nasal region that make them unique not only among hominids but possibly among terrestrial mammals in general as well. These features lend additional weight to the suggestion that Neanderthals are specifically distinct from Homo sapiens.

Distinct desmocollin isoforms occur in the same desmosomes and show reciprocally graded distributions in bovine nasal epidermis.

The adhesive core of the desmosome is composed of cadherin-like glycoproteins of two families, desmocollins and desmogleins. Three isoforms of each are expressed in a tissue-specific and developmentally regulated pattern. In bovine nasal epidermis, the three desmocollin (Dsc) isoforms are expressed in overlapping domains; Dsc3 expression is strongest in the basal layer, while Dsc2 and Dsc1 are strongly expressed in the suprabasal layers. Herein we have investigated whether different isoforms are assembled into the same or distinct desmosomes by performing double immunogold labeling using isoform-specific antibodies directed against Dsc1 and Dsc3. The results show that individual desmosomes harbor both isoforms in regions where their expression territories overlap. Quantification showed that the ratio of the proteins in each desmosome altered gradually from basal to immediately suprabasal and upper suprabasal layers, labeling for Dsc1 increasing and Dsc3 decreasing. Thus desmosomes are constantly modified as cells move up the epidermis, with continuing turnover of the desmosomal glycoproteins. Statistical analysis of the quantitative data showed a possible relationship between the distributions of the two isoforms. This gradual change in desmosomal composition may constitute a vertical adhesive gradient within the epidermis, having important consequences for cell positioning and differentiation.