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Hasmukharay K, Ngoi ST, Saedon NI, Tan KM, Khor HM, Chin AV, Tan MP, Kamarulzaman A, Idris NB, Niek WK, Teh CSJ, Kamaruzzaman SBB, Ponnampalavanar SSLS. Evaluation of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia: Epidemiology, clinical characteristics, and outcomes in the older patients in a tertiary teaching hospital in Malaysia. BMC Infect Dis 2023; 23:241. [PMID: 37072768 PMCID: PMC10111773 DOI: 10.1186/s12879-023-08206-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia is a major concern in the global healthcare system. However, data from Asian regions dealing with the singularity of this infection in older persons is lacking. We aimed to identify the differences in the clinical characteristics and outcomes of MRSA bacteremia between adults aged 18-64 and ≥ 65 years. METHODS A retrospective study cohort was conducted at the University Malaya Medical Centre (UMMC) on cases of MRSA bacteremia from 2012 to 2016. Patient demographic and clinical data were collected for risk factors analyses. RESULTS New cases of MRSA bacteremia showed a trend of increase from 0.12 to 100 admissions in 2012 to 0.17 per 100 admissions in 2016 but a drop was observed in 2014 (0.07 per 100 admissions). Out of the 275 patients with MRSA bacteremia, 139 (50.5%) patients were aged ≥ 65 years old. Co-morbidities and severity at presentation were significantly higher among older adults, including diabetes mellitus (p = 0.035), hypertension (p = 0.001), and ischemic heart disease (p < 0.001), as well as higher Charlson Comorbidity Index (p < 0.001) and Pitt bacteremia scores (p = 0.016). Central line-associated bloodstream infections were more common among younger patients (37.5% vs. 17.3% in older patients, p < 0.001), while skin and soft tissue infections are more frequent among older adults (20.9% vs. 10.3% in younger patients, p = 0.016). All-cause mortality and in-hospital mortality were significantly higher in older patients (82.7% and 56.1% vs. 63.2% and 28.7% in younger patients, p < 0.001). Multivariate analysis revealed age ≥ 65 years (adjusted odds ratio: 3.36; 95% confidence interval: 1.24-9.13), Pitt score ≥ 3 (2.15; 1.54-3.01), hospital (6.12; 1.81-20.72) and healthcare (3.19; 1.30-7.81) acquisition of MRSA, indwelling urinary catheters (5.43; 1.39-21.23), inappropriate targeted treatment (8.08; 1.15-56.86), lack of infectious disease team consultation (2.90; 1.04-8.11) and hypoalbuminemia (3.31; 1.25-8.79), were significant risk factors for 30-day mortality. CONCLUSION Older patients' risk of mortality from MRSA bacteremia was three times higher than younger patients. Our data will contribute to developing and validating a robust scoring system for risk-stratifying patients to achieve better management and improved clinical outcomes.
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Affiliation(s)
- Kejal Hasmukharay
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Soo Tein Ngoi
- Department of Anaesthesiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Nor Izzati Saedon
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Kit Mun Tan
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Hui Min Khor
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Ai Vyrn Chin
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Maw Pin Tan
- Geriatric Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Adeeba Kamarulzaman
- Infectious Disease Unit, Department of Medicine, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Nuryana Binti Idris
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Wen Kiong Niek
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
| | - Cindy Shuan Ju Teh
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia
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Chen B, Li S, Lin S, Huang M, Dong H. The association between antibiotics and community-associated Staphylococcus aureus colonization in the United States population: Analysis of the National Health and Nutrition Examination Survey (NHANES). Medicine (Baltimore) 2022; 101:e31702. [PMID: 36397391 PMCID: PMC9666097 DOI: 10.1097/md.0000000000031702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Staphylococcus aureus nasal colonization is a seriously opportunistic infection. However, there is a lack of research of relationship between antibiotics and S aureus colonization in the general population. Through a cross-sectional investigation, this study intends to establish the parameters related to S aureus nasal colonization, specifically the function antibiotics play in colonization. The key information from 2001 to 2004 was abstracted from National Health and Nutrition Examination Survey (NHANES), including information on general demographics, health care status, antibiotic prescription, diabetes, alcohol consumption, and tobacco smoke exposure. The participants colonized with methicillin-susceptible S aureus (MSSA), or methicillin-resistant S aureus (MRSA) were defined as the case group, and the control group was subjects without positive S aureus colonization. Univariate and multivariate logistic regression models were used to identify the variables associated with MSSA and MRSA colonization. The records of 18,607 individuals were included, involving 13,205 cases without S aureus colonization, 5195 cases with MSSA, and 207 cases with MRSA. In the multivariate logistic regression analysis, the risk of MSSA colonization was significantly reduced with fluoroquinolone use (75% risk reduction, P = .02), sulfonamide use (98% risk reduction, P < .01), tetracycline use (81% risk reduction, P < .01) and antibiotic combination therapy (risk reduction 76%, P < .01). Female, race and total household size were strongly associated with MSSA carriage. On the other hand, regarding MRSA colonization, fluoroquinolone use, long-term care, and former smoker were positively associated with MRSA colonization, while high income was negatively associated with MRSA colonization. More proper use of broad-spectrum antibiotics contributes to reducing MSSA colonization. Former smokers should also practice better personal hygiene to limit the possibility of MRSA colonization.
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Affiliation(s)
- Baixing Chen
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Shaoshuo Li
- Nanjing University of Chinese Medicine, Nanjing, Jiangsu Province, China
| | - Shi Lin
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Mingling Huang
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
| | - Hang Dong
- Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- Department of traumatology, The First Affiliated Hospital, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province, China
- *Correspondence: Hang Dong, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong Province 523900, China (e-mail: )
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Fatima M, Roach WE, Reddy AD, Olloqui J. Methicillin-Resistant Staphylococcus aureus Bacteremia of Indeterminate Primary Source: A Case Report and Review of Pain Management During Hospital Course. Cureus 2022; 14:e25729. [PMID: 35812588 PMCID: PMC9270092 DOI: 10.7759/cureus.25729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/07/2022] [Indexed: 11/30/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a bacteria that is present in both hospital and community settings. It commonly spreads through direct contact but may also spread through droplets. Our body’s innate and adaptive immunity is typically enough to protect against MRSA entering our body. MRSA has an increased ability to enter and spread throughout the body with the use of infected objects such as needles or even small breaks in the skin. When this spread occurs hematogenously, it is known as MRSA bacteremia. When a patient presents with MRSA bacteremia, it is a critical time-sensitive task to locate the source of infection as continual exposure to MRSA in the bloodstream can prolong infection and may ultimately be fatal. The interesting obstacle in our patient presenting with MRSA bacteremia was the inability to locate a source of infection, a pivotal component of medical management. After extensive testing and detailed history taking, there was no possible external source of infection, making source control a difficult task. Another unique component of this case report included the course of pain management and adjustments made to tailor pain control to this patient with a history of chronic opioid abuse.
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Che Hamzah AM, Yeo CC, Puah SM, Chua KH, A Rahman NI, Abdullah FH, Othman N, Chew CH. Tigecycline and inducible clindamycin resistance in clinical isolates of methicillin-resistant Staphylococcus aureus from Terengganu, Malaysia. J Med Microbiol 2019; 68:1299-1305. [PMID: 31140965 DOI: 10.1099/jmm.0.000993] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The spread of multidrug-resistant Staphylococcus aureus is a public health concern. The inducible macrolide-lincosamide-streptogrammin B (iMLSB ) phenotype (or inducible clindamycin resistance) is associated with false clindamycin susceptibility in routine laboratory testing and may lead to treatment failure. Tigecycline resistance remains rare in S. aureus worldwide. This study aims to determine the antimicrobial susceptibility profiles of clinical isolates of S. aureus obtained from the main tertiary hospital in Terengganu state, Malaysia, from July 2016 to June 2017. The antimicrobial susceptibilities of 90 methicillin-resistant S. aureus (MRSA) and 109 methicillin-susceptible S. aureus (MSSA) isolates were determined by disc diffusion with the iMLSB phenotype determined by D-test. Multidrug resistance (MDR) and the iMLSB phenotype were more prevalent in MRSA (84.4 and 46.7 %, respectively) compared to MSSA isolates. All five tigecycline-resistant isolates were MRSA. The high incidence of MDR and the iMLSB phenotype and the emergence of tigecycline resistance in the Terengganu S. aureus isolates warrants continuous vigilance.
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Affiliation(s)
- Ainal Mardziah Che Hamzah
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, 21300 Kuala Nerus, Terengganu, Malaysia
| | - Chew Chieng Yeo
- Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400 Kuala Terengganu, Terengganu, Malaysia
| | - Suat Moi Puah
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kek Heng Chua
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Nor Iza A Rahman
- Faculty of Medicine, Universiti Sultan Zainal Abidin, 20400 Kuala Terengganu, Terengganu, Malaysia
| | - Fatimah Haslina Abdullah
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400 Kuala Terengganu, Terengganu, Malaysia
| | - Norlela Othman
- Department of Pathology, Hospital Sultanah Nur Zahirah, 20400 Kuala Terengganu, Terengganu, Malaysia
| | - Ching Hoong Chew
- Faculty of Health Sciences, Universiti Sultan Zainal Abidin, 21300 Kuala Nerus, Terengganu, Malaysia
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Abstract
This narrative review summarises the benefits, risks and appropriate use of acid-suppressing drugs (ASDs), proton pump inhibitors and histamine-2 receptor antagonists, advocating a rationale balanced and individualised approach aimed to minimise any serious adverse consequences. It focuses on current controversies on the potential of ASDs to contribute to infections-bacterial, parasitic, fungal, protozoan and viral, particularly in the elderly, comprehensively and critically discusses the growing body of observational literature linking ASD use to a variety of enteric, respiratory, skin and systemic infectious diseases and complications (Clostridium difficile diarrhoea, pneumonia, spontaneous bacterial peritonitis, septicaemia and other). The proposed pathogenic mechanisms of ASD-associated infections (related and unrelated to the inhibition of gastric acid secretion, alterations of the gut microbiome and immunity), and drug-drug interactions are also described. Both probiotics use and correcting vitamin D status may have a significant protective effect decreasing the incidence of ASD-associated infections, especially in the elderly. Despite the limitations of the existing data, the importance of individualised therapy and caution in long-term ASD use considering the balance of benefits and potential harms, factors that may predispose to and actions that may prevent/attenuate adverse effects is evident. A six-step practical algorithm for ASD therapy based on the best available evidence is presented.
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Cohen B, Vawdrey DK, Liu J, Caplan D, Furuya EY, Mis FW, Larson E. Challenges Associated With Using Large Data Sets for Quality Assessment and Research in Clinical Settings. Policy Polit Nurs Pract 2015; 16:117-24. [PMID: 26351216 DOI: 10.1177/1527154415603358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The rapidly expanding use of electronic records in health-care settings is generating unprecedented quantities of data available for clinical, epidemiological, and cost-effectiveness research. Several challenges are associated with using these data for clinical research, including issues surrounding access and information security, poor data quality, inconsistency of data within and across institutions, and a paucity of staff with expertise to manage and manipulate large clinical data sets. In this article, we describe our experience with assembling a data-mart and conducting clinical research using electronic data from four facilities within a single hospital network in New York City. We culled data from several electronic sources, including the institution's admission-discharge-transfer system, cost accounting system, electronic health record, clinical data warehouse, and departmental records. The final data-mart contained information for more than 760,000 discharges occurring from 2006 through 2012. Using categories identified by the National Institutes of Health Big Data to Knowledge initiative as a framework, we outlined challenges encountered during the development and use of a domain-specific data-mart and recommend approaches to overcome these challenges.
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Affiliation(s)
- Bevin Cohen
- Columbia University School of Nursing, New York, NY, USA
| | - David K Vawdrey
- Department of Biomedical Informatics, Columbia University, New York, NY, USA
| | - Jianfang Liu
- Columbia University School of Nursing, New York, NY, USA
| | - David Caplan
- Department of Information Services, New York-Presbyterian Hospital, New York, NY, USA
| | - E Yoko Furuya
- Department of Medicine, Columbia University, New York, NY, USA
| | - Frederick W Mis
- Department of Information Services, New York-Presbyterian Hospital, New York, NY, USA
| | - Elaine Larson
- Columbia University School of Nursing, New York, NY, USA
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