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Pinheiro MVDB, Cavalcante FS, Ferreira DDC, Guimarães ACF, Ferreira ALP, da Costa CR, dos Santos KRN, Nouér SA. Can habits and behaviors predict colonization by community-associated MRSA in patients admitted to a Brazilian hospital? Rev Inst Med Trop Sao Paulo 2024; 66:e31. [PMID: 38747852 PMCID: PMC11095244 DOI: 10.1590/s1678-9946202466031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Accepted: 03/25/2024] [Indexed: 05/19/2024] Open
Abstract
This study aimed to identify factors associated with colonization by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in adult patients admitted to a Brazilian hospital. This is a cross-sectional study, in which patients underwent a nasal swab and were asked about hygiene behavior, habits, and clinical history. Among the 702 patients, 180 (25.6%) had S. aureus and 21 (2.9%) MRSA. The factors associated with MRSA colonization were attending a gym (OR 4.71; 95% CI; 1.42 - 15.06), smoking habit in the last year (OR 2.37; 95% CI; 0.88 - 6.38), previous hospitalization (OR 2.18; CI 95%; 0.89 - 5.25), and shared personal hygiene items (OR 1.99; 95% CI; 0.71 - 5.55). At the time of admission, colonization by CA-MRSA isolates was higher than that found in the general population. This can be an important public health problem, already endemic in hospitals, whose factors such as those associated with habits (smoking cigarettes) and behaviors (team sports practice and activities in gyms) have been strongly highlighted. These findings may help developing infection control policies, allowing targeting patients on higher-risk populations for MRSA colonization.
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Affiliation(s)
- Marcos Vinicius de Barros Pinheiro
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Fernanda Sampaio Cavalcante
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro, Instituto de Ciências Médicas, Departamento de Clínica Médica, Macaé, Rio de Janeiro, Brazil
| | | | - Ana Carolina Fonseca Guimarães
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Adriana Lúcia Pires Ferreira
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Claudia Regina da Costa
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Comissão de Controle de Infecção Hospitalar, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Kátia Regina Netto dos Santos
- Universidade Federal do Rio de Janeiro, Instituto de Microbiologia Paulo de Góes, Departamento de Microbiologia Médica, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Simone Aranha Nouér
- Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Programa de Pós-Graduação em Doenças Infecciosas e Parasitárias, Rio de Janeiro, Rio de Janeiro, Brazil
- Universidade Federal do Rio de Janeiro, Hospital Universitário Clementino Fraga Filho, Comissão de Controle de Infecção Hospitalar, Rio de Janeiro, Rio de Janeiro, Brazil
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Lin R, Akgun E, Erenay FS, Alev SA, Ciccotelli WA. Effectiveness of methicillin-resistant Staphylococcus aureus surveillance among exposed roommates in community hospitals: Conventional culture versus direct PCR. Am J Infect Control 2023; 51:1242-1249. [PMID: 37059122 DOI: 10.1016/j.ajic.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Roommates of unrecognized nosocomial methicillin-resistant Staphylococcus aureus (MRSA) cases are at a higher acquisition risk; however, optimal surveillance strategies are unknown. METHODS Using simulation, we analyzed surveillance testing and isolation strategies for MRSA among exposed hospital roommates. We compared isolating exposed roommates until conventional culture testing on day 6 and a nasal polymerase chain reaction test on day 3 (PCR3) with/without day 0 culture testing (Cult0). The model represents MRSA transmission in medium-sized hospitals using data and recommends best practices from the literature and Ontario community hospitals. RESULTS Cult0 + PCR3 incurred a slightly lower number of MRSA colonizations and 38.9% lower annual cost in the base case compared to Cult0 + culture testing on day 6 because the reduced isolation cost compensated for the increased testing cost. The reduction in MRSA colonizations was due to a 54.5% drop in MRSA transmissions during isolation as PCR3 reduced the exposure of MRSA-free roommates to new MRSA carriers. Removing the day 0 culture test from Cult0 + PCR3 increased total cost, the number of MRSA colonization, and missed cases by $1,631, 4.3%, and 50.9%, respectively. Improvements were higher under aggressive MRSA transmission scenarios. DISCUSSION AND CONCLUSIONS Adopting direct nasal polymerase chain reaction testing for determining post-exposure MRSA status reduces transmission risk and costs. Day 0 culture would still be beneficial.
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Affiliation(s)
- Ru Lin
- Department of Management Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Esma Akgun
- Department of Management Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - Fatih Safa Erenay
- Department of Management Sciences, University of Waterloo, Waterloo, Ontario, Canada.
| | - Sibel Alumur Alev
- Department of Management Sciences, University of Waterloo, Waterloo, Ontario, Canada
| | - William A Ciccotelli
- Department of Pathology & Molecular Medicine, McMaster University, Hamilton, Ontario, Canada; Grand River Hospital, Kitchener, Ontario, Canada.
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3
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Locey KJ, Webb TA, Weinstein RA, Hota B, Stein BD. Random variation drives a critical bias in the comparison of healthcare-associated infections. Infect Control Hosp Epidemiol 2023; 44:1396-1402. [PMID: 36896667 DOI: 10.1017/ice.2022.288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
OBJECTIVE To evaluate random effects of volume (patient days or device days) on healthcare-associated infections (HAIs) and the standardized infection ratio (SIR) used to compare hospitals. DESIGN A longitudinal comparison between publicly reported quarterly data (2014-2020) and volume-based random sampling using 4 HAI types: central-line-associated bloodstream infections, catheter-associated urinary tract infections, Clostridioides difficile infections, methicillin-resistant Staphylococcus aureus infections. METHODS Using 4,268 hospitals with reported SIRs, we examined relationships of SIRs to volume and compared distributions of SIRs and numbers of reported HAIs to the outcomes of simulated random sampling. We included random expectations into SIR calculations to produce a standardized infection score (SIS). RESULTS Among hospitals with volumes less than the median, 20%-33% had SIRs of 0, compared to 0.3%-5% for hospitals with volumes higher than the median. Distributions of SIRs were 86%-92% similar to those based on random sampling. Random expectations explained 54%-84% of variation in numbers of HAIs. The use of SIRs led hundreds of hospitals with more infections than either expected at random or predicted by risk-adjusted models to rank better than other hospitals. The SIS mitigated this effect and allowed hospitals of disparate volumes to achieve better scores while decreasing the number of hospitals tied for the best score. CONCLUSIONS SIRs and numbers of HAIs are strongly influenced by random effects of volume. Mitigating these effects drastically alters rankings for HAI types and may further alter penalty assignments in programs that aim to reduce HAIs and improve quality of care.
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Affiliation(s)
- Kenneth J Locey
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
| | - Thomas A Webb
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush Medical College, Chicago, Illinois
| | - Bala Hota
- Tendo Systems, Inc, Hinsdale, Illinois
| | - Brian D Stein
- Center for Quality, Safety and Value Analytics, Rush University Medical Center, Chicago, Illinois
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Coia JE, Wilson JA, Bak A, Marsden GL, Shimonovich M, Loveday HP, Humphreys H, Wigglesworth N, Demirjian A, Brooks J, Butcher L, Price JR, Ritchie L, Newsholme W, Enoch DA, Bostock J, Cann M, Wilson APR. Joint Healthcare Infection Society (HIS) and Infection Prevention Society (IPS) guidelines for the prevention and control of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2021; 118S:S1-S39. [PMID: 34757174 DOI: 10.1016/j.jhin.2021.09.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 12/28/2022]
Affiliation(s)
- J E Coia
- Department of Clinical Microbiology, Hospital South West Jutland, Esbjerg, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, Denmark; Healthcare Infection Society, London, UK
| | - J A Wilson
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - A Bak
- Healthcare Infection Society, London, UK.
| | | | - M Shimonovich
- Healthcare Infection Society, London, UK; MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - H P Loveday
- Richard Wells Research Centre, University of West London, London, UK; Infection Prevention Society, Seafield, UK
| | - H Humphreys
- Healthcare Infection Society, London, UK; Department of Clinical Microbiology, The Royal College of Surgeons, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
| | - N Wigglesworth
- Infection Prevention Society, Seafield, UK; East Kent Hospitals University, NHS Foundation Trust, Canterbury, UK
| | - A Demirjian
- Healthcare-associated Infection and Antimicrobial Resistance, Public Health England, London, UK; Paediatric Infectious Diseases and Immunology, Evelina London Children's Hospital, London, UK; Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - J Brooks
- Infection Prevention Society, Seafield, UK; University Hospital Southampton NHS Foundation Trust, UK
| | - L Butcher
- Infection Prevention Society, Seafield, UK; Oxford University Hospitals NHS Foundation Trust, UK
| | - J R Price
- Healthcare Infection Society, London, UK; Imperial College Healthcare NHS Trust, London, UK
| | - L Ritchie
- Healthcare Infection Society, London, UK; NHS England and NHS Improvement, London, UK
| | - W Newsholme
- Healthcare Infection Society, London, UK; Guy's and St Thomas' NHS Foundation Trust, UK
| | - D A Enoch
- Healthcare Infection Society, London, UK; Clinical Microbiology & Public Health Laboratory, Public Health England, Addenbrooke's Hospital, Cambridge, UK
| | | | - M Cann
- Lay Member, UK; MRSA Action UK, Preston, UK
| | - A P R Wilson
- Healthcare Infection Society, London, UK; University College London Hospitals NHS Foundation Trust, UK.
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5
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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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6
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Mitevska E, Wong B, Surewaard BGJ, Jenne CN. The Prevalence, Risk, and Management of Methicillin-Resistant Staphylococcus aureus Infection in Diverse Populations across Canada: A Systematic Review. Pathogens 2021; 10:pathogens10040393. [PMID: 33805913 PMCID: PMC8064373 DOI: 10.3390/pathogens10040393] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/21/2021] [Accepted: 03/22/2021] [Indexed: 12/04/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) first emerged after methicillin was introduced to combat penicillin resistance, and its prevalence in Canada has increased since the first MRSA outbreak in the early 1980s. We reviewed the existing literature on MRSA prevalence in Canada over time and in diverse populations across the country. MRSA prevalence increased steadily in the 1990s and 2000s and remains a public health concern in Canada, especially among vulnerable populations, such as rural, remote, and Indigenous communities. Antibiotic resistance patterns and risk factors for MRSA infection were also reported. All studies reported high susceptibility (>85%) to trimethoprim-sulfamethoxazole, with no significant resistance reported for vancomycin, linezolid, or rifampin. While MRSA continues to have susceptibility to several antibiotics, the high and sometimes variable resistance rates to other drugs underscores the importance of antimicrobial stewardship. Risk factors for high MRSA infection rates related to infection control measures, low socioeconomic status, and personal demographic characteristics were also reported. Additional surveillance, infection control measures, enhanced anti-microbial stewardship, and community education programs are necessary to decrease MRSA prevalence and minimize the public health risk posed by this pathogen.
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Affiliation(s)
- Elena Mitevska
- Immunology and Infectious Diseases, Department of Microbiology, University of Calgary, Calgary, AB T2N1N4, Canada; (E.M.); (B.W.)
| | - Britney Wong
- Immunology and Infectious Diseases, Department of Microbiology, University of Calgary, Calgary, AB T2N1N4, Canada; (E.M.); (B.W.)
| | - Bas G. J. Surewaard
- Snyder Institute for Chronic Diseases, Department of Physiology and Pharmacology, University of Calgary, Calgary, AB T2N1N4, Canada;
| | - Craig N. Jenne
- Immunology and Infectious Diseases, Department of Microbiology, University of Calgary, Calgary, AB T2N1N4, Canada; (E.M.); (B.W.)
- Correspondence: ; Tel.: +1-403-220-3471
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7
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Modelling pathogen spread in a healthcare network: Indirect patient movements. PLoS Comput Biol 2020; 16:e1008442. [PMID: 33253154 PMCID: PMC7728397 DOI: 10.1371/journal.pcbi.1008442] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 12/10/2020] [Accepted: 10/16/2020] [Indexed: 11/28/2022] Open
Abstract
Inter-hospital patient transfers (direct transfers) between healthcare facilities have been shown to contribute to the spread of pathogens in a healthcare network. However, the impact of indirect transfers (patients re-admitted from the community to the same or different hospital) is not well studied. This work aims to study the contribution of indirect transfers to the spread of pathogens in a healthcare network. To address this aim, a hybrid network–deterministic model to simulate the spread of multiresistant pathogens in a healthcare system was developed for the region of Lower Saxony (Germany). The model accounts for both, direct and indirect transfers of patients. Intra-hospital pathogen transmission is governed by a SIS model expressed by a system of ordinary differential equations. Our results show that the proposed model reproduces the basic properties of healthcare-associated pathogen spread. They also show the importance of indirect transfers: restricting the pathogen spread to direct transfers only leads to 4.2% system wide prevalence. However, adding indirect transfers leads to an increase in the overall prevalence by a factor of 4 (18%). In addition, we demonstrated that the final prevalence in the individual healthcare facilities depends on average length of stay in a way described by a non-linear concave function. Moreover, we demonstrate that the network parameters of the model may be derived from administrative admission/discharge records. In particular, they are sufficient to obtain inter-hospital transfer probabilities, and to express the patients’ transfers as a Markov process. Using the proposed model, we show that indirect transfers of patients are equally or even more important as direct transfers for the spread of pathogens in a healthcare network. Direct patient transfers between hospitals have been shown to play an important role in the spread of pathogens in a healthcare network. However, readmission of patients from the community (indirect transfers) to the same or a different hospital is not well studied, and its role for the spread of pathogens in a healthcare network is not quantified. In this work, we developed a network model of a healthcare system to study the impact of indirect transfers on the prevalence in the individual hospitals as well as in the overall healthcare system. The model includes both, direct and indirect transfers of patients between the healthcare facilities due to transferring as well as readmission of infectious (colonized or infected) patients. Our results show that the readmission of patients (indirect transfers), either to the same or different facility, is an important potential channel of pathogen transmission. Such indirect transfers are of no less importance than direct patient transfers in controlling the spread of pathogens in a healthcare network.
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Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol 2019; 56:907-921. [PMID: 30955124 PMCID: PMC6597605 DOI: 10.1007/s00592-019-01301-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
AIMS Diabetic patients have multiple risk factors for colonisation with methicillin-resistant Staphylococcus aureus (MRSA), a nosocomial pathogen associated with significant morbidity and mortality. This meta-analysis was conducted to estimate the prevalence of MRSA among diabetic patients. METHODS The MEDLINE, Embase, BIOSIS, and Web of Science databases were searched for studies published up to May 2018 that reported primary data on the prevalence of MRSA in 10 or more diabetic patients. Two authors independently assessed study eligibility and extracted the data. The main outcomes were the pooled prevalence rates of MRSA colonisation and infection among diabetic populations. RESULTS Eligible data sets were divided into three groups containing data about the prevalence of MRSA colonisation or in diabetic foot or other infections. From 23 data sets, the prevalence of MRSA colonisation among 11577 diabetics was 9.20% (95% CI, 6.26-12.63%). Comparison of data from 14 studies that examined diabetic and non-diabetic patients found that diabetics had a 4.75% greater colonisation rate (P < 0.0001). From 41 data sets, the prevalence of MRSA in 10994 diabetic foot infection patients was 16.78% (95% CI, 13.21-20.68%). Among 2147 non-foot skin and soft-tissue infections, the MRSA prevalence rate was 18.03% (95% CI, 6.64-33.41). CONCLUSIONS The prevalence of MRSA colonisation among diabetic patients is often higher than among non-diabetics; this may make targeted screening attractive. In the UK, many diabetic patients may already be covered by the current screening policies. The prevalence and impact of MRSA among diabetic healthcare workers requires further research. The high prevalence of MRSA among diabetic foot infections may have implications for antimicrobial resistance, and should encourage strategies aimed at infection prevention or alternative therapies.
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Affiliation(s)
- Helen J Stacey
- Edinburgh Medical School, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Caitlin S Clements
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Susan C Welburn
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
- International Campus, ZJU-UoE Institute, Zhejiang University School of Medicine, Zhejiang University, 718 East Haizhou Road, 314400, Haining, Zhejiang, People's Republic of China
| | - Joshua D Jones
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.
- International Campus, ZJU-UoE Institute, Zhejiang University School of Medicine, Zhejiang University, 718 East Haizhou Road, 314400, Haining, Zhejiang, People's Republic of China.
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9
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Henderson A, Nimmo GR. Control of healthcare- and community-associated MRSA: recent progress and persisting challenges. Br Med Bull 2018; 125:25-41. [PMID: 29190327 DOI: 10.1093/bmb/ldx046] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/31/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Healthcare adapted meticillin-resistant Staphylococcus aureus (MRSA) has spread to hospitals around the world over 50 years. More recently, other strains of MRSA have emerged with the ability to spread in the community and infect otherwise healthy individuals. Morbidity and mortality associated with MRSA remains high and its control in both the healthcare and community setting has proven challenging. SOURCES OF DATA Pubmed (Medline). AREAS OF AGREEMENT The use of targeted screening and decolonization, hand hygiene and antimicrobial stewardship is supported by the most robust studies, though many studies have implemented bundles for effective healthcare-associated (HA)-MRSA control. AREAS OF CONTENTION Universal screening, universal decolonization and contact precautions for HA-MRSA control are supported by less evidence. Some interventions may not be cost-effective. Contact precautions may be associated with potential for patient harm. Evidence for effective control community acquired (CA)-MRSA is largely lacking. GROWING POINTS Programmes that focus on implementing bundles of interventions aimed at targeting HA-MRSA are more likely to be effective, with an emphasis on hand hygiene as a key component. Control of CA-MRSA is likely to be more difficult to achieve and relies on prevalence, risk factors and community healthcare interactions on a broader scale. AREAS TIMELY FOR DEVELOPING RESEARCH Further research in the area of CA-MRSA in particular is required. Antimicrobial stewardship for both CA and HA-MRSA is promising, as is the role of whole genome sequencing in characterizing transmission. However, further work is required to assess their long-term roles in controlling MRSA. With many institutions applying widespread use of chlorhexidine washes, monitoring for chlorhexidine resistance is paramount to sustaining efforts at controlling MRSA.
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Affiliation(s)
- Andrew Henderson
- Infection Management Services, Princess Alexandra Hospital, Woolloongabba, Queensland 4102, Australia.,School of Chemistry and Molecular Biosciences, University of Queensland, St Lucia, Queensland 4067, Australia.,University of Queensland Centre for Clinical Research, Herston, Queensland 4029, Australia
| | - Graeme R Nimmo
- Pathology Queensland Central Laboratory, Herston, Queensland 4029, Australia.,School of Medicine, Griffith University, Southport 4222, Queensland, Australia
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Wang B, Suh KN, Muldoon KA, Oake N, Forster A, Ramotar K, Roth VR. Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization Among Patients Admitted to Obstetrical Units: A Nested Case-Control Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 40:669-676. [PMID: 29248358 DOI: 10.1016/j.jogc.2017.09.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Revised: 09/29/2017] [Accepted: 09/29/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) among obstetrical patients can increase birth complications for both mothers and infants, but little is known about the risk factors for MRSA in this population. The objective of this study was to determine the prevalence of MRSA among obstetrical patients and identify risk factors associated with MRSA colonization. METHODS This nested case-control study used obstetrical patients with MRSA colonization identified through a universal screening program at The Ottawa Hospital (February 2008-January 2010). Cases and three matched controls were compared using chi-square tests for categorical variables, median and interquartile range (IQR), and Wilcoxon rank-sum tests for continuous variables. Conditional logistic regression using ORs and 95% CIs was used to identify risk factors. Standard microbiologic techniques and pulsed-field gel electrophoresis of the MRSA isolates from case patients were performed. RESULTS Out of 11 478 obstetrical patients, 39 (0.34%) were MRSA colonized; 117 patients were selected as matched controls. The median age was 30 (IQR 27.5-35.00) and median length of stay was 2.55 days (IQR 1.95-3.24). Only MRSA cases had a previous MRSA infection (4 vs. 0). MRSA cases had significantly higher parity (median 3; IQR 2-5) compared with controls (median 2; IQR 1-3) (OR 1.52; 95% CI 1.22-1.90) CONCLUSION: This study identified a low prevalence of MRSA among obstetrical patients. Risk factors associated with MRSA colonization were previous MRSA infection and multiparity. Obstetrical patients who previously tested positive for MRSA should be placed on contact precautions at the time of hospital admission because this is a risk factor for future colonization.
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Affiliation(s)
- Bing Wang
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - Kathryn N Suh
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON.
| | - Katherine A Muldoon
- Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - Natalie Oake
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - Alan Forster
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
| | - Karam Ramotar
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON
| | - Virginia R Roth
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, ON; Ottawa Hospital Research Institute, Ottawa, ON; School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON
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11
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Maxwell RA, Croft CA, Creech CB, Thomsen I, Soper N, Brown LE, Mejia VA, Dart BW, Barker DE. Methicillin-Resistant Staphylococcus aureus in a Trauma Population: Does Decolonization Prevent Infection? Am Surg 2017. [DOI: 10.1177/000313481708301227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.
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Affiliation(s)
- Robert A. Maxwell
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Chasen A. Croft
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - C. Buddy Creech
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Isaac Thomsen
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Nicole Soper
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Laura E. Brown
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Vicente A. Mejia
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Benjamin W. Dart
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Donald E. Barker
- Department of Surgery, University of Tennessee College of Medicine, Chattanooga, Tennessee
- Department of Surgery, University of Florida College of Medicine, Gainesville, Florida; and
- Vanderbilt Vaccine Research Program, Division of Pediatric Infectious Diseases, Vanderbilt University School of Medicine, Nashville, Tennessee
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Cavalcante FS, Pinheiro MV, Ferreira DDC, Alvarenga CVDCG, Guimarães ACF, Nouér SA, Dos Santos KRN. Characteristics of methicillin-resistant Staphylococcus aureus in patients on admission to a teaching hospital in Rio de Janeiro, Brazil. Am J Infect Control 2017; 45:1190-1193. [PMID: 28751036 DOI: 10.1016/j.ajic.2017.06.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 06/03/2017] [Accepted: 06/05/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are associated with greater mortality and morbidity; however, risk factors for community-acquired infections caused by MRSA have not been established. Therefore, community patients who are admitted to hospitals without the necessary contact precautions and are infected with community-acquired lineages eventually cause these lineages to spread to these settings. The aim of this study was to detect community-acquired lineages of MRSA in patients on admission to a Brazilian teaching hospital. METHODS The antimicrobial susceptibility of the MRSA isolates from nasal swabs was evaluated as was the molecular characteristics of the staphylococcal cassette chromosome mec (SCCmec). The clonality was determined using pulsed-field gel electrophoresis and multilocus sequence type analysis. RESULTS A total of 702 patients were evaluated between March 2012 and March 2013; 180 (25%) of them were colonized by S aureus, and 21 (3%) were MRSA. The SCCmec IV/USA1100/sequence type (ST) 30 was the predominant MRSA lineage (42.8%), followed by SCCmec IV/USA800/ST5 (23.8%). CONCLUSIONS The occurrence of MRSA colonization was very low, and only 1 patient from cardiac surgery developed an infection, which was caused by an SCCmec II/USA100/ST5 isolate. Screening for MRSA colonization on admission does not seem to be productive; however, for populations submitted to specific surgeries, active surveillance should be implemented.
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Affiliation(s)
| | | | - Dennis de Carvalho Ferreira
- School of Dentistry, Veiga de Almeida University, Rio de Janeiro, Brazil; School of Dentistry, Estácio de Sá University, Rio de Janeiro, Brazil
| | | | | | - Simone Aranha Nouér
- School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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McGowan JE. The 2016 Garrod Lecture: The role of the healthcare epidemiologist in antimicrobial chemotherapy-a view from the USA. J Antimicrob Chemother 2017; 71:2370-8. [PMID: 27550989 DOI: 10.1093/jac/dkw292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Antimicrobial chemotherapy now spans 80 years and four generations. The healthcare epidemiologist has an important role to play in this field. Efforts focus in three areas: (i) minimizing the transmission of antimicrobial-resistant bacteria in healthcare settings (infection control); (ii) optimizing use of currently available antibacterial drugs (antibiotic stewardship); and (iii) recognizing and responding to opportunities for new drug development. For each area, the epidemiologist provides data that address four practical questions-'What is the problem?', 'What should be done?', 'Is it being done?' and 'Is it working?'. A team approach is crucial to acting on the epidemiological data. Examples are presented to illustrate different roles of the epidemiologist, and tools and measures that have been developed to address some problems of current importance. Monitoring of quality, integrity and security of data remains a major focus. The epidemiologist will continue to have a key role in antimicrobial chemotherapy.
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Affiliation(s)
- John E McGowan
- Department of Epidemiology, Rollins School of Public Health of Emory University Department of Medicine (Infectious Diseases), Emory University School of Medicine, 1518 Clifton Rd NE, Atlanta, GA 30322, USA
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14
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Chmielarczyk A, Pomorska-Wesołowska M, Szczypta A, Romaniszyn D, Pobiega M, Wójkowska-Mach J. Molecular analysis of meticillin-resistant Staphylococcus aureus strains isolated from different types of infections from patients hospitalized in 12 regional, non-teaching hospitals in southern Poland. J Hosp Infect 2017; 95:259-267. [DOI: 10.1016/j.jhin.2016.10.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 10/27/2016] [Indexed: 12/14/2022]
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Roth VR, Longpre T, Coyle D, Suh KN, Taljaard M, Muldoon KA, Ramotar K, Forster A. Cost Analysis of Universal Screening vs. Risk Factor-Based Screening for Methicillin-Resistant Staphylococcus aureus (MRSA). PLoS One 2016; 11:e0159667. [PMID: 27462905 PMCID: PMC4963093 DOI: 10.1371/journal.pone.0159667] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 07/05/2016] [Indexed: 12/03/2022] Open
Abstract
Background The literature remains conflicted regarding the most effective way to screen for MRSA. This study was designed to assess costs associated with universal versus risk factor-based screening for the reduction of nosocomial MRSA transmission. Methods The study was conducted at The Ottawa Hospital, a large multi-centre tertiary care facility with approximately 47,000 admissions annually. From January 2006-December 2007, patients underwent risk factor-based screening for MRSA on admission. From January 2008 to August 2009 universal MRSA screening was implemented. A comparison of costs incurred during risk factor-based screening and universal screening was conducted. The model incorporated probabilities relating to the likelihood of being tested and the results of polymerase chain reaction (PCR) testing with associated effects in terms of MRSA bacteremia and true positive and negative test results. Inputted costs included laboratory testing, contact precautions and infection control, private room costs, housekeeping, and length of hospital stay. Deterministic sensitivity analyses were conducted. Results The risk factor-based MRSA screening program screened approximately 30% of admitted patients and cost the hospital over $780 000 annually. The universal screening program screened approximately 83% of admitted patients and cost over $1.94 million dollars, representing an excess cost of $1.16 million per year. The estimated additional cost per patient screened was $17.76. Conclusion This analysis demonstrated that a universal MRSA screening program was costly from a hospital perspective and was previously known to not be clinically effective at reducing MRSA transmission. These results may be useful to inform future model-based economic analyses of MRSA interventions.
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Affiliation(s)
- Virginia R. Roth
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Tara Longpre
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Doug Coyle
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Health Economics Research Group, Brunel University, Uxbridge, Middlesex, United Kingdom
| | - Kathryn N. Suh
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Monica Taljaard
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Katherine A. Muldoon
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Karamchand Ramotar
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
| | - Alan Forster
- Department of Medicine, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Methicillin-Resistant Staphylococcus aureus Control in the 21st Century: Laboratory Involvement Affecting Disease Impact and Economic Benefit from Large Population Studies. J Clin Microbiol 2016; 54:2647-2654. [PMID: 27307459 DOI: 10.1128/jcm.00698-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a global health care problem. Large studies (e.g., >25,000 patients) show that active surveillance testing (AST) followed by contact precautions for positive patients is an effective approach for MRSA disease control. With this approach, the clinical laboratory will be asked to select what AST method(s) to use and to provide data monitoring outcomes of the infection prevention interventions. This minireview summarizes evidence for MRSA disease control, reviews the involvement of the laboratory, and provides examples of how to undertake a program cost analysis. Health care organizations with total MRSA clinical infections of >0.3/1,000 patient days or bloodstream infections of >0.03/1,000 patient days should implement a MRSA control plan.
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Claassen-Weitz S, Shittu AO, Ngwarai MR, Thabane L, Nicol MP, Kaba M. Fecal Carriage of Staphylococcus aureus in the Hospital and Community Setting: A Systematic Review. Front Microbiol 2016; 7:449. [PMID: 27242671 PMCID: PMC4861718 DOI: 10.3389/fmicb.2016.00449] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 03/18/2016] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND AND RATIONALE Staphylococcus aureus fecal carriage has been identified as a potential source for nosocomial transmission and a risk factor for disease development. This systematic review determined the overall S. aureus [including methicillin susceptible and resistant S. aureus (MSSA and MRSA)] fecal carriage rates within the community and healthcare settings. METHODOLOGY Peer-reviewed articles indexed in Medline, Scopus, Academic Search Premier, Africa-Wide Information, CINAHL, and Web of Science were identified using applicable and controlled vocabulary through to 11 November 2015. Eligible studies were ascertained by three independent reviewers. Random-effects meta-analyses of proportions were performed to determine S. aureus, MSSA and MRSA fecal carriage rates reported by eligible studies. RESULTS Twenty six studies were included in this review. The pooled estimates for S. aureus, MSSA and MRSA fecal carriage were 26% (95% confidence interval (CI): 16.8-36.3%), 86% (95% confidence interval (CI): 65.9-97.9%) and 10% (95% CI: 0.7-27.0%), respectively. Fecal S. aureus carriage rates increased on average from 10 to 65% during the first 8 weeks of life, followed by an average carriage rate of 64% at 6 months and 46% at 1 year of life. Genotyping techniques were employed mainly in studies conducted in developed countries and comprised largely of gel-based techniques. Six studies reported on the role of S. aureus fecal strains in diarrhea (n = 2) and the risk for acquiring infections (n = 4). Eight of the 26 studies included in this review performed antibiotic susceptibility testing of S. aureus fecal isolates. CONCLUSION This study provides evidence that screening for S. aureus fecal carriage, at least in populations at high risk, could be an effective measure for the prevention of S. aureus transmission and infection in the healthcare and community setting. More well-structured studies need to be conducted and sequence-based genotyping techniques should be employed for the comparison of isolates on a global scale in both developing and developed countries.
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Affiliation(s)
- Shantelle Claassen-Weitz
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Adebayo O. Shittu
- Department of Microbiology, Obafemi Awolowo UniversityIle-Ife, Nigeria
| | - Michelle R. Ngwarai
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
| | - Lehana Thabane
- Department of Clinical Epidemiology and Biostatistics, McMaster UniversityHamilton, ON, Canada
| | - Mark P. Nicol
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- National Health Laboratory Service of South Africa, Groote Schuur HospitalCape Town, South Africa
| | - Mamadou Kaba
- Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape TownCape Town, South Africa
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