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Waldeck F, Seiffert SN, Manser S, Zemp D, Walt A, Berger C, Albrich WC, Schlegel M, Roloff T, Egli A, Nolte O, Kahlert CR. Outbreak investigation including molecular characterization of community associated methicillin-resistant Staphylococcus aureus in a primary and secondary school in Eastern Switzerland. Sci Rep 2022; 12:19826. [PMID: 36400917 PMCID: PMC9674615 DOI: 10.1038/s41598-022-24363-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022] Open
Abstract
At our tertiary children's hospital, infections with newly detected methicillin-resistant Staphylococcus aureus (MRSA) among children attending primary (age 6-12 years) and secondary school (age 13-16 years) nearly doubled in 2018 compared to previous years. This observation initiated an epidemiological outbreak investigation including phenotypic (susceptibility testing) and genotypic (whole genome sequencing) characterization of the isolates. In addition, a cross-sectional study was conducted to determine source of the outbreak, colonization frequency and to identify risk factors for transmission using a questionnaire. As a result, 49 individuals were detected with 57 corresponding isolates. Based on the case definition combined with whole genome sequencing, a core cluster was identified that shared common genetic features and a similar antimicrobial susceptibility pattern (efflux-mediated macrolide resistance, tetracycline susceptibility along with presence of Panton-Valentine leukocidin). Epidemiologic evaluation identified a distinct school as a common risk factor. However, the source of the clustered infections within that school could not be further specified. No further cases could be detected after decolonization of infected and colonized children.
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Affiliation(s)
- Frederike Waldeck
- grid.413349.80000 0001 2294 4705Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.412468.d0000 0004 0646 2097Division of Infectious Diseases & Microbiology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Salome N. Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Susanne Manser
- grid.414079.f0000 0004 0568 6320Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Danuta Zemp
- Division of Public Health, Department of Health, Office of the Chief Medical Officer of Canton St. Gallen, St. Gallen, Switzerland
| | - Angela Walt
- Division of Public Health, Department of Health, Office of School Medicine, St. Gallen, Switzerland
| | - Christoph Berger
- grid.412341.10000 0001 0726 4330Division of Infectious Diseases and Hospital Epidemiology, University Children’s Hospital Zurich, Zurich, Switzerland
| | - Werner C. Albrich
- grid.413349.80000 0001 2294 4705Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Matthias Schlegel
- grid.413349.80000 0001 2294 4705Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Tim Roloff
- grid.7400.30000 0004 1937 0650Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland ,grid.410567.1Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Adrian Egli
- grid.7400.30000 0004 1937 0650Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland ,grid.410567.1Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland ,grid.6612.30000 0004 1937 0642Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Christian R. Kahlert
- grid.413349.80000 0001 2294 4705Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.414079.f0000 0004 0568 6320Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
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2
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Huang S, He J, Zhang Y, Su L, Tong L, Sun Y, Zhou M, Chen Z. The Correlation Between Biofilm-Forming Ability of Community-Acquired Methicillin-Resistant Staphylococcus aureus Isolated from the Respiratory Tract and Clinical Characteristics in Children. Infect Drug Resist 2022; 15:3657-3668. [PMID: 35855760 PMCID: PMC9288189 DOI: 10.2147/idr.s370755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 06/17/2022] [Indexed: 01/09/2023] Open
Abstract
Objective This study aimed to investigate the biofilm-forming ability, molecular typing, and antimicrobial resistance of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) strains isolated from the respiratory tract of children and their correlation with clinical characteristics. Methods All CA-MRSA strains were isolated from hospitalized children, and their presentation, molecular typing, antimicrobial susceptibility, and biofilm formation were investigated. The clinical characteristics were compared between the strong and weak biofilm producer groups. Results Fifty-three CA-MRSA strains were isolated from the respiratory samples of 53 children, with nearly half of them being young infants (0-12 months). Approximately, 88.7% (47/53) of the isolates were resistant to four or more antibiotics, mainly β-lactam antibiotics, lincosamides, and macrolides. Twelve sequence types (STs) and 20 subtypes of staphylococcal protein A (spa) typing were identified, with ST59-t437 (39.6%, 21/53) as the predominant subtype. All strains showed the ability to form biofilms. When compared to children with weak biofilm-forming CA-MRSA strains, those with strong biofilm-forming strains had higher proportions of lower respiratory tract infections (LRTI) (88.5% vs 59.3%), obvious cough symptoms (84.6% vs 51.9%), and severe chest imaging manifestations (76.9% vs 37.0%). Furthermore, a strong biofilm-forming ability significantly increased the risk of prolonged cough in children with LRTI (44.4% vs 14.3%), and a positive correlation between the duration of cough and the extent of biofilm formation was observed. Medical history investigation revealed that the strong biofilm-forming group had a much higher percentage of macrolides intake than the weak biofilm-forming group in the last month before admission (61.5% vs 14.8%). Conclusion ST59-t437 was the most prevalent clone in CA-MRSA respiratory isolates among the hospitalized children. All CA-MRSA strains formed biofilms. The stronger the biofilm-forming ability, the more serious and prolonged were the respiratory symptoms.
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Affiliation(s)
- Shumin Huang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Jing He
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Yiting Zhang
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Su
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Lin Tong
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Ying Sun
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China
| | - Mingming Zhou
- National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Department of Clinical Laboratory, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China
| | - Zhimin Chen
- Department of Pulmonology, Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, 310052, People’s Republic of China,National Clinical Research Center for Child Health, National Children’s Regional Medical Center, Hangzhou, 310052, People’s Republic of China,Correspondence: Zhimin Chen, Email
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3
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Lynch L, Shrotri M, Brown CS, Heathcock RT. Is decolonisation to prevent PVL-positive Staphylococcus aureus infection in the population effective? A systematic review. J Hosp Infect 2021; 121:91-104. [PMID: 34973237 DOI: 10.1016/j.jhin.2021.12.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 11/26/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Panton-Valentine Leukocidin (PVL) producing Staphylococcus aureus is associated with recurrent skin and soft tissue infections and occasionally invasive infections. There is limited evidence to support current public health guidance on decolonisation of cases and household contacts. METHODS This systematic review (CRD42020189906) investigated the efficacy of decolonisation against PVL-positive S. aureus to inform future public health practice. It included studies of cases with PVL-positive infections providing information on the efficacy of decolonisation of cases, carriers, or contacts of cases. Studies were assessed for the risk of bias using the GRADE approach and summarised to inform a narrative synthesis. RESULTS The search identified 20, mostly observational, studies with small samples and lacking control groups. Studies with longer follow-ups found that, while early post-decolonisation screening was negative for most individuals, testing over subsequent months identified re-colonisation in some. There is no high quality evidence to show whether decolonisation is effective in reducing (re)infection or long-term carriage of PVL-positive S. aureus and the low quality evidence available indicates it may not be effective in eradicating carriage or reducing future disease. Furthermore, there may be risks associated with decolonisation, for example, potentially increased risk of infection from other microbes, opportunity costs and negative impacts of repeated testing for asymptomatic carriage. CONCLUSIONS Further research is required to better understand what affects the ability of decolonisation efforts to reduce risk to cases and their contacts, including strain, host and environmental factors.
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Affiliation(s)
- Lucy Lynch
- Public Health England, London, United Kingdom.
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4
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Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-Resistant Staphylococcus aureus: An Update on Prevention and Control in Acute Care Settings. Infect Dis Clin North Am 2021; 35:931-952. [PMID: 34752226 DOI: 10.1016/j.idc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health-care-associated infections. Controversies regarding the effectiveness of various control strategies have contributed to varying approaches to MRSA control. However, new evidence from large-scale studies has emerged, particularly concerning screening and decolonization. Importantly, implementation and outcomes of control measures in practice are not only influenced by scientific evidence, but also economic, administrative, and political factors, as demonstrated by decreasing MRSA rates in a number of countries after concerted and coordinated efforts at a national level. Flexibility to adapt measures based on local epidemiology and resources is essential for successful MRSA control.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
| | - Benedikt D Huttner
- Division of Infectious Diseases, University of Geneva Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Gaud Catho
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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5
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Zhao N, Khamash DF, Koh H, Voskertchian A, Egbert E, Mongodin EF, White JR, Hittle L, Colantuoni E, Milstone AM. Low Diversity in Nasal Microbiome Associated With Staphylococcus aureus Colonization and Bloodstream Infections in Hospitalized Neonates. Open Forum Infect Dis 2021; 8:ofab475. [PMID: 34651052 PMCID: PMC8507450 DOI: 10.1093/ofid/ofab475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 09/14/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is a leading cause of infectious morbidity and mortality in neonates. Few data exist on the association of the nasal microbiome and susceptibility to neonatal S. aureus colonization and infection. METHODS We performed 2 matched case-control studies (colonization cohort-neonates who did and did not acquire S. aureus colonization; bacteremia cohort-neonates who did [colonized neonates] and did not [controls] acquire S. aureus colonization and neonates with S. aureus bacteremia [bacteremic neonantes]). Neonates in 2 intensive care units were enrolled and matched on week of life at time of colonization or infection. Nasal samples were collected weekly until discharge and cultured for S. aureus, and the nasal microbiome was characterized using 16S rRNA gene sequencing. RESULTS In the colonization cohort, 43 S. aureus-colonized neonates were matched to 82 controls. At 1 week of life, neonates who acquired S. aureus colonization had lower alpha diversity (Wilcoxon rank-sum test P < .05) and differed in beta diversity (omnibus MiRKAT P = .002) even after adjusting for birth weight (P = .01). The bacteremia cohort included 10 neonates, of whom 80% developed bacteremia within 4 weeks of birth and 70% had positive S. aureus cultures within a few days of bacteremia. Neonates with bacteremia had an increased relative abundance of S. aureus sequences and lower alpha diversity measures compared with colonized neonates and controls. CONCLUSIONS The association of increased S. aureus abundance and decrease of microbiome diversity suggest the need for interventions targeting the nasal microbiome to prevent S. aureus disease in vulnerable neonates.
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Affiliation(s)
- Ni Zhao
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Dina F Khamash
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Hyunwook Koh
- Deptartment of Applied Mathematics & Statistics, The State University of New York, Korea (SUNY Korea), Incheon, South Korea
| | - Annie Voskertchian
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emily Egbert
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Emmanuel F Mongodin
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | | | - Elizabeth Colantuoni
- Department of Biostatistics, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron M Milstone
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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6
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Determinants for voluntary participation in staff screening during an methicillin-resistant Staphylococcus aureus (MRSA) outbreak on a neonatal ward. Infect Control Hosp Epidemiol 2020; 42:881-884. [PMID: 33256866 DOI: 10.1017/ice.2020.1319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We investigated healthcare worker (HCW) behavior with regard to a voluntary methicillin-resistant Staphylococcus aureus (MRSA) staff screening during a MRSA outbreak in a neonatal ward. Avoiding MRSA transmission from HCWs to patients was the most important reason for participation. Inconvenient screening time was the most frequently cited reason for nonparticipation.
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7
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Cremers AJH, Coolen JPM, Bleeker-Rovers CP, van der Geest-Blankert ADJ, Haverkate D, Hendriks H, Henriet SSV, Huynen MA, Kolwijck E, Liem D, Melchers WJG, Rossen JW, Zoll J, van Heijst A, Hopman J, Wertheim HFL. Surveillance-embedded genomic outbreak resolution of methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit. Sci Rep 2020; 10:2619. [PMID: 32060342 PMCID: PMC7021795 DOI: 10.1038/s41598-020-59015-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/22/2020] [Indexed: 01/14/2023] Open
Abstract
We observed an increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections at a Dutch neonatal intensive care unit. Weekly neonatal MSSA carriage surveillance and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. Traditional clustering of MSSA isolates by spa typing and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections. We investigated whether whole-genome sequencing (WGS) of MSSA surveillance would provide additional evidence for transmission. MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to WGS and bioinformatic analysis for identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. By measuring the genetic diversity in background surveillance, we defined transmission-level relatedness and identified isolates that had been unjustly assigned to clusters based on MLVA, while spa typing was concordant but of insufficient resolution. Detailing particular subsets of isolates provided evidence that HCWs were involved in multiple outbreaks, yet it alleviated concerns about one particular HCW. The improved resolution and accuracy of genomic outbreak analyses substantially altered the view on outbreaks, along with apposite measures. Therefore, inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference.
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Affiliation(s)
- A J H Cremers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands.
| | - J P M Coolen
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | | | - D Haverkate
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H Hendriks
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - S S V Henriet
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - M A Huynen
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - E Kolwijck
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - D Liem
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - J W Rossen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Zoll
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - A van Heijst
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - J Hopman
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H F L Wertheim
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
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8
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Cheng VCC, Wong SC, Cao H, Chen JHK, So SYC, Wong SCY, Sridhar S, Yuen KY, Ho PL. Whole-genome sequencing data-based modeling for the investigation of an outbreak of community-associated methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit in Hong Kong. Eur J Clin Microbiol Infect Dis 2019; 38:563-573. [PMID: 30680562 DOI: 10.1007/s10096-018-03458-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/17/2018] [Indexed: 01/09/2023]
Abstract
We describe a nosocomial outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) ST59-SCCmec type V in a neonatal intensive care unit (NICU) in Hong Kong. In-depth epidemiological analysis was performed by whole-genome sequencing (WGS) of the CA-MRSA isolates collected from patients and environment during weekly surveillance and healthcare workers from the later phase of the outbreak. Case-control analysis was performed to analyze potential risk factors for the outbreak. The outbreak occurred from September 2017 to February 2018 involving 15 neonates and one healthcare worker. WGS analysis revealed complicated transmission dynamics between patients, healthcare worker, and environment, from an unrecognized source introduced into the NICU within 6 months before the outbreak. In addition to enforcement of directly observed hand hygiene, environmental disinfection, cohort nursing of colonized and infected patients, together with contact tracing for secondary patients, medical, nursing, and supporting staff were segregated where one team would care for CA-MRSA-confirmed/CA-MRSA-exposed patients and the other for newly admitted patients in the NICU only. Case-control analysis revealed use of cephalosporins [odds ratio 49.84 (3.10-801.46), p = 0.006] and length of hospitalization [odds ratio 1.02 (1.00-1.04), p = 0.013] as significant risk factors for nosocomial acquisition of CA-MRSA in NICU using multivariate analysis. WGS facilitates the understanding of transmission dynamics of an outbreak, providing insights for outbreak prevention.
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Affiliation(s)
- Vincent C C Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong, Special Administrative Region, China.,Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong, Special Administrative Region, China
| | - Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong, Special Administrative Region, China
| | - Huiluo Cao
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Jonathan H K Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong, Special Administrative Region, China
| | - Simon Y C So
- Department of Microbiology, Queen Mary Hospital, Hong Kong, Special Administrative Region, China
| | - Sally C Y Wong
- Department of Microbiology, Queen Mary Hospital, Hong Kong, Special Administrative Region, China
| | - Siddharth Sridhar
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Special Administrative Region, China
| | - Pak-Leung Ho
- Department of Microbiology and Carol Yu Centre for Infection, Queen Mary Hospital, The University of Hong Kong, Hong Kong, Special Administrative Region, China.
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9
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 774] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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10
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Dong Y, Glaser K, Speer CP. New Threats from an Old Foe: Methicillin-Resistant Staphylococcus aureus Infections in Neonates. Neonatology 2018; 114:127-134. [PMID: 29804104 PMCID: PMC6159825 DOI: 10.1159/000488582] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 03/17/2018] [Indexed: 12/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a ubiquitous human inhabitant and one of the important pathogens of neonatal infections. MRSA is associated with significant mortality and morbidity, especially in very immature preterm neonates. Moreover, MRSA may be implicated in adverse long-term neonatal outcomes, posing a substantial disease burden. Recent advances in molecular microbiology have shed light on the evolution of MRSA population structure and virulence factors, which may contribute to MRSA epidemic waves worldwide. Equipped with remarkable genetic flexibility, MRSA has successfully developed resistance to an extensive range of antibiotics including vancomycin, as well as antiseptics. In the face of these new challenges from MRSA, our armamentarium of anti-infective strategies is very limited and largely dependent on prevention measures. Active surveillance cultures followed by decolonization may be a promising approach to control MRSA infections, with its efficacy and safety in the specific population of neonates yet to be addressed by large multicenter studies.
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Affiliation(s)
- Ying Dong
- University Children's Hospital, University of Würzburg, Würzburg, Germany.,Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Kirsten Glaser
- University Children's Hospital, University of Würzburg, Würzburg, Germany
| | - Christian P Speer
- University Children's Hospital, University of Würzburg, Würzburg, Germany
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11
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Khairalla AS, Wasfi R, Ashour HM. Carriage frequency, phenotypic, and genotypic characteristics of methicillin-resistant Staphylococcus aureus isolated from dental health-care personnel, patients, and environment. Sci Rep 2017; 7:7390. [PMID: 28784993 PMCID: PMC5547136 DOI: 10.1038/s41598-017-07713-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 06/28/2017] [Indexed: 01/03/2023] Open
Abstract
There is limited data on methicillin-resistant Staphylococcus aureus (MRSA) carriage in dental clinics. 1300 specimens from patients, health personnel, and environmental surfaces of a dental clinic in Egypt were tested for MRSA. Antibiotic susceptibility, biofilm formation, Staphylococcal protein A (spa) typing, SCCmec typing, and PCR-based assays were used to detect mecA, mecC, vanA, Panton-Valentine Leukocidin toxin (PVL), and toxic shock syndrome toxin-1 (tst) genes. Among 34 mecA-positive MRSA isolates, five (14.7%) were PVL-positive, seventeen (50%) were tst-positive, ten (29.4%) were vanA-positive, while none harboured mecC. MRSA hand carriage rates in patients, nurses, and dentists were 9.8%, 6.6%, and 5%. The respective nasal colonization rates were 11.1%, 6.7%, and 9.7%. 1.3% of the environmental isolates were MRSA-positive. Strong and moderate biofilm-forming isolates represented 23.5% and 29.4% of MRSA isolates. 24 MRSA isolates (70.6%) were multi-resistant and 18 (52.9%) harboured SCCmec IV. Among eight spa types, t223 (26.5%), t267 (23.5%), and t14339 (23.5%) were predominant. We noted an alarming genetic relatedness between 7 (20.6%) MRSA isolates and the epidemic EMRSA-15 clone, as well as a combined occurrence of tst and PVL in 3 (8.8%) isolates. Results suggest high MRSA pathogenicity in dental wards highlighting the need for more efficient surveillance/infection control strategies.
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Affiliation(s)
- Ahmed S Khairalla
- Department of Microbiology & Immunology, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | - Reham Wasfi
- Department of Microbiology & Immunology, Faculty of Pharmacy, October University for Modern Sciences and Arts (MSA), Giza, Egypt
| | - Hossam M Ashour
- Department of Biological Sciences, College of Arts and Sciences, University of South Florida St. Petersburg, St. Petersburg, Florida, USA.
- Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
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12
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Bakthavatchalam YD, Nabarro LEB, Ralph R, Veeraraghavan B. Diagnosis and management of Panton-Valentine leukocidin toxin associated Staphylococcus aureus infection: an update. Virulence 2017:0. [PMID: 28783418 DOI: 10.1080/21505594.2017.1362532] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
The incidence of invasive Staphylococcus aureus (SA) infection has increased in the past decade and is associated with poor outcomes and high mortality rates. Of all the virulence factors, Panton-Valentine Leukocidin (PVL) has received the greatest attention. PVL producing SA strains are more likely to produce severe skin and soft tissue infections (SSTIs) and necrotizing pneumonia. This review focuses on the current evidence on PVL-SA virulence, epidemiology, clinical disease and treatment with relevance to healthcare in India.
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Affiliation(s)
| | - Laura E B Nabarro
- a Department of Clinical Microbiology , Christian Medical College , Vellore - 632004 , India
| | - Ravikar Ralph
- b Department of Medicine (unit II) , Christian Medical College , Vellore - 632004 , India
| | - Balaji Veeraraghavan
- a Department of Clinical Microbiology , Christian Medical College , Vellore - 632004 , India
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13
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Farr BM. What To Think If the Results of the National Institutes of Health Randomized Trial of Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusControl Measures Are Negative (and Other Advice to Young Epidemiologists): A Review and an Au Revoir. Infect Control Hosp Epidemiol 2016; 27:1096-106. [PMID: 17006818 DOI: 10.1086/508759] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Accepted: 08/31/2006] [Indexed: 12/27/2022]
Abstract
The incidence of methicillin-resistantStaphylococcus aureus(MRSA) and vancomycin-resistantEnterococcus(VRE) infections continues to rise in National Nosocomial Infections Surveillance system hospitals, and these pathogens are reportedly causing more than 100,000 infections and many deaths each year in US healthcare facilities. This has led some to insist that control measures are now urgently needed, but several recent articles have suggested that isolation of patients does not work, is not needed, or is unsafe, or that a single cluster-randomized trial could be used to decide such matters. At least 101 studies have reported controlling MRSA infection and 38 have reported controlling VRE infection by means of active detection by surveillance culture and use of isolation for all colonized patients in healthcare settings where the pathogens are epidemic or endemic, in academic and nonacademic hospitals, and in acute care, intensive care, and long-term care settings. MRSA colonization and infection have been controlled to exceedingly low levels in multiple nations and in the state of Western Australia for decades by use of active detection and isolation. Studies suggesting problems with using such data to control MRSA colonization and infection have their own problems, which are discussed. Randomized trials are epidemiologic tools that can sometimes provide erroneous results, and they have not been considered necessary for studying isolation before it is used to control other important infections, such as tuberculosis, smallpox, and severe acute respiratory syndrome. No single epidemiologic study should be considered definitive. One should always weigh all available evidence. Infection with antibiotic-resistant pathogens such as MRSA and VRE is controllable to a low level by active detection and isolation of colonized and infected patients. Effective measures should be used to minimize the morbidity and mortality attributable to these largely preventable infections.
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Affiliation(s)
- Barry M Farr
- Department of Medicine, University of Virginia Health System, Charlottesville, VA 22908, USA.
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Von Dach E, Diene SM, Fankhauser C, Schrenzel J, Harbarth S, François P. Comparative Genomics of Community-Associated Methicillin-Resistant Staphylococcus aureus Shows the Emergence of Clone ST8-USA300 in Geneva, Switzerland. J Infect Dis 2015; 213:1370-9. [PMID: 26464204 DOI: 10.1093/infdis/jiv489] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 09/18/2015] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previous investigations of community-associated methicillin-resistant Staphylococcus aureus(CA-MRSA) isolates have revealed a wide diversity of genetic backgrounds, with only sporadic occurrence of ST8-USA300, in Geneva, Switzerland. We conducted a molecular epidemiologic analysis to identify the origin of a sudden increase of ST8 PVL-positive isolates in Geneva during 2013. METHODS On the basis of prospective CA-MRSA surveillance, we collected colonizing and infecting ST8-USA300 isolates and compared them to non-ST8 CA-MRSA isolates. Whole-genome sequencing (WGS) was performed for each isolate of this collection, and discriminating molecular features were linked to patient data. RESULTS In 2013, 22 isolates with the ST8-USA300 profile were identified among 46 cases of CA-MRSA. WGS revealed 2 groups of strains that differed by the type of the SCCmec IV element encoded and whether they harbored an arginine catabolism mobile element (ACME) locus. ACME-negative strains were mainly isolated from patients traveling in or originating from South America. Single-nucleotide polymorphism positions in isolate groups were used to infer their common ancestor, determine their geographical origin, and trace their relatedness. CONCLUSIONS WGS allowed the identification of transmission events and revealed that the increased prevalence of USA300 CA-MRSA isolates resulted from multiple importation events from the Americas but not from local clonal expansion of a successful clone.
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Affiliation(s)
- Elodie Von Dach
- Infection Control Program, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
| | - Seydina M Diene
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
| | - Carolina Fankhauser
- Infection Control Program, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
| | - Patrice François
- Genomic Research Laboratory, Service of Infectious Diseases, Geneva University Hospitals Faculty of Medicine, University of Geneva, Switzerland
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15
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Milstone AM, Koontz DW, Voskertchian A, Popoola VO, Harrelson K, Ross T, Aucott SW, Gilmore MM, Carroll KC, Colantuoni E. Treating Parents to Reduce NICU Transmission of Staphylococcus aureus (TREAT PARENTS) trial: protocol of a multisite randomised, double-blind, placebo-controlled trial. BMJ Open 2015; 5:e009274. [PMID: 26353875 PMCID: PMC4567681 DOI: 10.1136/bmjopen-2015-009274] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION More than 33,000 healthcare-associated infections occur in neonatal intensive care units (NICUs) each year in the USA. Parents, rather than healthcare workers, may be a reservoir from which neonates acquire Staphylococcus aureus (S. aureus) colonisation in the NICU. This study looks to measure the effect of treating parents with short course intranasal mupirocin and topical chlorhexidine antisepsis on acquisition of S. aureus colonisation and infection in neonates. METHODS AND ANALYSIS The TREAT PARENTS trial (Treating Parents to Reduce Neonatal Transmission of S. aureus) is a multicentre randomised, masked, placebo-controlled trial. Shortly after a neonate is admitted to the NICU, parents will be tested for S. aureus colonisation. If either parent screens positive for S. aureus, then both parents as a pair will be enrolled and randomised to one of the two possible masked treatment arms. Arm 1 will include assignment to intranasal 2% mupirocin plus topical antisepsis with chlorhexidine gluconate impregnated cloths for 5 days. Arm 2 will include assignment to placebo ointment and placebo cloths for skin antisepsis for 5 days. The primary outcome will be neonatal acquisition of an S. aureus strain that is concordant to the parental baseline S. aureus strain as determined by periodic surveillance cultures or a culture collected during routine clinical care that grows S. aureus. Secondary outcomes will include neonatal acquisition of S. aureus, neonatal S. aureus infection, eradication of S. aureus colonisation in parents, natural history of S. aureus colonisation in parents receiving placebo, adverse reactions to treatment, feasibility of intervention, and attitudes and behaviour in consented parents. Four hundred neonate-parent pairs will be enrolled. ETHICS AND DISSEMINATION The study was approved by Johns Hopkins University IRB in June 2014 (IRB number 00092982). Protocol V.7 was approved in November 2014. Findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT02223520.
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Affiliation(s)
- Aaron M Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Danielle W Koontz
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Annie Voskertchian
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Victor O Popoola
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kathleen Harrelson
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Tracy Ross
- Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Susan W Aucott
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Maureen M Gilmore
- Department of Pediatrics, Division of Neonatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Karen C Carroll
- Department of Pathology, Division of Medical Microbiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Elizabeth Colantuoni
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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16
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Layer F, Sanchini A, Strommenger B, Cuny C, Breier AC, Proquitté H, Bührer C, Schenkel K, Bätzing-Feigenbaum J, Greutelaers B, Nübel U, Gastmeier P, Eckmanns T, Werner G. Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit. Int J Med Microbiol 2015; 305:790-8. [PMID: 26321006 DOI: 10.1016/j.ijmm.2015.08.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected.
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Affiliation(s)
- Franziska Layer
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany.
| | - Andrea Sanchini
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Birgit Strommenger
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Christiane Cuny
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Ann-Christin Breier
- Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany
| | - Hans Proquitté
- Department of Neonatology, Charité University Medical Centre, Berlin, Germany
| | - Christoph Bührer
- Department of Neonatology, Charité University Medical Centre, Berlin, Germany
| | - Karl Schenkel
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany; Department of Infectious Disease Prevention and Control, Community Health Office City of Berlin Mitte, Berlin, Germany
| | - Jörg Bätzing-Feigenbaum
- Department of Infectious Disease Epidemiology and Environmental Health Protection, State Office for Health and Social Affairs, Federal State of Berlin, Berlin, Germany
| | - Benedikt Greutelaers
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Ulrich Nübel
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medical Centre, Berlin, Germany
| | - Tim Eckmanns
- Division of Healthcare Associated Infections, Surveillance of Antibiotic Resistance and Consumption, Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Guido Werner
- National Reference Centre for Staphylococci and Enterococci, Division Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Burgstraße 37, 38855 Wernigerode, Germany
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Epidemiology of Methicillin-Susceptible Staphylococcus aureus in a Neonatology Ward. Infect Control Hosp Epidemiol 2015; 36:1305-12. [PMID: 26290400 DOI: 10.1017/ice.2015.184] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE In-hospital transmission of methicillin-susceptible Staphylococcus aureus (MSSA) among neonates remains enigmatic. We describe the epidemiology of MSSA colonization and infection in a 30-bed neonatal ward. DESIGN Multimodal outbreak investigation SETTING A public 800-bed tertiary care university hospital in Switzerland METHODS Investigations in 2012-2013, triggered by a MSSA infection cluster, included prospective MSSA infection surveillance, microbiologic screening of neonates and environment, onsite observations, and a prospective cohort study. MSSA isolates were characterized by pulsed-field gel electrophoresis (PFGE) and selected isolates were examined for multilocus sequence type (MLST) and virulence factors. RESULTS Among 726 in 2012, 30 (4.1%) patients suffered from MSSA infections including 8 (1.1%) with bacteremia. Among 655 admissions in 2013, 13 (2.0%) suffered from MSSA infections including 2 (0.3%) with bacteremia. Among 177 neonates screened for S. aureus carriage, overall 77 (44%) tested positive. A predominant PFGE-1-ST30 strain was identified in 6 of 30 infected neonates (20%) and 30 of 77 colonized neonates (39%). This persistent clone was pvl-negative, tst-positive and belonged to agr group III. We found no environmental point source. MSSA carriage was associated with central vascular catheter use but not with a particular midwife, nurse, physician, or isolette. Observed healthcare worker behavior may have propagated transmission via hands and fomites. Despite multimodal interventions, clonal transmission and colonization continued and another clone, PFGE-6-ST5, became predominant. CONCLUSIONS Hospital-acquired MSSA clones represent a high proportion of MSSA colonization but not MSSA infections in neonate inpatients. In contrast to persisting MSSA, transmission infection rates decreased concurrently with interventions. It remains to be established whether eradication of hospital-acquired MSSA strains would reduce infection rates further.
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Kraus-Haas M, Mielke M, Simon A. [Update on outbreaks reported from neonatal intensive care units (2010-203): Staphylococcus aureus]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2015; 58:323-38. [PMID: 25566845 DOI: 10.1007/s00103-014-2115-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
In terms of the unique risk profile of the patients and the morbidity associated with S. aureus infections in this vulnerable patient population, the literature on outbreaks of S. aureus (including MRSA) in neonatal intensive care units (NICUs) needs to be analyzed separately from reports derived from other intensive care units. With the objective of updating important information for those involved in outbreak management and fostering preventive efforts, this article summarizes the results of a systematic literature analysis, referring to an earlier publication by Gastmeier et al. It focuses on NICU outbreaks caused by S. aureus (including MRSA) and on controlling them.
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19
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Uçkay I, Sax H, Iten A, Camus V, Renzi G, Schrenzel J, Perrier A, Pittet D. Effect of Screening for Methicillin-Resistant Staphylococcus aureus Carriage by Polymerase Chain Reaction on the Duration of Unnecessary Preemptive Contact Isolation. Infect Control Hosp Epidemiol 2015; 29:1077-9. [DOI: 10.1086/591452] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage at hospital readmission among previous MRSA carriers warrants screening and preemptive isolation precautions. The replacement of culture on chromogenic agar with rapid quantitative polymerase chain reaction for readmission screening reduces the number of unnecessary preemptive isolation-days by 54% (from 6.88 to 3.14 isolation-days) and related costs by 45% (from US$113.2 to US$62.1) for patients who test negative for MRSA.
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One size does not fit all: why universal decolonization strategies to prevent methicillin-resistant Staphylococcus aureus colonization and infection in adult intensive care units may be inappropriate for neonatal intensive care units. J Perinatol 2014; 34:653-5. [PMID: 25010223 PMCID: PMC4152419 DOI: 10.1038/jp.2014.125] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 05/06/2014] [Accepted: 05/14/2014] [Indexed: 12/16/2022]
Abstract
The REDUCE MRSA Trial (Randomized Evaluation of Decolonization vs Universal Clearance to Eliminate Methicillin-Resistant Staphylococcus aureus), a large multicenter, randomized controlled trial in adult intensive care units (ICUs), found universal decolonization to be more effective than surveillance and isolation procedures with or without targeted decolonization for reducing rates of MRSA-positive clinical cultures. The Agency for Healthcare Research and Quality and the Centers for Disease Control and Prevention subsequently published protocols for implementing universal decolonization in ICUs based on the trial's methods. Caution should be exercised before widely adopting these procedures in neonatal intensive care units (NICUs), particularly strategies that involve bathing with chlorhexidine and mupirocin application due to the potential for adverse events in their unique patient population, especially preterm infants. Large multicenter trials in the NICUs are needed to evaluate the efficacy, short- and long-term safety, and cost effectiveness of these strategies prior to their widespread implementation.
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Nüesch‐Inderbinen MT, Stadler U, Johler S, Hächler H, Stephan R, Nüesch H. Intrafamilial spread of a Panton‐Valentine leukocidin‐positive community‐acquired methicillin‐resistant Staphylococcus aureus belonging to the paediatric clone ST5 SSCmecIV. JMM Case Rep 2014. [DOI: 10.1099/jmmcr.0.001859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Magdalena T. Nüesch‐Inderbinen
- National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Ueli Stadler
- National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Sophia Johler
- National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Herbert Hächler
- National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
| | - Roger Stephan
- National Centre for Enteropathogenic Bacteria and Listeria, Institute for Food Safety and Hygiene, University of Zurich, Zurich, Switzerland
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Scheithauer S, Trepels-Kottek S, Häfner H, Keller D, Ittel T, Wagner N, Heimann K, Schoberer M, Schwarz R, Haase G, Waitschies B, Orlikowsky T, Lemmen S. Healthcare worker-related MRSA cluster in a German neonatology level III ICU: A true European story. Int J Hyg Environ Health 2014; 217:307-11. [DOI: 10.1016/j.ijheh.2013.07.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
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Giuffrè M, Bonura C, Cipolla D, Mammina C. MRSA infection in the neonatal intensive care unit. Expert Rev Anti Infect Ther 2014; 11:499-509. [DOI: 10.1586/eri.13.28] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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24
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Tsiodras S, Daikos GL, Lee A, Plachouras D, Antoniadou A, Ploiarchopoulou F, Psichogiou M, Petrikkos G, Harbarth S. Risk factors for community-associated methicillin-resistant Staphylococcus aureus colonisation in a large metropolitan area in Greece: An epidemiological study using two case definitions. J Glob Antimicrob Resist 2013; 2:27-33. [PMID: 27873634 DOI: 10.1016/j.jgar.2013.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Revised: 08/28/2013] [Accepted: 10/01/2013] [Indexed: 01/09/2023] Open
Abstract
The aim of this study was to evaluate the epidemiology and characteristics and to identify modifiable risk factors for community-associated (CA) MRSA colonisation in a region with high prevalence. A large patient population (n=2280) from two tertiary care centres in Athens (Greece) was evaluated. Demographics and potential risk factors for CA-MRSA colonisation were recorded prospectively. Presence of the Panton-Valentine Leukocidin (PVL) toxin and mecA gene was determined in all MRSA isolates. Two definitions for CA-MRSA were applied. Univariate and multivariate analyses to identify predictors of previously unknown CA-MRSA colonisation were performed. In total, 120 (5.3%) MRSA carriers were identified; in 67 the isolates were classified as CA-MRSA using criteria based on the CDC definition, compared with 35 based on a definition including PVL toxin positivity. Factors significantly associated with previously unknown CA-MRSA carriage (CDC definition) included being a child or adolescent (OR=3.6, 95% CI 1.5-8.6), belonging to the family of an index case (OR=2.4, 95% CI 1.2-4.8), and presence of any co-morbidity (OR=1.7, 95% CI 1.04-2.8) or chronic skin disease (OR=3.6, 95% CI=2.2-6.1). In multivariate analysis, presence of any co-morbidity was the only significant predictor (OR=4.9, 95% CI 1.07-22.5; P=0.04). No easily modifiable risk factor for previously unknown CA-MRSA colonisation was identified. The CDC-based epidemiological definition for CA-MRSA appears to be more sensitive in detection of CA-MRSA colonisation than a purely molecular definition based on presence of the PVL gene.
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Affiliation(s)
- Sotirios Tsiodras
- Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece
| | - George L Daikos
- First Department of Propaedeutic Medicine, Laikon General Hospital, Athens University Medical School, Athens, Greece
| | - Andie Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia; Infection Control Program, University of Geneva Hospitals and Medical Faculty, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
| | - Diamantis Plachouras
- Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece
| | - Anastasia Antoniadou
- Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece
| | - Fani Ploiarchopoulou
- Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece
| | - Mina Psichogiou
- First Department of Propaedeutic Medicine, Laikon General Hospital, Athens University Medical School, Athens, Greece
| | - George Petrikkos
- Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece
| | - Stephan Harbarth
- Infection Control Program, University of Geneva Hospitals and Medical Faculty, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
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Methicillin-resistant Staphylococcus aureus nasal carriage in neonates and children attending a pediatric outpatient clinics in Brazil. Braz J Infect Dis 2013; 18:42-7. [PMID: 24076111 PMCID: PMC9425255 DOI: 10.1016/j.bjid.2013.04.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Accepted: 04/25/2013] [Indexed: 12/02/2022] Open
Abstract
Background In Latin America, few studies have been carried out on methicillin-resistant Staphylococcus aureus carriage in the pediatric population. We conducted a survey of nasal S. aureus carriage in neonates and in children attending the pediatric outpatient clinics in a large Brazilian city with high antimicrobial consumption. Methods Pernasal swabs of neonates were collected upon admission and at discharge in four neonatal intensive care units and of children less than five years of age during outpatient visits. Methicillin-resistant S. aureus isolates were characterized for antibiotic susceptibility, mec gene presence, pulsed-field gel electrophoresis, spa type, SCCmec-type, multilocus sequence type, and presence of Panton-Valentine leukocidin genes. Results S. aureus was carried by 9.1% and 20.1% of the 701 neonates and of 2034 children attending the outpatient clinics, respectively; methicillin-resistant S. aureus carriage was detected in 0.6% and 0.2%, of the these populations, respectively. Healthcare-associated methicillin-resistant S. aureus strains found in neonates from neonatal intensive care units and outpatients were genetically related to the Brazilian (SCCmec-III, ST239) and to the Pediatric (SCCmec-IV, ST5) clones. Community-associated methicillin-resistant S. aureus was only detected in outpatients. None of the methicillin-resistant S. aureus strains contained the Panton-Valentine leukocidin gene. Methicillin-resistant S. aureus strains related to the Brazilian clone showed multidrug resistance pattern. Conclusions Despite the high antibiotic pressure in our area, and the cross transmission of the healthcare-associated methicillin-resistant S. aureus clones between neonatal intensive care units and outpatients, the prevalence of methicillin-resistant S. aureus carriage is still low in our setting.
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Ramsing BGU, Arpi M, Andersen EA, Knabe N, Mogensen D, Buhl D, Westh H, Ostergaard C. First outbreak with MRSA in a Danish neonatal intensive care unit: risk factors and control procedures. PLoS One 2013; 8:e66904. [PMID: 23825581 PMCID: PMC3692537 DOI: 10.1371/journal.pone.0066904] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Accepted: 05/10/2013] [Indexed: 11/19/2022] Open
Abstract
Introduction The purpose of the study was to describe demographic and clinical characteristics and outbreak handling of a large methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a neonatal intensive care unit (NICU) in Denmark June 25th–August 8th 2008, and to identify risk factors for MRSA transmission. Methods Data were collected retrospectively from medical records and the Danish Neobase database. All MRSA isolates obtained from neonates, relatives and NICU health care workers (HCW) as well as environmental cultures were typed. Results During the 46 day outbreak period, 102 neonates were admitted to the two neonatal wards. Ninety-nine neonates were subsequently sampled, and 32 neonates (32%) from 25 families were colonized with MRSA (spa-type t127, SCCmec V, PVL negative). Thirteen family members from 11 of those families (44%) and two of 161 HCWs (1%) were colonized with the same MRSA. No one was infected. Five environmental cultures were MRSA positive. In a multiple logistic regression analysis, nasal Continuous Positive Airway Pressure (nCPAP) treatment (p = 0.006) and Caesarean section (p = 0.016) were independent risk factors for MRSA acquisition, whereas days of exposure to MRSA was a risk factors in the unadjusted analysis (p = 0.04). Conclusions MRSA transmission occurs with high frequency in the NICU during hospitalization with unidentified MRSA neonates. Caesarean section and nCPAP treatment were identified as risk factors for MRSA colonization. The MRSA outbreak was controlled through infection control procedures.
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YU FENGLING, LIU TINGTING, ZHU XIANG, YANG WENGXUAN, ZHANG TAO, LIN NA, LIU YONG, LIU CONGSEN, JIANG JIU, GUAN JUNCHANG. Staphylococcal enterotoxin B and α-toxin induce the apoptosis of ECV304 cells via similar mechanisms. Mol Med Rep 2013; 8:591-6. [DOI: 10.3892/mmr.2013.1550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Accepted: 06/13/2013] [Indexed: 11/06/2022] Open
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Comprehensive strategy including prophylactic mupirocin to reduce Staphylococcus aureus colonization and infection in high-risk neonates. J Perinatol 2013; 33:313-8. [PMID: 22918547 DOI: 10.1038/jp.2012.102] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To examine the use of long-term prophylactic mupirocin as part of a comprehensive strategy in reducing Staphylococcus aureus colonization and infection in a neonatal intensive care unit (NICU). STUDY DESIGN Twice daily mupirocin was applied to all infants admitted to the NICU throughout hospitalization starting in 2004. S. aureus surveillance was implemented in 2008. The efficacy of these practices was evaluated with a retrospective review of infants admitted from 2004 to 2010 found to be colonized or infected with S. aureus. RESULT During the study period, 66 of 6283 NICU infants had a S. aureus infection with 67% methicillin resistance. There were three distinctive S. aureus outbreaks, the first being a methicillin-resistant strain July 2004. After implementation of daily mupirocin, the outbreak was eradicated and the rate of S. aureus infection significantly decreased (1.82 to 0.40/1000 patient-days-at-risk, P=0.0049). Mupirocin was discontinued March 2005 followed by a methicillin-sensitive S. aureus outbreak November 2005. In December 2005, mupirocin was reinstituted and has continued to present day, again significantly reducing S. aureus infections (1.42 to 0.33/1000 patient-days-at-risk, P<0.0001) with zero isolates resistant to mupirocin. In the pre-mupirocin period, S. aureus colonization was upwards of 60% now with rates typically <5%. S. aureus colonization strongly predicted later invasive infection (P<0.0001). CONCLUSION Although controversial, prophylactic mupirocin in all NICU infants has acted as a barrier to colonization and markedly decreased S. aureus infection rates over a 5-year period.
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Pérez A, Orta L, Padilla E, Mesquida X. CA-MRSA puerperal mastitis and breast abscess: a potential problem emerging in Europe with many unanswered questions. J Matern Fetal Neonatal Med 2013; 26:949-51. [DOI: 10.3109/14767058.2013.766700] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent source of infections affecting premature and critically ill infants in neonatal intensive care units (NICUs). Neonates are particularly vulnerable to colonization and infection with MRSA, and many studies have attempted to identify risk factors that predispose certain infants to its acquisition to discover potential areas for clinical intervention. In addition, epidemiologic assessment of transmission patterns and molecular analysis of changes in the characteristics of MRSA strains over time have helped clarify additional factors affecting MRSA infections in the NICU. Numerous strategies for prevention and eradication have been used with variable rates of success. Despite these interventions, MRSA remains a significant source of morbidity in the NICU population.
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Affiliation(s)
- Melissa U Nelson
- Division of Perinatal Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, CT 06520-8064, USA
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Alsubaie S, Bahkali K, Somily AM, Alzamil F, Alrabiaah A, Alaska A, Alkhattaf F, Kambal A, Al-Qahtani AA, Al-Ahdal MN. Nosocomial transmission of community-acquired methicillin-resistant Staphylococcus aureus in a well-infant nursery of a teaching hospital. Pediatr Int 2012; 54:786-92. [PMID: 22640461 DOI: 10.1111/j.1442-200x.2012.03673.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection due to community-acquired strains of methicillin-resistant Staphylococcus aureus (CA-MRSA) has been reported with increasing frequency. Herein is described the nosocomial transmission of CA-MRSA involving 13 neonates and two mothers in a well-infant nursery in a teaching hospital in Saudi Arabia. METHODS From October to November 2009, temporally related cases of CA-MRSA skin and soft-tissue infection occurred in newborns shortly after discharge from a well-infant nursery. An outbreak investigation including case identification, review of medical records, staff screening, environmental cultures, pulsed-field gel electrophoresis, and a case-control study were conducted. Controls were selected from among asymptomatic neonates admitted to the same nursery and matched for the day of admission. RESULTS Fifteen subjects were found to be CA-MRSA positive: 13 neonates and two mothers. The crude attack rate among neonates was 5.5% during the outbreak period. All 13 neonates presented with skin and soft-tissue infection; one of the mothers had mastitis and a breast abscess. The source of the outbreak was not evident. Pulsed-field gel electrophoresis showed that all of the tested isolates from one strain except one, all contained the staphylococcal cassette chromosome mec (SCCmec) type IV. CONCLUSION MRSA strains that initially emerged in the community are now causing disease in health-care settings. Adherence to standard infection control practices, including consistent hand hygiene, in newborn nurseries is important to prevent transmission in such settings.
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Affiliation(s)
- Sarah Alsubaie
- Departments of Pediatrics, College of Medicine, King Saud University and King Khalid University Hospital, Riyadh, Saudi Arabia.
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Outbreak of skin and soft tissue infections in a hospital newborn nursery in Italy due to community-acquired meticillin-resistant Staphylococcus aureus USA300 clone. J Hosp Infect 2012; 83:36-40. [PMID: 23158684 DOI: 10.1016/j.jhin.2012.09.017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 09/28/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) is responsible for severe infections in previously healthy people acquired in the community in different areas of the world. AIM To report an outbreak of CA-MRSA in a hospital newborn nursery in northern Italy in September-October 2010, its investigation and control measures. METHODS The epidemiology of the outbreak is reported. The investigation included screening neonates, parents and staff for MRSA carriage. Molecular strain typing was performed on MRSA isolates. FINDINGS The outbreak affected nine neonates with three severe infections. In addition, four mothers had postpartum mastitis, and three mothers and one father had skin infection. The outbreak strain belonged to the USA300 CA-MRSA clone. Asymptomatic carriage of the outbreak strain was found among neonates, parents and hospital staff. The implementation of appropriate infection control measures in the hospital terminated the outbreak. CONCLUSIONS To our knowledge, this is the first report of a hospital outbreak caused by the USA300 CA-MRSA clone in Europe. It is important to reinforce infection control measures, particularly in high-risk groups, such as neonates, to prevent USA300 from becoming endemic in European hospitals.
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Ali H, Nash J, Kearns A, Pichon B, Vasu V, Nixon Z, Burgess A, Weston D, Sedgwick J, Ashford G, Mühlschlegel F. Outbreak of a South West Pacific clone Panton–Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus infection in a UK neonatal intensive care unit. J Hosp Infect 2012; 80:293-8. [DOI: 10.1016/j.jhin.2011.12.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 12/07/2011] [Indexed: 11/30/2022]
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Conceição T, Aires de Sousa M, Miragaia M, Paulino E, Barroso R, Brito MJ, Sardinha T, Sancho L, Carreiro H, de Sousa G, Machado MDC, de Lencastre H. Staphylococcus aureusReservoirs and Transmission Routes in a Portuguese Neonatal Intensive Care Unit: A 30-Month Surveillance Study. Microb Drug Resist 2012; 18:116-24. [DOI: 10.1089/mdr.2011.0182] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Teresa Conceição
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
| | | | - Maria Miragaia
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
| | | | | | | | | | | | | | | | | | - Hermínia de Lencastre
- Laboratory of Molecular Genetics, Instituto de Tecnologia Química e Biológica, Oeiras, Portugal
- Laboratory of Microbiology, The Rockefeller University, New York, New York
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How can the microbiologist help in diagnosing neonatal sepsis? Int J Pediatr 2012; 2012:120139. [PMID: 22319539 PMCID: PMC3272815 DOI: 10.1155/2012/120139] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 09/15/2011] [Accepted: 11/29/2011] [Indexed: 01/23/2023] Open
Abstract
Neonatal sepsis can be classified into two subtypes depending upon whether the onset of symptoms is before 72 hours of life (early-onset neonatal sepsis—EONS) or later (late-onset neonatal sepsis—LONS). These definitions have contributed greatly to diagnosis and treatment by identifying which microorganisms are likely to be responsible for sepsis during these periods and the expected outcomes of infection. This paper focuses on the tools that microbiologist can offer to diagnose and eventually prevent neonatal sepsis. Here, we discuss the advantages and limitation of the blood culture, the actual gold standard for sepsis diagnosis. In addition, we examine the utility of molecular techniques in the diagnosis and management of neonatal sepsis.
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Geva A, Wright SB, Baldini LM, Smallcomb JA, Safran C, Gray JE. Spread of methicillin-resistant Staphylococcus aureus in a large tertiary NICU: network analysis. Pediatrics 2011; 128:e1173-80. [PMID: 22007011 PMCID: PMC3208963 DOI: 10.1542/peds.2010-2562] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) colonization in NICUs increases the risk of nosocomial infection. Network analysis provides tools to examine the interactions among patients and staff members that put patients at risk of colonization. METHODS Data from MRSA surveillance cultures were combined with patient room locations, nursing assignments, and sibship information to create patient- and unit-based networks. Multivariate models were constructed to quantify the risk of incident MRSA colonization as a function of exposure to MRSA-colonized infants in these networks. RESULTS A MRSA-negative infant in the NICU simultaneously with a MRSA-positive infant had higher odds of becoming colonized when the colonized infant was a sibling, compared with an unrelated patient (odds ratio: 8.8 [95% confidence interval [CI]: 5.3-14.8]). Although knowing that a patient was MRSA-positive and was placed on contact precautions reduced the overall odds of another patient becoming colonized by 35% (95% CI: 20%-47%), having a nurse in common with that patient still increased the odds of colonization by 43% (95% CI: 14%-80%). Normalized group degree centrality, a unitwide network measure of connectedness between colonized and uncolonized patients, was a significant predictor of incident MRSA cases (odds ratio: 18.1 [95% CI: 3.6-90.0]). CONCLUSIONS Despite current infection-control strategies, patients remain at significant risk of MRSA colonization from MRSA-positive siblings and from other patients with whom they share nursing care. Strategies that minimize the frequency of staff members caring for both colonized and uncolonized infants may be beneficial in reducing the spread of MRSA colonization.
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Affiliation(s)
- Alon Geva
- Departments of Neonatology, ,Department of Medicine, Children's Hospital Boston, Boston, Massachusetts; and ,Departments of Pediatrics and
| | - Sharon B. Wright
- Health Care Quality, and ,Medicine and ,Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | - Jane A. Smallcomb
- Neonatal Intensive Care Unit, Beth Israel-Deaconess Medical Center, Boston, Massachusetts
| | - Charles Safran
- Medicine and ,Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
| | - James E. Gray
- Departments of Neonatology, ,Medicine and ,Departments of Pediatrics and ,Medicine, Harvard Medical School, Harvard University, Boston, Massachusetts
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Otter JA, French GL. Community-associated meticillin-resistant Staphylococcus aureus strains as a cause of healthcare-associated infection. J Hosp Infect 2011; 79:189-93. [PMID: 21741111 DOI: 10.1016/j.jhin.2011.04.028] [Citation(s) in RCA: 117] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2011] [Accepted: 04/26/2011] [Indexed: 11/28/2022]
Abstract
Community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) was first noticed as a cause of infection in community-based individuals without healthcare contact. As the global epidemic of CA-MRSA has continued, CA-MRSA strain types have begun to emerge as a cause of healthcare-associated infections (HAIs) and hospital outbreaks have occurred worldwide. In areas where CA-MRSA clones have become established with high prevalence, for example USA300 (ST8-IV) in the USA, CA-MRSA are beginning to supplant or overtake traditional healthcare-associated MRSA strains as causes of HAI. The emergence of CA-MRSA as a cause of HAI puts a wider group of hospitalised patients, healthcare workers and their community contacts potentially at risk of MRSA infection. It also exposes CA-MRSA strains to the selective pressure of antibiotic use in hospitals, potentially resulting in increased antibiotic resistance, challenges traditional definitions of CA-MRSA and hampers control efforts due to the constant re-introduction of MRSA from an emerging community reservoir. There is thus an urgent need to clarify the definitions, prevalence and epidemiology of CA-MRSA and to develop systems for the identification and control of these organisms in the community, in hospitals and other healthcare facilities, and at the community-hospital interface.
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Affiliation(s)
- J A Otter
- Directorate of Infection, King's College London and Guy's and St Thomas' NHS Foundation Trust, London, UK.
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Lazarevic V, Beaume M, Corvaglia A, Hernandez D, Schrenzel J, François P. Epidemiology and virulence insights from MRSA and MSSA genome analysis. Future Microbiol 2011; 6:513-32. [DOI: 10.2217/fmb.11.38] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Staphylococcus aureus is a major human pathogen responsible for a wide diversity of infections ranging from localized to life threatening diseases. From 1961 and the emergence of methicillin-resistant S. aureus (MRSA), this bacterium has shown a particular capacity to survive and adapt to drastic environmental changes and since the beginning of the 1990s it has spread worldwide. Until recently, S. aureus was considered as the prototype of a nosocomial pathogen but it has now been recognized as an agent responsible for outbreaks in the community. Several recent reports suggest that the epidemiology of MRSA is changing. Understanding of pathogenicity, virulence and emergence of epidemic clones within MRSA populations is not clearly defined, despite several attempts to identify common molecular features between strains that share similar epidemiological and/or virulence behavior. These studies included: pattern profiling of bacterial adhesins, analysis of clonal complex groups, molecular genotyping and enterotoxin content analysis. To date, all approaches failed to find a correlation between molecular determinants and clinical outcomes. We hypothesize that the capacity of the bacterium to become more invasive or virulent is determined by genetics. The utilization of massively parallel methods of analysis is therefore ideal to study the contribution of genetics. Therefore, this article focuses on the entire genome including coding sequences as well as noncoding sequences. This high resolution approach allows the monitoring micro- and macroevolution of MRSA and identification of specific genomic markers of evolution of invasive or highly virulent phenotypes.
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Affiliation(s)
- Vladimir Lazarevic
- Genomic Research Laboratory, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
| | - Marie Beaume
- Genomic Research Laboratory, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
| | - Anna Corvaglia
- Department of Microbiology & Molecular Medicine, University Medical Centre, University of Geneva, 1211 Geneva 4, Switzerland
| | - David Hernandez
- Genomic Research Laboratory, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
| | - Jacques Schrenzel
- Genomic Research Laboratory, Geneva University Hospitals, CH-1211 Geneva 14, Switzerland
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Otto M. Basis of Virulence in Community-Associated Methicillin-ResistantStaphylococcus aureus. Annu Rev Microbiol 2010; 64:143-62. [DOI: 10.1146/annurev.micro.112408.134309] [Citation(s) in RCA: 350] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Michael Otto
- Laboratory of Human Bacterial Pathogenesis, National Institute of Allergy and Infectious Diseases, The National Institutes of Health, Bethesda, Maryland 20892;
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David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616-87. [PMID: 20610826 PMCID: PMC2901661 DOI: 10.1128/cmr.00081-09] [Citation(s) in RCA: 1357] [Impact Index Per Article: 96.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus is an important cause of skin and soft-tissue infections (SSTIs), endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, foreign-body infections, and sepsis. Methicillin-resistant S. aureus (MRSA) isolates were once confined largely to hospitals, other health care environments, and patients frequenting these facilities. Since the mid-1990s, however, there has been an explosion in the number of MRSA infections reported in populations lacking risk factors for exposure to the health care system. This increase in the incidence of MRSA infection has been associated with the recognition of new MRSA clones known as community-associated MRSA (CA-MRSA). CA-MRSA strains differ from the older, health care-associated MRSA strains; they infect a different group of patients, they cause different clinical syndromes, they differ in antimicrobial susceptibility patterns, they spread rapidly among healthy people in the community, and they frequently cause infections in health care environments as well. This review details what is known about the epidemiology of CA-MRSA strains and the clinical spectrum of infectious syndromes associated with them that ranges from a commensal state to severe, overwhelming infection. It also addresses the therapy of these infections and strategies for their prevention.
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Affiliation(s)
- Michael Z David
- Department of Pediatrics and Department of Medicine, the University of Chicago, 5841 S. Maryland Ave., Chicago, IL 60637, USA.
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First outbreak of PVL-positive nonmultiresistant MRSA in a neonatal ICU in Australia: comparison of MALDI-TOF and SNP-plus-binary gene typing. Eur J Clin Microbiol Infect Dis 2010; 29:1311-4. [PMID: 20549528 DOI: 10.1007/s10096-010-0995-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2010] [Accepted: 05/29/2010] [Indexed: 10/19/2022]
Abstract
The purpose of this brief report is to describe the first outbreak of a community-associated nonmultiresistant and PVL-positive MRSA strain (CC30) in a neonatal intensive care unit in Australia. The utility of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF-MS) for microbial typing is compared with single nucleotide polymorphism (SNP) plus binary gene analysis. The composite correlation index analysis of the MALDI-TOF-MS data demonstrated the similar inter-strain relatedness found with the SNP-plus-binary gene typing used to confirm the outbreak. The evolving spread of MRSA emphasizes the importance of surveillance, infection control vigilance and the ongoing investigation of rapid typing methods for MRSA.
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Otter JA, French GL. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Europe. THE LANCET. INFECTIOUS DISEASES 2010; 10:227-39. [DOI: 10.1016/s1473-3099(10)70053-0] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Risk factors for treatment failure in orthopedic device-related methicillin-resistant Staphylococcus aureus infection. Eur J Clin Microbiol Infect Dis 2009; 29:171-80. [DOI: 10.1007/s10096-009-0837-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Accepted: 11/01/2009] [Indexed: 10/20/2022]
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Abstract
This report describes the unusual occurrence of mastitis and breast abscess in both mother and infant, both caused by methicillin-resistant Staphylococcus aureus (MRSA). Mother and child were both immunocompetent, and their only risk factor was routine confinement. The case highlights the importance of considering MRSA as a cause for mastitis in mothers and infants. MRSA is increasingly common, and failure to consider it as a cause for mastitis will lead to delays in treatment (as it did in this case). The case also demonstrates the role of Hospital in the Home in the treatment of postnatal infections, where hospitalization can be extremely disruptive.
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Andrews JI, Fleener DK, Messer SA, Kroeger JS, Diekema DJ. Screening for Staphylococcus aureus carriage in pregnancy: usefulness of novel sampling and culture strategies. Am J Obstet Gynecol 2009; 201:396.e1-5. [PMID: 19716114 DOI: 10.1016/j.ajog.2009.06.062] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2009] [Revised: 05/14/2009] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the most sensitive strategy for the detection of Staphylococcus aureus among pregnant women and newborn infants. STUDY DESIGN We obtained cultures for S aureus from 5 body sites of women at 35-37 weeks' gestation. We obtained cultures from their newborn infants before hospital discharge. RESULTS Of 209 women who were screened, 29% of the women had at least 1 culture that was positive for S aureus; 5% of infants were S aureus carriers. The sensitivities of each site for S aureus detection were 52% nares, 50% throat, 13% rectum, 8% vagina, and 10% skin. The most sensitive combination of 2 sites was nares and throat (88%). Perinatal transmission of S aureus occurred in 4 women. Maternal methicillin-resistant S aureus carriage rate was 1%. Two infants carried the USA300 methicillin-resistant S aureus. CONCLUSION Screening single body sites is insensitive for the detection of S aureus carriage in pregnancy. Sampling nares and throat is essential to the identification of S aureus carriers.
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Trends in incidence of late-onset methicillin-resistant Staphylococcus aureus infection in neonatal intensive care units: data from the National Nosocomial Infections Surveillance System, 1995-2004. Pediatr Infect Dis J 2009; 28:577-81. [PMID: 19478687 DOI: 10.1097/inf.0b013e31819988bf] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is increasingly being reported to cause outbreaks in neonatal intensive care units (NICUs). We assessed the scope and magnitude of MRSA infections with disease onset after 3 days of age (late-onset MRSA infections) in NICUs. METHODS We analyzed data reported by NICUs participating in the National Nosocomial Infections Surveillance system from 1995 through 2004. For each surveillance month, all healthcare-associated infections as defined by National Nosocomial Infections Surveillance criteria were reported, along with antimicrobial susceptibility patterns of the isolates. We pooled the data from all NICUs by birth weight category and calendar year. Poisson regression was used to assess changes in incidence of late-onset MRSA infections per 10,000 patient-days. RESULTS Overall, 149 NICUs reported 4831 S. aureus infections and 5,878,139 patient-days. Methicillin testing data were available for 4302 S. aureus isolates, of which 975 (23%) were MRSA. Incidence of late-onset MRSA infection per 10,000 patient-days, combining all birthweight categories, increased 308% from 0.7 in 1995 to 3.1 in 2004 (P < 0.001). A significant increase in incidence of MRSA infections was observed among all 4 birthweight categories analyzed separately (<or=1000 g, 1001-1500 g, 1501-2500 g, and >2500 g). The distribution of MRSA infection by type of infection did not vary during the study period; 299 (31%) of MRSA infections were bloodstream infections, 174 (18%) were pneumonia, and 161 (17%) were conjunctivitis. CONCLUSION The incidence of late-onset MRSA infections increased substantially between 1995 and 2004, indicating a need to reinforce infection control recommendations and to explore potential sources and routes of transmission.
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Tinelli M, Monaco M, Vimercati M, Ceraminiello A, Pantosti A. Methicillin-susceptible Staphylococcus aureus in skin and soft tissue infections, Northern Italy. Emerg Infect Dis 2009; 15:250-7. [PMID: 19193269 PMCID: PMC2657610 DOI: 10.3201/eid1502.080010] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Summary statement: A community outbreak with intrafamilial skin infections was associated with an MSSA clone. During February 2004–September 2006, familial clusters and sporadic cases of Staphylococcus aureus skin and soft tissue infections were observed in a suburban area near Milan in northern Italy. Molecular typing of the isolates showed an epidemic methicillin-susceptible S. aureus (MSSA) strain, spa type 005 and sequence type 22 that harbored Panton-Valentine leukocidin (PVL) genes. The first case-patients were neonates or mothers who had recently delivered in the local hospital. Examination of the medical records showed a cluster of postpartum mastitis and neonatal skin infections antedating the emergence of infections in the community. Nasal swabs of neonates, mothers, and hospital staff were positive for the epidemic MSSA. Hospital circulation of the strain was interrupted by implementation of infection control measures, although infections continued to occur in the community. The PVL-positive MSSA strain resembles typical community-acquired methicillin-resistant S. aureus in its ability to cause prolonged community and hospital outbreaks of skin infections.
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Schultz ED, Tanaka DT, Goldberg RN, Benjamin DK, Smith PB. Effect of methicillin-resistant Staphylococcus aureus colonization in the neonatal intensive care unit on total hospital cost. Infect Control Hosp Epidemiol 2009; 30:383-5. [PMID: 19222371 DOI: 10.1086/596610] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The rate of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing in neonatal intensive care units. We determined the economic impact of isolating and cohorting MRSA-colonized neonates on total hospital cost at a 49-bed, level III-IV neonatal intensive care unit.
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Affiliation(s)
- Eric D Schultz
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
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Gregory ML, Eichenwald EC, Puopolo KM. Seven-year experience with a surveillance program to reduce methicillin-resistant Staphylococcus aureus colonization in a neonatal intensive care unit. Pediatrics 2009; 123:e790-6. [PMID: 19403471 DOI: 10.1542/peds.2008-1526] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The objectives of this study were to determine the incidence rates of neonatal methicillin-resistant Staphylococcus aureus colonization and infection after the implementation of a NICU methicillin-resistant S aureus surveillance and isolation program and to describe the characteristics of infants with methicillin-resistant S aureus colonization and invasive disease. METHODS From August 2000 through August 2007, all infants admitted to the study NICU were screened for methicillin-resistant S aureus colonization with weekly nasal/rectal swabs; colonized or infected infants were isolated and cared for as a cohort. The annual incidence rates of methicillin-resistant S aureus colonization and infection were monitored, and characteristics of methicillin-resistant S aureus-colonized and -infected infants were compared. Data were collected from infant, maternal, and hospital laboratory records. RESULTS During the study period, 7997 infants were admitted to the NICU and 102 methicillin-resistant S aureus-colonized or -infected infants (1.3%) were identified. The incidence of methicillin-resistant S aureus decreased progressively from 1.79 cases per 1000 patient-days in 2000 to 0.15 cases per 1000 patient-days in 2005, but the incidence then increased to 1.26 cases per 1000 patient-days in 2007. Fifteen of the 102 case infants (14.7%) had invasive infections; no significant differences between infected and colonized infants were identified. Methicillin-resistant S aureus isolates with 14 different antibiograms were found during the study period. There was a shift from isolates predominantly likely to be hospital-associated in 2000-2004 to those likely to be community-associated in 2006-2007. CONCLUSIONS A continuous program of weekly methicillin-resistant S aureus surveillance cultures and isolation of affected infants was associated with a variable incidence of methicillin-resistant S aureus colonization over a 7-year study period. Methicillin-resistant S aureus was not eradicated from this tertiary-care NICU, and our data suggest that infants were colonized by multiple different methicillin-resistant S aureus strains during the study period.
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Affiliation(s)
- Mary Lucia Gregory
- Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Rose Building, Room 318, Boston, MA 02215, USA.
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