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Exudative Epidermitis in Combination with Staphylococcal Pyoderma in Suckling Piglets. Antibiotics (Basel) 2021; 10:antibiotics10070840. [PMID: 34356759 PMCID: PMC8300706 DOI: 10.3390/antibiotics10070840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 01/04/2023] Open
Abstract
A case of generalized exudative epidermitis (EE) is described, which occurred in a very small piglet producing farm in Austria. The antimicrobial treatment prescribed by the herd veterinarian did not improve the clinical problem. Therefore, the University Clinic for Swine intervened in the case. Lab investigations were initiated in which Staphylococcus hyicus (SH) and Staphylococcus aureus (SA), both methicillin-resistant and susceptible strains, could be isolated from the skin of affected piglets. Poor hygiene and management practices were identified as predisposing factors on site. Adaptation of antimicrobial treatment according to results of the in vitro susceptibility testing and the implementation of proper hygiene measures resolved the clinical problem. Here, we describe a fatal coinfection of SH and SA in suckling piglets.
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Xia H, Horn J, Piotrowska MJ, Sakowski K, Karch A, Tahir H, Kretzschmar M, Mikolajczyk R. Effects of incomplete inter-hospital network data on the assessment of transmission dynamics of hospital-acquired infections. PLoS Comput Biol 2021; 17:e1008941. [PMID: 33956787 PMCID: PMC8130968 DOI: 10.1371/journal.pcbi.1008941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 05/18/2021] [Accepted: 04/06/2021] [Indexed: 11/25/2022] Open
Abstract
In the year 2020, there were 105 different statutory insurance companies in Germany with heterogeneous regional coverage. Obtaining data from all insurance companies is challenging, so that it is likely that projects will have to rely on data not covering the whole population. Consequently, the study of epidemic spread in hospital referral networks using data-driven models may be biased. We studied this bias using data from three German regional insurance companies covering four federal states: AOK (historically “general local health insurance company”, but currently only the abbreviation is used) Lower Saxony (in Federal State of Lower Saxony), AOK Bavaria (in Bavaria), and AOK PLUS (in Thuringia and Saxony). To understand how incomplete data influence network characteristics and related epidemic simulations, we created sampled datasets by randomly dropping a proportion of patients from the full datasets and replacing them with random copies of the remaining patients to obtain scale-up datasets to the original size. For the sampled and scale-up datasets, we calculated several commonly used network measures, and compared them to those derived from the original data. We found that the network measures (degree, strength and closeness) were rather sensitive to incompleteness. Infection prevalence as an outcome from the applied susceptible-infectious-susceptible (SIS) model was fairly robust against incompleteness. At incompleteness levels as high as 90% of the original datasets the prevalence estimation bias was below 5% in scale-up datasets. Consequently, a coverage as low as 10% of the local population of the federal state population was sufficient to maintain the relative bias in prevalence below 10% for a wide range of transmission parameters as encountered in clinical settings. Our findings are reassuring that despite incomplete coverage of the population, German health insurance data can be used to study effects of patient traffic between institutions on the spread of pathogens within healthcare networks. Patterns of patients’ transfer between different hospitals contribute crucially to the risk of hospital-acquired infections (HAIs) in the health care system. To quantify this risk, network models can be applied. The estimated risk can be inaccurate in the case of incomplete data on hospital admissions, which can be a consequence of the multiplicity of insurance companies as it is the case in Germany. To develop a better understanding of how incompleteness of data affects network measures and the simulated spread of HAI, we compared those measures derived from sampled, scale-up and original data, based on hospitalization data from three AOK insurance companies. We found that common network measures were affected by incompleteness, but the simulated prevalence as a measure of epidemic spread in the network was robust over a large range of incompleteness proportions. Epidemics and the transition of the infectious diseases may be modelled on hospital data with a coverage as low as 10% of the local population, whilst maintaining accuracy to within 10% of the true population prevalence.
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Affiliation(s)
- Hanjue Xia
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Johannes Horn
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
| | - Monika J. Piotrowska
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Warsaw, Poland
| | - Konrad Sakowski
- Institute of Applied Mathematics and Mechanics, University of Warsaw, Warsaw, Poland
- Institute of High Pressure Physics, Polish Academy of Sciences, Warsaw, Poland
| | - André Karch
- Institute for Epidemiology and Social Medicine, University of Münster, Münster, North Rhine-Westphalia, Germany
| | - Hannan Tahir
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Mirjam Kretzschmar
- Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Rafael Mikolajczyk
- Institute for Medical Epidemiology, Biometrics and Informatics (IMEBI), Interdisciplinary Center for Health Sciences, Medical School of the Martin-Luther University Halle-Wittenberg, Halle, Saxony-Anhalt, Germany
- * E-mail:
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3
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Reorganization of nurse scheduling reduces the risk of healthcare associated infections. Sci Rep 2021; 11:7393. [PMID: 33795708 PMCID: PMC8016903 DOI: 10.1038/s41598-021-86637-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 03/18/2021] [Indexed: 11/21/2022] Open
Abstract
Efficient prevention and control of healthcare associated infections (HAIs) is still an open problem. Using contact data from wearable sensors at a short-stay geriatric ward, we propose a proof-of-concept modeling study that reorganizes nurse schedules for efficient infection control. This strategy switches and reassigns nurses’ tasks through the optimization of shift timelines, while respecting feasibility constraints and satisfying patient-care requirements. Through a Susceptible-Colonized-Susceptible transmission model, we found that schedules reorganization reduced HAI risk by 27% (95% confidence interval [24, 29]%) while preserving timeliness, number, and duration of contacts. More than 30% nurse-nurse contacts should be avoided to achieve an equivalent reduction through simple contact removal. Nurse scheduling can be reorganized to break potential chains of transmission and substantially limit HAI risk, while ensuring the timeliness and quality of healthcare services. This calls for including optimization of nurse scheduling practices in programs for infection control in hospitals.
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Tosas Auguet O, Stabler RA, Betley J, Preston MD, Dhaliwal M, Gaunt M, Ioannou A, Desai N, Karadag T, Batra R, Otter JA, Marbach H, Clark TG, Edgeworth JD. Frequent Undetected Ward-Based Methicillin-Resistant Staphylococcus aureus Transmission Linked to Patient Sharing Between Hospitals. Clin Infect Dis 2019; 66:840-848. [PMID: 29095965 PMCID: PMC5850096 DOI: 10.1093/cid/cix901] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/16/2017] [Indexed: 12/04/2022] Open
Abstract
Background Recent evidence suggests that hospital transmission of methicillin-resistant Staphylococcus aureus (MRSA) is uncommon in UK centers that have implemented sustained infection control programs. We investigated whether a healthcare-network analysis could shed light on transmission paths currently sustaining MRSA levels in UK hospitals. Methods A cross-sectional observational study was performed in 2 National Health Service hospital groups and a general district hospital in Southeast London. All MRSA patients identified at inpatient, outpatient, and community settings between 1 November 2011 and 29 February 2012 were included. We identified genetically defined MRSA transmission clusters in individual hospitals and across the healthcare network, and examined genetic differentiation of sequence type (ST) 22 MRSA isolates within and between hospitals and inpatient or outpatient and community settings, as informed by average and median pairwise single-nucleotide polymorphisms (SNPs) and SNP-based proportions of nearly identical isolates. Results Two hundred forty-eight of 610 (40.7%) MRSA patients were linked in 90 transmission clusters, of which 27 spanned multiple hospitals. Analysis of a large 32 patient ST22-MRSA cluster showed that 26 of 32 patients (81.3%) had multiple contacts with one another during ward stays at any hospital. No residential, outpatient, or significant community healthcare contacts were identified. Genetic differentiation between ST22 MRSA inpatient isolates from different hospitals was less than between inpatient isolates from the same hospitals (P ≤ .01). Conclusions There is evidence of frequent ward-based transmission of MRSA brought about by frequent patient admissions to multiple hospitals. Limiting in-ward transmission requires sharing of MRSA status data between hospitals.
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Affiliation(s)
- Olga Tosas Auguet
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust.,Oxford Health Systems Collaboration, Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford
| | - Richard A Stabler
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Jason Betley
- Illumina, Cambridge Ltd, Chesterford Research Park, Little Chesterford, Essex
| | - Mark D Preston
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Mandeep Dhaliwal
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Michael Gaunt
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine
| | - Avgousta Ioannou
- Illumina, Cambridge Ltd, Chesterford Research Park, Little Chesterford, Essex
| | - Nergish Desai
- Department of Medical Microbiology, King's College Hospital NHS Foundation Trust
| | - Tacim Karadag
- Department of Microbiology, University Hospital Lewisham, Lewisham and Greenwich NHS Trust
| | - Rahul Batra
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust
| | - Jonathan A Otter
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust.,National Institute for Health Research Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance at Imperial College London, and Imperial College Healthcare NHS Trust, Infection Prevention and Control
| | - Helene Marbach
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust
| | - Taane G Clark
- Department of Pathogen Molecular Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine.,Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jonathan D Edgeworth
- Centre for Clinical Infection and Diagnostics Research, Department of Infectious Diseases, King's College London and Guy's and St Thomas' NHS Foundation Trust
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Darbon A, Colombi D, Valdano E, Savini L, Giovannini A, Colizza V. Disease persistence on temporal contact networks accounting for heterogeneous infectious periods. ROYAL SOCIETY OPEN SCIENCE 2019; 6:181404. [PMID: 30800384 PMCID: PMC6366198 DOI: 10.1098/rsos.181404] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 12/13/2018] [Indexed: 05/09/2023]
Abstract
The infectious period of a transmissible disease is a key factor for disease spread and persistence. Epidemic models on networks typically assume an identical average infectious period for all individuals, thus allowing an analytical treatment. This simplifying assumption is, however, often unrealistic, as hosts may have different infectious periods, due, for instance, to individual host-pathogen interactions or inhomogeneous access to treatment. While previous work accounted for this heterogeneity in static networks, a full theoretical understanding of the interplay of varying infectious periods and time-evolving contacts is still missing. Here, we consider a susceptible-infectious-susceptible epidemic on a temporal network with host-specific average infectious periods, and develop an analytical framework to estimate the epidemic threshold, i.e. the critical transmissibility for disease spread in the host population. Integrating contact data for transmission with outbreak data and epidemiological estimates, we apply our framework to three real-world case studies exploring different epidemic contexts-the persistence of bovine tuberculosis in southern Italy, the spread of nosocomial infections in a hospital, and the diffusion of pandemic influenza in a school. We find that the homogeneous parametrization may cause important biases in the assessment of the epidemic risk of the host population. Our approach is also able to identify groups of hosts mostly responsible for disease diffusion who may be targeted for prevention and control, aiding public health interventions.
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Affiliation(s)
- Alexandre Darbon
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
| | - Davide Colombi
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
| | - Eugenio Valdano
- Departament d’Enginyeria Informàtica i Matemàtiques, Universitat Rovira i Virgili, Tarragona 43007, Spain
| | - Lara Savini
- Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise ‘G. Caporale’, Teramo 64100, Italy
| | - Armando Giovannini
- Istituto Zooprofilattico Sperimentale dell’Abruzzo e del Molise ‘G. Caporale’, Teramo 64100, Italy
| | - Vittoria Colizza
- INSERM, Sorbonne Université, Institut Pierre Louis d’Épidémiologie et de Santé Publique (IPLESP), 75012 Paris, France
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Almagor J, Temkin E, Benenson I, Fallach N, Carmeli Y. The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent-based model. PLoS One 2018; 13:e0197111. [PMID: 29758063 PMCID: PMC5951570 DOI: 10.1371/journal.pone.0197111] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 04/26/2018] [Indexed: 12/15/2022] Open
Abstract
Extensive antibiotic use over the years has led to the emergence and spread of antibiotic resistant bacteria (ARB). Antibiotic resistance poses a major threat to public health since for many infections antibiotic treatment is no longer effective. Hospitals are focal points for ARB spread. Antibiotic use in hospitals exerts selective pressure, accelerating the spread of ARB. We used an agent-based model to explore the impact of antibiotics on the transmission dynamics and to examine the potential of stewardship interventions in limiting ARB spread in a hospital. Agents in the model consist of patients and health care workers (HCW). The transmission of ARB occurs through contacts between patients and HCW and between adjacent patients. In the model, antibiotic use affects the risk of transmission by increasing the vulnerability of susceptible patients and the contagiousness of colonized patients who are treated with antibiotics. The model shows that increasing the proportion of patients receiving antibiotics increases the rate of acquisition non-linearly. The effect of antibiotics on the spread of resistance depends on characteristics of the antibiotic agent and the density of antibiotic use. Antibiotic's impact on the spread increases when the bacterial strain is more transmissible, and decreases as resistance prevalence rises. The individual risk for acquiring ARB increases in parallel with antibiotic density both for patients treated and not treated with antibiotics. Antibiotic treatment in the hospital setting plays an important role in determining the spread of resistance. Interventions to limit antibiotic use have the potential to reduce the spread of resistance, mainly by choosing an agent with a favorable profile in terms of its impact on patient's vulnerability and contagiousness. Methods to measure these impacts of antibiotics should be developed, standardized, and incorporated into drug development programs and approval packages.
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Affiliation(s)
- Jonatan Almagor
- Laboratory of Geosimulation and Spatial Analysis, Department of Geography and Human Environment, Tel Aviv University, Tel Aviv, Israel
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- * E-mail:
| | - Elizabeth Temkin
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Itzhak Benenson
- Laboratory of Geosimulation and Spatial Analysis, Department of Geography and Human Environment, Tel Aviv University, Tel Aviv, Israel
| | - Noga Fallach
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Yehuda Carmeli
- Department of Epidemiology and Preventive Medicine, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Jörgensen J, Månsson F, Janson H, Petersson AC, Nilsson AC. The majority of MRSA colonized children not given eradication treatment are still colonized one year later. Systemic antibiotics improve the eradication rate. Infect Dis (Lond) 2018; 50:687-696. [PMID: 29688141 DOI: 10.1080/23744235.2018.1459828] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
BACKGROUND Colonization with methicillin-resistant Staphylococcus aureus (MRSA) can cause endogenously derived infections and be a source of transmission to other people. Neither colonization time of asymptomatic MRSA colonization nor the effect of treatment aiming at MRSA eradication in children has been thoroughly investigated. METHODS Two hundred ninety-three children <18 years in the mandatory follow-up program for MRSA-carriers in Malmö, Sweden were evaluated. Samples from the throat, nares, perineum and skin lesions from each child were screened for MRSA with a PCR-based broth enrichment method. PVL presence and spa-type were evaluated in a majority of cases. The sampling was repeated approximately every 6 month after initial detection. When three consecutive sets of negative samples during at least a 6-month period were obtained, the MRSA was considered permanently eradicated. MRSA eradication treatment given, on clinical grounds during follow-up, was noted. RESULTS One year after detection 62% of the untreated children were still MRSA positive and after 2 years 28%. MRSA throat colonization and having MRSA positive household contacts significantly prolonged the observed colonization time. Topical MRSA eradication treatment was successful in 36% of cases and in 65% if systemic antibiotics were added. Presence of PVL correlated with shorter observed colonization time in the older age group and with increased eradication success among throat carriers. CONCLUSION MRSA throat colonization and having MRSA positive household contacts prolongs the time of MRSA colonization in children. Systemic antibiotics enhance the effect of MRSA eradication treatment.
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Affiliation(s)
- Jimmy Jörgensen
- a Department of Translational Medicine, Infectious Disease Research Unit , Lund University , Malmö , Sweden
| | - Fredrik Månsson
- a Department of Translational Medicine, Infectious Disease Research Unit , Lund University , Malmö , Sweden
| | - Håkan Janson
- b Department of Clinical Microbiology , Central Hospital , Växjö , Sweden
| | - Ann Cathrine Petersson
- c Department of Clinical Microbiology, Division of Laboratory Medicine , Lund University Hospital , Lund , Sweden
| | - Anna C Nilsson
- a Department of Translational Medicine, Infectious Disease Research Unit , Lund University , Malmö , Sweden
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8
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Chiew CJ, Ho HJ, Win MK, Tan A, Lim JW, Ang B, Chow A. Persistence of meticillin-resistant Staphylococcus aureus carriage in re-admitted patients. J Hosp Infect 2018; 100:350-354. [PMID: 29649554 DOI: 10.1016/j.jhin.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/03/2018] [Indexed: 12/01/2022]
Abstract
A retrospective cohort study was conducted to investigate the duration and risk factors for persistence of meticillin-resistant Staphylococcus aureus (MRSA) colonization among known carriers who were re-admitted to hospital. MRSA carriage persisted in a high proportion of known carriers up to two years after their last date of discharge, and re-admission screening should be performed for at least this duration. A targeted screening approach should focus on older patients with a history of long inpatient stays, who are at higher risk of persistent carriage. Timely discharge planning is important in reducing the risk of persistent MRSA colonization among known carriers.
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Affiliation(s)
- C J Chiew
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - H J Ho
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - M K Win
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore.
| | - A Tan
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - J W Lim
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
| | - B Ang
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
| | - A Chow
- Department of Clinical Epidemiology, Tan Tock Seng Hospital, Singapore
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10
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Werner C, Shaban RZ. Successfully clearing discharged patients of methicillin-resistant Staphylococcus aureus: Opportunities for the prevention and containment of antimicrobial resistance. Infect Dis Health 2017; 23:57-62. [PMID: 30479306 DOI: 10.1016/j.idh.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/29/2017] [Accepted: 10/29/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Australian hospitals routinely screen for multi-resistant organisms (MRO) to prevent the spread of healthcare-associated infection. The results of positive MRSA screening typically include: informing patient of their MRSA, single accommodation and contact precautions within the health care facility. These actions are associated with both negative and positive psychosocial effects, but also bring economic and human resource costs. MRSA clearance, however, is a less routine practice, and it is typically conducted only while patients are admitted. This paper reports the results of a study implementing a MRSA clearance program that included giving patients the opportunity to continue the clearance swabbing regime once discharged from hospital. METHODS Retrospective cohort study of MRSA clearance between 2013 and 2016 at a private hospital in Australia. RESULTS The MRSA clearance program was successful in increasing the MRSA clearance rate from 0 patients in 2013 to 13% (n12) in 2014, 11% (n10) in 2015, and 18% (n14) in 2016. CONCLUSION Allowing patients to continuing participation in MRSA clearance following discharge has increased the clearance rate of MRSA. Clearing patients of MRSAs is advantageous to patients, the health system and society, reducing health economic costs and the negative psychosocial effects associated with contact precautions.
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Affiliation(s)
- Curt Werner
- Pindara Private Hospital, Allchurch Avenue, Benowa 4212, Gold Coast, QLD, Australia.
| | - Ramon Z Shaban
- Infection Control Department, Division of Infectious Diseases and Immunology, Gold Coast Hospital and Health Service & Griffith University, Level 2, Block E Gold Coast University Hospital, Southport, QLD 4215, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydeny and Western Sydney Local Health District, Westmead, NSW 2145, Australia
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The Effect of Total Household Decolonization on Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2016; 37:1226-33. [PMID: 27465112 PMCID: PMC9906270 DOI: 10.1017/ice.2016.138] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the impact of total household decolonization with intranasal mupirocin and chlorhexidine gluconate body wash on recurrent methicillin-resistant Staphylococcus aureus (MRSA) infection among subjects with MRSA skin and soft-tissue infection. DESIGN Three-arm nonmasked randomized controlled trial. SETTING Five academic medical centers in Southeastern Pennsylvania. PARTICIPANTS Adults and children presenting to ambulatory care settings with community-onset MRSA skin and soft-tissue infection (ie, index cases) and their household members. INTERVENTION Enrolled households were randomized to 1 of 3 intervention groups: (1) education on routine hygiene measures, (2) education plus decolonization without reminders (intranasal mupirocin ointment twice daily for 7 days and chlorhexidine gluconate on the first and last day), or (3) education plus decolonization with reminders, where subjects received daily telephone call or text message reminders. MAIN OUTCOME MEASURES Owing to small numbers of recurrent infections, this analysis focused on time to clearance of colonization in the index case. RESULTS Of 223 households, 73 were randomized to education-only, 76 to decolonization without reminders, 74 to decolonization with reminders. There was no significant difference in time to clearance of colonization between the education-only and decolonization groups (log-rank P=.768). In secondary analyses, compliance with decolonization was associated with decreased time to clearance (P=.018). CONCLUSIONS Total household decolonization did not result in decreased time to clearance of MRSA colonization among adults and children with MRSA skin and soft-tissue infection. However, subjects who were compliant with the protocol had more rapid clearance Trial registration. ClinicalTrials.gov identifier: NCT00966446 Infect Control Hosp Epidemiol 2016;1-8.
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12
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Brans R, Kolomanski K, Mentzel F, Vollmer U, Kaup O, John SM. Colonisation with methicillin-resistant Staphylococcus aureus and associated factors among nurses with occupational skin diseases. Occup Environ Med 2016; 73:670-5. [PMID: 27358469 DOI: 10.1136/oemed-2016-103632] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 06/14/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To evaluate the prevalence of colonisation with methicillin-resistant Staphylococcus aureus (MRSA), associated factors and the effectiveness of decolonisation procedures among nurses with occupational skin diseases (OSD). METHODS In a retrospective cohort study, the medical records of 319 nurses from Germany who were screened consecutively for MRSA when participating in a tertiary individual prevention programme (TIP) for severe OSD between July 2009 and December 2014 were evaluated. RESULTS 90.3% of nurses with severe OSD suffered from hand eczema. 43 were colonised with MRSA on admission (13.5%), mainly in the nose (n=35, 81.4%). However, the hands were affected in more than half of the MRSA carriers (n=24, 55.8%). Risk factors for MRSA colonisation were atopic skin diathesis (OR 2.01, 95% CI 1.03 to 3.92, p=0.049) and presence of atopic dermatitis on other body parts than the hands (OR 4.33, 95% CI 2.23 to 8.43, p<0.001). Hand eczema was significantly more severe in MRSA carriers than in non-carriers (OR 1.23, 95% CI 1.10 to 1.37, p<0.001) and showed a higher prevalence of vesicles, erosions or fissures. MRSA eradication was successful in 67.4% after the first attempt. CONCLUSIONS Nurses with OSD have a twofold to threefold higher prevalence of MRSA colonisation than what has been reported for point-prevalence screenings among healthcare workers in Germany. Atopic skin diathesis, atopic dermatitis and severe hand eczema are the main risk factors. Thus, prevention and treatment of OSD could be important elements in reduction of colonisation with MRSA among nurses and transmission to others.
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Affiliation(s)
- Richard Brans
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Katarzyna Kolomanski
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Franziska Mentzel
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
| | - Ulrike Vollmer
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Olaf Kaup
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany
| | - Swen Malte John
- Department of Dermatology, Environmental Medicine and Health Theory, University of Osnabrück, Osnabrück, Germany Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the University of Osnabrück, Osnabrück, Germany
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13
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Hospital based clearance of patients with skin and soft tissue methicillin resistant Staphylococcus aureus (MRSA): A systematic review of the literature. Infect Dis Health 2016. [DOI: 10.1016/j.idh.2016.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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14
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Challenges of Long-Term MRSA Management in a Complex Continuing Care Setting. Infect Control Hosp Epidemiol 2016; 37:363-5. [DOI: 10.1017/ice.2015.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Determinants of Successful Methicillin-Resistant Staphylococcus aureus Decolonization. Infect Control Hosp Epidemiol 2016; 37:732-6. [PMID: 26880575 DOI: 10.1017/ice.2016.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Chang HH, Dordel J, Donker T, Worby CJ, Feil EJ, Hanage WP, Bentley SD, Huang SS, Lipsitch M. Identifying the effect of patient sharing on between-hospital genetic differentiation of methicillin-resistant Staphylococcus aureus. Genome Med 2016; 8:18. [PMID: 26873713 PMCID: PMC4752745 DOI: 10.1186/s13073-016-0274-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 01/29/2016] [Indexed: 01/17/2023] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common healthcare-associated pathogens. To examine the role of inter-hospital patient sharing on MRSA transmission, a previous study collected 2,214 samples from 30 hospitals in Orange County, California and showed by spa typing that genetic differentiation decreased significantly with increased patient sharing. In the current study, we focused on the 986 samples with spa type t008 from the same population. Methods We used genome sequencing to determine the effect of patient sharing on genetic differentiation between hospitals. Genetic differentiation was measured by between-hospital genetic diversity, FST, and the proportion of nearly identical isolates between hospitals. Results Surprisingly, we found very similar genetic diversity within and between hospitals, and no significant association between patient sharing and genetic differentiation measured by FST. However, in contrast to FST, there was a significant association between patient sharing and the proportion of nearly identical isolates between hospitals. We propose that the proportion of nearly identical isolates is more powerful at determining transmission dynamics than traditional estimators of genetic differentiation (FST) when gene flow between populations is high, since it is more responsive to recent transmission events. Our hypothesis was supported by the results from coalescent simulations. Conclusions Our results suggested that there was a high level of gene flow between hospitals facilitated by patient sharing, and that the proportion of nearly identical isolates is more sensitive to population structure than FST when gene flow is high. Electronic supplementary material The online version of this article (doi:10.1186/s13073-016-0274-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hsiao-Han Chang
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Janina Dordel
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK. .,Department of Biology, Drexel University, Philadelphia, PA, USA.
| | - Tjibbe Donker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK.
| | - Colin J Worby
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Edward J Feil
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AY, UK.
| | - William P Hanage
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Stephen D Bentley
- Pathogen Genomics, The Wellcome Trust Sanger Institute, Wellcome Trust Genome Campus, Hinxton, CB10 1SA, UK.
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, USA.
| | - Marc Lipsitch
- Department of Epidemiology, Center for Communicable Disease Dynamics, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Sai N, Laurent C, Strale H, Denis O, Byl B. Efficacy of the decolonization of methicillin-resistant Staphylococcus aureus carriers in clinical practice. Antimicrob Resist Infect Control 2015; 4:56. [PMID: 26688720 PMCID: PMC4683972 DOI: 10.1186/s13756-015-0096-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Accepted: 11/26/2015] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Nasal and extra nasal carriage of methicillin-resistant S. aureus (MRSA) is a pre-existing condition that often leads to invasive MRSA infection, as MRSA colonization is associated with a high risk of acquiring MRSA infection during hospital stays. Decolonization may reduce the risk of meticillin-resistant Staphylococcus aureus (MRSA) infection in individual carriers and prevent transmission to other patients. METHODS A retrospective cohort study was conducted to evaluate the effectiveness of two decolonization protocols for newly diagnosed MRSA carriage in hospitalized patients and to assess the impact of decolonization on the rate of MRSA infection. The study population consisted of all patients diagnosed as MRSA-positive between January 2006 and June 2010. Patients diagnosed as carriers were designated as requiring contact precautions by the hospital infection control team. The standing order protocol of the hospital pertaining to decolonization procedures was then applied, and all newly diagnosed patients were administered one of the two decolonization treatments outlined in the hospital protocol, with the exception of MRSA respiratory carriers (MRSA obtained from sputum or other lower respiratory tract samples). The two decolonization treatments consisted of the application of intranasal mupirocin 2 % and washing with chlorhexidine soap (40 mg/mL) (mupi/CHX) or application of intranasal povidone-iodine and washing with povidone-iodine soap (PVPI), with each treatment lasting for 5 days. Success was determined by at least three successive nose swabs and throat and other screened site swabs that tested negative for MRSA before patient discharge. RESULTS A total of 1150 patients admitted to the hospital were found to be infected or colonized with MRSA. Of the 1150 patients, 268 were prescribed decolonization treatment. 104 out of 268 patients (39 %) were successfully decolonized. There was no significant success after two decolonization failures. MRSA infection rate among the successes and failures were 0.0 and 4.3 %, respectively [P = 0.04]. CONCLUSIONS Our results fit well with the prescription of decolonization based on local strategy protocols but reflect a low rate of successful treatment. Although the success rate of decolonization was not high in our study, the effectiveness of decolonization on the infection rate, justifies the continuation of this strategy, even if a marginal cost is incurred.
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Affiliation(s)
- N Sai
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium
| | - C Laurent
- Hygiène Hospitalière, Centre Hospitalier Régional de Namur, Namur, Belgium
| | - H Strale
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium
| | - O Denis
- Department of Clinical Microbiology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium ; School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
| | - B Byl
- Hospital Epidemiology and Infection Control Unit, Erasme Hospital, Université Libre de Bruxelles, 808, Route de Lennik, 1070 Brussels, Belgium ; School of Public Health, Université Libre de Bruxelles, Brussels, Belgium
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Effectiveness of meticillin-resistant Staphylococcus aureus decolonization in long-term haemodialysis patients: a systematic review and meta-analysis. J Hosp Infect 2015; 91:250-6. [DOI: 10.1016/j.jhin.2015.08.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 08/04/2015] [Indexed: 11/19/2022]
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Screening for methicillin-resistant Staphylococcus aureus colonization using sponges. Infect Control Hosp Epidemiol 2015; 36:28-33. [PMID: 25627758 DOI: 10.1017/ice.2014.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Nasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection. DESIGN Hospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR). PATIENTS A total of 105 MRSA patients were included in the study. RESULTS At least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites. CONCLUSION Screening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.
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Fluoroquinolone Impact on Nasal Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Colonization Durations in Neurologic Long-Term-Care Facilities. Antimicrob Agents Chemother 2015; 59:7621-8. [PMID: 26416866 DOI: 10.1128/aac.01338-15] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/23/2015] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus nasal carriage is a risk factor for subsequent infection. Estimates of colonization duration vary widely among studies, and factors influencing the time to loss of colonization, especially the impact of antibiotics, remain unclear. We conducted a prospective study on patients naive for S. aureus colonization in 4 French long-term-care facilities. Data on nasal colonization status and potential factors for loss of colonization were collected weekly. We estimated methicillin-resistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) colonization durations using the Kaplan-Meier method and investigated factors for loss of colonization using shared-frailty Cox proportional hazards models. A total of 285 S. aureus colonization episodes were identified in 149 patients. The median time to loss of MRSA or MSSA colonization was 3 weeks (95% confidence interval, 2 to 8 weeks) or 2 weeks (95% confidence interval, 2 to 3 weeks), respectively. In multivariable analyses, the methicillin resistance phenotype was not associated with S. aureus colonization duration (P = 0.21); the use of fluoroquinolones (hazard ratio, 3.37; 95% confidence interval, 1.31 to 8.71) and having a wound positive for a nonnasal strain (hazard ratio, 2.17; 95% confidence interval, 1.15 to 4.07) were associated with earlier loss of MSSA colonization, while no factor was associated with loss of MRSA colonization. These results suggest that the methicillin resistance phenotype does not influence the S. aureus colonization duration and that fluoroquinolones are associated with loss of MSSA colonization but not with loss of MRSA colonization.
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Ye X, Liu W, Fan Y, Wang X, Zhou J, Yao Z, Chen S. Frequency-risk and duration-risk relations between occupational livestock contact and methicillin-resistant Staphylococcus aureus carriage among workers in Guangdong, China. Am J Infect Control 2015; 43:676-81. [PMID: 25934060 DOI: 10.1016/j.ajic.2015.03.026] [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] [Received: 01/06/2015] [Revised: 03/18/2015] [Accepted: 03/25/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Increasing evidence indicates a strong association between occupational livestock contact and methicillin-resistant Staphylococcus aureus (MRSA) carriage. However, it remains unclear whether there are frequency-risk and duration-risk relations between occupational livestock contact and human MRSA carriage. METHODS A cross-sectional survey was conducted in Guangdong, China, using a multistage sampling method. Participants were interviewed and provided a nasal swab for S aureus analysis. All MRSA isolates were genotyped by multilocus sequence typing. The dose-response relation was examined using logistic regression models. RESULTS Among the 1,860 participants, 1.4% of controls tested positive for MRSA (characterized as sequence type [ST] 59 and ST7), and 7% of workers with livestock contact tested positive for MRSA (characterized as ST9, ST59, and ST7). There was a 5.31 times increased risk of MRSA carriage corresponding to occupational livestock contact (odds ratio = 6.31; 95% confidence interval, 3.44-11.57) using no contact as reference. We found frequency and short-term duration of occupational livestock contact were associated with increased risk of MRSA carriage in a dose-response manner. These significant trends were observed consistently among workers with occupational pig contact. However, no long-term duration-risk increasing trend was observed for occupational livestock or pig contact. CONCLUSION Our findings suggest that there may be dose-response relations between occupational livestock contact and human MRSA carriage. Nasal MRSA clonal complex 9 is not found in controls, but it is found in workers with livestock contact.
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Risk factors for recurrent colonization with methicillin-resistant Staphylococcus aureus in community-dwelling adults and children. Infect Control Hosp Epidemiol 2015; 36:786-93. [PMID: 25869756 PMCID: PMC9859687 DOI: 10.1017/ice.2015.76] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN Prospective cohort study conducted from January 1, 2010, through December 31, 2012. SETTING Five adult and pediatric academic medical centers. PARTICIPANTS Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection. METHODS Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members. RESULTS The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36-84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29-0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00-1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses. CONCLUSION A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
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Low Yield of Methicillin-Resistant Staphylococcus aureus Screening in Hemodialysis Patients: 10 Years' Experience. Infect Control Hosp Epidemiol 2015; 36:1046-9. [PMID: 26008616 DOI: 10.1017/ice.2015.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in hemodialysis patients and to analyze the cost-effectiveness of our screening approach compared with an alternative strategy. DESIGN Screening study and cost-effectiveness analysis. METHODS Analysis of twice-yearly MRSA prevalence studies conducted in the hemodialysis unit of a 950-bed tertiary care hospital from January 1, 2004, through December 31, 2013. For this purpose, nasal swab samples were cultured on MRSA screening agar (mannitol-oxacillin biplate). RESULTS There were 20 mass screenings during the 10-year study period. We identified 415 patients participating in at least 1 screening, with an average of 4.5 screenings per patient. Of 415 screened patients, 15 (3.6%) were found to be MRSA carriers. The first mass screening in 2004 yielded the highest percentage of MRSA (6/101 [6%]). Only 7 subsequent screenings revealed new MRSA carriers, whereas 4 screenings confirmed previously known carriers, and 8 remained negative. None of the carriers developed MRSA bacteremia during the study period. The total cost of our screening approach, that is, screening and isolation costs, was US $93,930. The total cost of an alternative strategy (ie, no mass screening administered) would be equivalent to costs of isolation of index cases and contact tracing was estimated to be US $5,382 (difference, US $88,548). CONCLUSIONS In an area of low MRSA endemicity (<5%), regular nasal screenings of a high-risk population yielded a low rate of MRSA carriers. Twice-yearly MRSA screening of dialysis patients is unlikely to be cost-effective if MRSA prevalence is low.
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Calderwood MS. Editorial Commentary: Duration of Colonization With Methicillin-Resistant Staphylococcus aureus: A Question With Many Answers. Clin Infect Dis 2015; 60:1497-9. [PMID: 25648241 PMCID: PMC4412190 DOI: 10.1093/cid/civ082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 01/27/2015] [Indexed: 12/05/2022] Open
Affiliation(s)
- Michael S Calderwood
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts
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25
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Cluzet VC, Gerber JS, Nachamkin I, Metlay JP, Zaoutis TE, Davis MF, Julian KG, Royer D, Linkin DR, Coffin SE, Margolis DJ, Hollander JE, Mistry RD, Gavin LJ, Tolomeo P, Wise JA, Wheeler MK, Bilker WB, Han X, Hu B, Fishman NO, Lautenbach E. Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus. Clin Infect Dis 2015; 60:1489-96. [PMID: 25648237 DOI: 10.1093/cid/civ075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear. METHODS We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization. RESULTS Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06). CONCLUSIONS With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.
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Affiliation(s)
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | | | - Joshua P Metlay
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Theoklis E Zaoutis
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - Meghan F Davis
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - David Royer
- Department of Biology, Lincoln University, Pennsylvania
| | - Darren R Linkin
- Division of Infectious Diseases, Department of Medicine Philadelphia Veterans Administration Medical Center
| | - Susan E Coffin
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - David J Margolis
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Dermatology, Perelman School of Medicine, University of Pennsylvania
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia
| | - Rakesh D Mistry
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Laurence J Gavin
- Department of Emergency Medicine, Penn Presbyterian Medical Center
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics
| | | | | | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
| | - Xiaoyan Han
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
| | - Baofeng Hu
- Department of Pathology and Laboratory Medicine
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
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Evison J, Mühlemann K. Screening for Carriage of Methicillin-Resistant Staphylococcus aureus Shortly After Exposure May Lead to False-Negative Results. Infect Control Hosp Epidemiol 2015; 29:774-6. [DOI: 10.1086/589814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We evaluated a double screening strategy for carriage of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to a newly detected MRSA carrier. If the first screening of the exposed patient yielded negative results, screening was repeated 4 days later. This strategy detected 12 (28%) of the 43 new MRSA carriers identified during the study period. The results suggest that there is an incubation period before MRSA carriage is detectable.
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Ferrer J, Boelle PY, Salomon J, Miliani K, L'Hériteau F, Astagneau P, Temime L. Management of nurse shortage and its impact on pathogen dissemination in the intensive care unit. Epidemics 2014; 9:62-9. [PMID: 25480135 DOI: 10.1016/j.epidem.2014.07.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Revised: 07/11/2014] [Accepted: 07/23/2014] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Studies provide evidence that reduced nurse staffing resources are associated to an increase in health care-associated infections in intensive care units, but tools to assess the contribution of the mechanisms driving these relations are still lacking. We present an agent-based model of pathogen spread that can be used to evaluate the impact on nosocomial risk of alternative management decisions adopted to deal with transitory nurse shortage. MATERIALS AND METHODS We constructed a model simulating contact-mediated dissemination of pathogens in an intensive-care unit with explicit staffing where nurse availability could be temporarily reduced while maintaining requisites of patient care. We used the model to explore the impact of alternative management decisions adopted to deal with transitory nurse shortage under different pathogen- and institution-specific scenarios. Three alternative strategies could be adopted: increasing the workload of working nurses, hiring substitute nurses, or transferring patients to other intensive-care units. The impact of these decisions on pathogen spread was examined while varying pathogen transmissibility and severity of nurse shortage. RESULTS The model-predicted changes in pathogen prevalence among patients were impacted by management decisions. Simulations showed that increasing nurse workload led to an increase in pathogen spread and that patient transfer could reduce prevalence of pathogens among patients in the intensive-care unit. The outcome of nurse substitution depended on the assumed skills of substitute nurses. Differences between predicted outcomes of each strategy became more evident with increasing transmissibility of the pathogen and with higher rates of nurse shortage. CONCLUSIONS Agent-based models with explicit staff management such as the model presented may prove useful to design staff management policies that mitigate the risk of healthcare-associated infections under episodes of increased nurse shortage.
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Affiliation(s)
- Jordi Ferrer
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France.
| | | | - Jérôme Salomon
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France
| | - Katiuska Miliani
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France
| | - François L'Hériteau
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France
| | - Pascal Astagneau
- Regional Coordinating Centre for Nosocomial Infection Control (C-CLIN Paris Nord), Paris, France; EHESP School of Public Health, Paris, France
| | - Laura Temime
- Laboratoire Modélisation, Epidémiologie et Surveillance des Risques Sanitaires, Conservatoire national des Arts et Métiers, Paris, France
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Grohs P, Podglajen I, Guerot E, Bellenfant F, Caumont-Prim A, Kac G, Tillecovidin B, Carbonnelle E, Chatellier G, Meyer G, Fagon JY, Gutmann L. Assessment of five screening strategies for optimal detection of carriers of third-generation cephalosporin-resistant Enterobacteriaceae in intensive care units using daily sampling. Clin Microbiol Infect 2014; 20:O879-86. [PMID: 24807791 DOI: 10.1111/1469-0691.12663] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 04/14/2014] [Accepted: 04/30/2014] [Indexed: 11/29/2022]
Abstract
There is no consensus on optimal screening procedures for multidrug-resistant Enterobacteriaceae (MDRE) in intensive care units (ICUs). Therefore, we assessed five strategies for the detection of extended-spectrum beta-lactamase (ESBL) and high-level expressed AmpC cephalosporinase (HL-CASE) producers. During a 3-month period, a rectal screening swab sample was collected daily from every ICU patient, from the first 24 h to the last day of ICU stay. Samples were plated on MDRE-selective media. Bacteria were identified using MALDI-TOF mass spectrometry and antibiograms were performed using disk diffusion. MDREs were isolated from 682/2348 (29.0%) screening samples collected from 93/269 (34.6%) patients. Incidences of patients with ESBL and HL-CASE producers were 17.8 and 19.3 per 100 admissions, respectively. In 48/93 patients, MDRE carriage was intermittent. Compared with systematic screening at admission, systematic screening at discharge did not significantly increase the rate of MDRE detection among the 93 patients (62% vs. 70%). In contrast, screening at admission and discharge, screening at admission and weekly thereafter, and screening at admission and weekly thereafter and at discharge significantly increased MDRE detection (77%, p 0.02; 76%, p 0.01; 86%, p<0.001, respectively). The difference in MDRE detection between these strategies relies essentially on the levels of detection of patients with HL-CASE producers. The most reasonable strategy would be to collect two samples, one at admission and one at discharge, which would detect 87.5% of the ESBL strains, 67.3% of the HL-CASE strains and 77.4% of all MDRE strains. This study should facilitate decision-making concerning the most suitable screening policy for MDRE detection in a given ICU setting.
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Affiliation(s)
- P Grohs
- Service de Microbiologie, AP-HP Hôpital Européen Georges Pompidou, Paris Cedex 15, France
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Didelot X, Gardy J, Colijn C. Bayesian inference of infectious disease transmission from whole-genome sequence data. Mol Biol Evol 2014; 31:1869-79. [PMID: 24714079 PMCID: PMC4069612 DOI: 10.1093/molbev/msu121] [Citation(s) in RCA: 138] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Genomics is increasingly being used to investigate disease outbreaks, but an important question remains unanswered—how well do genomic data capture known transmission events, particularly for pathogens with long carriage periods or large within-host population sizes? Here we present a novel Bayesian approach to reconstruct densely sampled outbreaks from genomic data while considering within-host diversity. We infer a time-labeled phylogeny using Bayesian evolutionary analysis by sampling trees (BEAST), and then infer a transmission network via a Monte Carlo Markov chain. We find that under a realistic model of within-host evolution, reconstructions of simulated outbreaks contain substantial uncertainty even when genomic data reflect a high substitution rate. Reconstruction of a real-world tuberculosis outbreak displayed similar uncertainty, although the correct source case and several clusters of epidemiologically linked cases were identified. We conclude that genomics cannot wholly replace traditional epidemiology but that Bayesian reconstructions derived from sequence data may form a useful starting point for a genomic epidemiology investigation.
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Affiliation(s)
- Xavier Didelot
- Department of Infectious Disease Epidemiology, Imperial College London, London, United Kingdom
| | - Jennifer Gardy
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, BC, CanadaSchool of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Caroline Colijn
- Department of Mathematics, Imperial College London, United Kingdom
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Haverkate MR, Derde LPG, Brun-Buisson C, Bonten MJM, Bootsma MCJ. Duration of colonization with antimicrobial-resistant bacteria after ICU discharge. Intensive Care Med 2014; 40:564-71. [PMID: 24522879 PMCID: PMC3969519 DOI: 10.1007/s00134-014-3225-8] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 01/20/2014] [Indexed: 11/27/2022]
Abstract
PURPOSE Readmission of patients colonized with antimicrobial-resistant bacteria (AMRB) is important in the nosocomial dynamics of AMRB. We assessed the duration of colonization after discharge from the intensive care unit (ICU) with highly resistant Enterobacteriaceae (HRE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant enterococci (VRE). METHODS Data were obtained from a cluster-randomized trial in 13 ICUs in 8 European countries (MOSAR-ICU trial, 2008-2011). All patients were screened on admission and twice weekly for AMRB. All patients colonized with HRE, MRSA, or VRE and readmitted to the same ICU during the study period were included in the current analysis. Time between discharge and readmission was calculated, and the colonization status at readmission was assessed. Because of interval-censored data, a maximum likelihood analysis was used to calculate the survival function, taking censoring into account. A nonparametric two-sample test was used to test for differences in the survival curves. RESULTS The MOSAR-ICU trial included 14,390 patients, and a total of 64,997 cultures were taken from 8,974 patients admitted for at least 3 days. One hundred twenty-five unique patients had 141 episodes with AMRB colonization and at least 1 readmission. Thirty-two patients were colonized with two or more AMRBs. Median times until clearance were 4.8 months for all AMRB together, 1.4 months for HRE, <1 month for MRSA, and 1.5 months for VRE. There were no significant differences between the survival curves. CONCLUSION Fifty percent of the patients had lost colonization when readmitted 2 or more months after previous ICU discharge.
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Affiliation(s)
- Manon R Haverkate
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Huispost Geuns 5.02, Heidelberglaan 100, 3584 CK, Utrecht, The Netherlands,
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Shenoy ES, Paras ML, Noubary F, Walensky RP, Hooper DC. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis 2014; 14:177. [PMID: 24678646 PMCID: PMC4230428 DOI: 10.1186/1471-2334-14-177] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 03/19/2014] [Indexed: 11/17/2022] Open
Abstract
Background No published systematic reviews have assessed the natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE). Time to clearance of colonization has important implications for patient care and infection control policy. Methods We performed parallel searches in OVID Medline for studies that reported the time to documented clearance of MRSA and VRE colonization in the absence of treatment, published between January 1990 and July 2012. Results For MRSA, we screened 982 articles, identified 16 eligible studies (13 observational studies and 3 randomized controlled trials), for a total of 1,804 non-duplicated subjects. For VRE, we screened 284 articles, identified 13 eligible studies (12 observational studies and 1 randomized controlled trial), for a total of 1,936 non-duplicated subjects. Studies reported varying definitions of clearance of colonization; no study reported time of initial colonization. Studies varied in the frequency of sampling, assays used for sampling, and follow-up period. The median duration of total follow-up was 38 weeks for MRSA and 25 weeks for VRE. Based on pooled analyses, the model-estimated median time to clearance was 88 weeks after documented colonization for MRSA-colonized patients and 26 weeks for VRE-colonized patients. In a secondary analysis, clearance rates for MRSA and VRE were compared by restricting the duration of follow-up for the MRSA studies to the maximum observed time point for VRE studies (43 weeks). With this restriction, the model-fitted median time to documented clearance for MRSA would occur at 41 weeks after documented colonization, demonstrating the sensitivity of the pooled estimate to length of study follow-up. Conclusions Few available studies report the natural history of MRSA and VRE colonization. Lack of a consistent definition of clearance, uncertainty regarding the time of initial colonization, variation in frequency of sampling for persistent colonization, assays employed and variation in duration of follow-up are limitations of the existing published literature. The heterogeneity of study characteristics limits interpretation of pooled estimates of time to clearance, however, studies included in this review suggest an increase in documented clearance over time, a result which is sensitive to duration of follow-up.
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Affiliation(s)
- Erica S Shenoy
- Division of Infectious Diseases, Infection Control Unit and Medical Practice Evaluation Center, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
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Lucet JC, Koulenti D, Zahar JR. Persistence of colonisation with MDRO following discharge from the ICU. Intensive Care Med 2014; 40:603-5. [PMID: 24610480 DOI: 10.1007/s00134-014-3258-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Jean-Christophe Lucet
- Infection Control Unit, Bichat-Claude Bernard Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France,
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Rogers C, Sharma A, Rimland D, Stafford C, Jernigan J, Satola S, Crispell E, Gaynes R. Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features. Am J Infect Control 2014; 42:249-53. [PMID: 24406255 DOI: 10.1016/j.ajic.2013.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with a history of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection are often presumed to remain colonized when they are readmitted to the hospital. This assumption underlies the hospital practice that flags MRSA-positive patients so that these patients can be placed in contact isolation at hospital admission and, when necessary, be given the appropriate empirical therapy and/or antibiotic prophylaxis. METHODS To determine the duration of and factors associated with MRSA colonization among patients following discharge, we designed a cohort study of patients hospitalized between October 1, 2007, and July 31, 2009, at the Atlanta Veterans Affairs Medical Center, a 128-bed acute care facility. We defined 3 cohorts: cohort A; patients with both a MRSA infection during hospitalization and nasal colonization at discharge; cohort B; patients with a MRSA infection but no nasal colonization at discharge; and cohort C; patients only nasally colonized at discharge. We collected information on demographic characteristics, underlying conditions, infections, and antibiotic use. We cultured nasal swabs obtained from patients at home. We calculated hazard ratios (HR), comparing cohorts A, B, and C after controlling for other factors. RESULTS We obtained 231 swabs (23 in cohort A, 34 in cohort B, and 174 in cohort C). We documented MRSA colonization in 92 (39.9%) of the 231 patients who returned swabs. The median duration of colonization was 33.3 months. Factors significantly associated with persistent MRSA colonization were (1) total duration of hospital stay from previous admissions prior to study entry and (2) a member of cohort A who had a longer duration of colonization compared with cohorts B and C (P < .001). CONCLUSION Our data suggest that higher initial inocula of bacteria may be an important determinant of persistent colonization with MRSA.
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Affiliation(s)
| | - Akshay Sharma
- Atlanta Veterans Affairs Medical Center, Decatur, GA; Department of Epidemiology, Emory University Laney Graduate School, Atlanta, GA
| | - David Rimland
- Atlanta Veterans Affairs Medical Center, Decatur, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Emory University School of Medicine, Atlanta, GA
| | | | - John Jernigan
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah Satola
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Emory University School of Medicine, Atlanta, GA
| | | | - Robert Gaynes
- Atlanta Veterans Affairs Medical Center, Decatur, GA; Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Emory University School of Medicine, Atlanta, GA.
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Miller RR, Walker AS, Godwin H, Fung R, Votintseva A, Bowden R, Mant D, Peto TEA, Crook DW, Knox K. Dynamics of acquisition and loss of carriage of Staphylococcus aureus strains in the community: the effect of clonal complex. J Infect 2014; 68:426-39. [PMID: 24393651 PMCID: PMC4003537 DOI: 10.1016/j.jinf.2013.12.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 12/17/2013] [Accepted: 12/24/2013] [Indexed: 11/29/2022]
Abstract
Background Staphylococcus aureus nasal carriage increases infection risk. However, few studies have investigated S. aureus acquisition/loss over >1 year, and fewer still used molecular typing. Methods 1123 adults attending five Oxfordshire general practices had nasal swabs taken. 571 were re-swabbed after one month then every two months for median two years. All S. aureus isolates were spa-typed. Risk factors were collected from interviews and medical records. Results 32% carried S. aureus at recruitment (<1% MRSA). Rates of spa-type acquisition were similar in participants S. aureus positive (1.4%/month) and negative (1.8%/month, P = 0.13) at recruitment. Rates were faster in those carrying clonal complex (CC)15 (adjusted (a)P = 0.03) or CC8 (including USA300) (aP = 0.001) at recruitment versus other CCs. 157/274 (57%) participants S. aureus positive at recruitment returning ≥12 swabs carried S. aureus consistently, of whom 135 carried the same spa-type. CC22 (including EMRSA-15) was more prevalent in long-term than intermittent spa-type carriers (aP = 0.03). Antibiotics transiently reduced carriage, but no other modifiable risk factors were found. Conclusions Both transient and longer-term carriage exist; however, the approximately constant rates of S. aureus gain and loss suggest that ‘never’ or truly ‘persistent’ carriage are rare. Long-term carriage varies by strain, offering new explanations for the success of certain S. aureus clones.
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Affiliation(s)
- Ruth R Miller
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; UBC School of Population and Public Health, British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada.
| | - A Sarah Walker
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Heather Godwin
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; Oxford University Hospitals National Health Service Trust, Oxford OX3 9DU, United Kingdom
| | - Rowena Fung
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Antonina Votintseva
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Rory Bowden
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; Department of Statistics, University of Oxford, Oxford OX1 3TG, United Kingdom; Wellcome Trust Centre for Human Genetics, Oxford OX3 7BN, United Kingdom
| | - David Mant
- Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2ET, United Kingdom
| | - Timothy E A Peto
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Derrick W Crook
- Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Kyle Knox
- National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom; Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2ET, United Kingdom
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Wang X, Panchanathan S, Chowell G. A data-driven mathematical model of CA-MRSA transmission among age groups: evaluating the effect of control interventions. PLoS Comput Biol 2013; 9:e1003328. [PMID: 24277998 PMCID: PMC3836697 DOI: 10.1371/journal.pcbi.1003328] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 09/24/2013] [Indexed: 01/29/2023] Open
Abstract
Community associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has become a major cause of skin and soft tissue infections (SSTIs) in the US. We developed an age-structured compartmental model to study the spread of CA-MRSA at the population level and assess the effect of control intervention strategies. We used Monte-Carlo Markov Chain (MCMC) techniques to parameterize our model using monthly time series data on SSTIs incidence in children (≤ 19 years) during January 2004 -December 2006 in Maricopa County, Arizona. Our model-based forecast for the period January 2007-December 2008 also provided a good fit to data. We also carried out an uncertainty and sensitivity analysis on the control reproduction number, Rc which we estimated at 1.3 (95% CI [1.2,1.4]) based on the model fit to data. Using our calibrated model, we evaluated the effect of typical intervention strategies namely reducing the contact rate of infected individuals owing to awareness of infection and decolonization strategies targeting symptomatic infected individuals on both [Formula: see text] and the long-term disease dynamics. We also evaluated the impact of hypothetical decolonization strategies targeting asymptomatic colonized individuals. We found that strategies focused on infected individuals were not capable of achieving disease control when implemented alone or in combination. In contrast, our results suggest that decolonization strategies targeting the pediatric population colonized with CA-MRSA have the potential of achieving disease elimination.
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Affiliation(s)
- Xiaoxia Wang
- Mathematical, Computational and Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
| | - Sarada Panchanathan
- Department of Pediatrics, Maricopa Integrated Health System, Phoenix, Arizona, United States of America
- Department of Biomedical Informatics, Arizona State University, Tempe, Arizona, United States of America
| | - Gerardo Chowell
- Mathematical, Computational and Modeling Sciences Center, School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, United States of America
- Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America
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Deeny SR, Cooper BS, Cookson B, Hopkins S, Robotham JV. Targeted versus universal screening and decolonization to reduce healthcare-associated meticillin-resistant Staphylococcus aureus infection. J Hosp Infect 2013; 85:33-44. [PMID: 23911111 DOI: 10.1016/j.jhin.2013.03.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 03/13/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND The benefits of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening, compared with screening targeted patient groups and the additional impact of discharge screening, are uncertain. AIMS To quantify the impact of MRSA screening plus decolonization treatment on MRSA infection rates. To compare universal with targeted screening policies, and to evaluate the additional impact of screening and decolonization on discharge. METHODS A stochastic, individual-based model of MRSA transmission was developed that included patient movements between general medical and intensive care unit (ICU) wards, and between the hospital and community, informed by 18 months of individual patient data from a 900-bed tertiary care hospital. We simulated the impact of universal and targeted [for ICU, acute care of the elderly (ACE) or readmitted patients] MRSA screening and decolonization policies, both on admission and discharge. FINDINGS Universal admission screening plus decolonization resulted in 77% (95% confidence interval: 76-78) reduction in MRSA infections over 10 years. Screening only ACE specialty or ICU patients yielded 62% (61-63) and 66% (65-67) reductions, respectively. Targeted policies reduced the number of screens by up to 95% and courses of decolonization by 96%. In addition to screening on admission, screening on discharge had little impact, with a maximum 7% additional reduction in infection. CONCLUSIONS Compared with universal screening, targeted screening substantially reduced the amount of screening and decolonization required to achieve only 12% lower reduction in infection. Targeted screening and decolonization could lower the risk of resistance emerging as well as offer a more efficient use of resources.
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Kluytmans-van den Bergh MFQ, Vos MC, Diederen BMW, Vandenbroucke-Grauls CMJE, Voss A, Kluytmans JAJW. Dutch guideline on the laboratory detection of methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2013; 33:89-101. [PMID: 23893016 DOI: 10.1007/s10096-013-1933-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/11/2013] [Indexed: 01/25/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has rapidly emerged worldwide, affecting both healthcare and community settings, and intensive livestock industry. The efficient control of MRSA strongly depends on its adequate laboratory detection. This guideline provides recommendations on the appropriate use of currently available diagnostic laboratory methods for the timely and accurate detection of MRSA in patients and healthcare workers. Herewith, it aims to standardise and improve the diagnostic laboratory procedures that are used for the detection of MRSA in Dutch medical microbiology laboratories.
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Shenoy ES, Kim J, Rosenberg ES, Cotter JA, Lee H, Walensky RP, Hooper DC. Discontinuation of contact precautions for methicillin-resistant staphylococcus aureus: a randomized controlled trial comparing passive and active screening with culture and polymerase chain reaction. Clin Infect Dis 2013; 57:176-84. [PMID: 23572482 PMCID: PMC3689342 DOI: 10.1093/cid/cit206] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Accepted: 02/20/2013] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There have been no randomized controlled trials comparing active and passive screening for documenting clearance of colonization with methicillin-resistant Staphylococcus aureus (MRSA). We compared the efficacy of active and passive screening using both culture and commercial polymerase chain reaction (PCR) for documentation of MRSA clearance and discontinuation of MRSA contact precautions (CPs). METHODS Inpatients with a history of MRSA infection or colonization enrolled between December 2010 and September 2011 were randomized to either passive (nonintervention arm; n = 202; observation with local standard of care) or active screening (intervention arm; n = 405; study staff screened using culture and commercial PCR). The primary outcome was discontinuation of CPs by trial arm based on 3 negative cultures. In the intervention arm, sensitivity, specificity, and positive and negative predictive values of the first PCR were compared to cultures. RESULTS CPs were discontinued significantly more often (rate ratio [RR], 4.1; 95% confidence interval [CI], 2.3%-7.1%) in the intervention arm, including in an intent-to-screen analysis (RR, 2.6; 95% CI, 1.5%-4.7%). The first PCR, compared to 3 cultures, detected MRSA with a sensitivity of 93.9% (95% CI, 85.4%-97.6%), a specificity of 92.0% (95% CI, 85.9%-95.6%), a positive predictive value of 86.1% (95% CI, 75.9%-93.1%), and a negative predictive value of 96.6% (95% CI, 91.6%-99.1%). CONCLUSIONS Compared to passive screening using culture methods, active screening resulted in discontinuation of MRSA CPs at a significantly higher frequency. Active screening with a single PCR would significantly increase the completion of the screening process. Clinical Trials Registration. NCT01234831.
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Affiliation(s)
- Erica S Shenoy
- Massachusetts General Hospital, Division of Infectious Diseases and Infection Control Unit, 55 Fruit St, Bulfinch 340, Boston, MA 02114, USA.
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Sim BLH, McBryde E, Street AC, Marshall C. Multiple site surveillance cultures as a predictor of methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 2013; 34:818-24. [PMID: 23838222 DOI: 10.1086/671273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relationship between methicillin-resistant Staphylococcus aureus (MRSA) colonization density, colonization site, and probability of infection in a frequently screened cohort of intensive care unit (ICU) patients. METHODS Patients had swab samples tested for MRSA at admission to the ICU, discharge from the ICU, and twice weekly during their ICU stay, and they were followed up for development of MRSA infection. Swab test results were analyzed to determine the proportion of patients colonized and the proportion colonized at each screening site. Hazard of MRSA infection (rate of infection per day at risk) was calculated using a Cox proportional hazards analysis, and risk factors for MRSA infection, including presence of MRSA, degree of colonization, and pattern of colonization were determined. RESULTS Among the 4,194 patient episodes, 238 (5.7%) had screening results that were positive for MRSA, and there were 34 cases of MRSA infection. The hazard ratio (HR) for developing an infection increased as more sites were colonized (HR, 3.4 for being colonized at more than 1 site compared with colonization at 1 site [95% confidence interval, 1.2-9.9]). Colonization site was predictive of developing infection (HR for nose or throat colonization compared with no colonization, 168 [95% confidence interval, 69-407]). CONCLUSION This study demonstrated that the hazard of developing an infection was higher when more sites were colonized and that certain sites were more predictive of infection than others. These results may be useful for predicting infection in ICU patients and may influence treatment.
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Affiliation(s)
- Benedict Lim Heng Sim
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
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Grohs P, Pineau B, Kac G, Gutmann L, Meyer G. Readmission of known MRSA carriers and MRSA colonization pressure in hospital. Epidemiol Infect 2013; 141:1181-6. [PMID: 22963888 PMCID: PMC9151857 DOI: 10.1017/s0950268812001847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/27/2012] [Accepted: 07/27/2012] [Indexed: 11/06/2022] Open
Abstract
Readmission of asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) carriers may contribute to the hospital reservoir. Using an electronic alert system, we assessed the weight of readmission of known MRSA carriers on MRSA colonization pressure in a hospital setting. During the 2004-2010 period, 2058 alerts were generated for 1060 inpatients. A total of 486/1060 patients (46%) were readmitted at least once, and 330/486 (64·4%) were readmitted <3 months after discharge. A mean of 20 MRSA patients were present on the same day (from 40 in 2004 to eight in 2010). The number of MRSA patient-days was 34 575, i.e. 2·5% of the 1 366 277 patient-days of the study period, and 17 737 (51·3%) MRSA patient-days were due to readmission of known MRSA carriers. The number of new MRSA cases was partly correlated with the number of MRSA patients hospitalized (R 2 = 0·49). Rapid electronic identification of these patients proved essential in decreasing the global burden of MRSA in our hospital.
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Affiliation(s)
- P Grohs
- Service de Microbiologie, AP-HP, Hôpital Européen Georges Pompidou, Paris, France.
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Grgurich PE, Hudcova J, Lei Y, Sarwar A, Craven DE. Management and prevention of ventilator-associated pneumonia caused by multidrug-resistant pathogens. Expert Rev Respir Med 2013; 6:533-55. [PMID: 23134248 DOI: 10.1586/ers.12.45] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Ventilator-associated pneumonia (VAP) due to multidrug-resistant (MDR) pathogens is a leading healthcare-associated infection in mechanically ventilated patients. The incidence of VAP due to MDR pathogens has increased significantly in the last decade. Risk factors for VAP due to MDR organisms include advanced age, immunosuppression, broad-spectrum antibiotic exposure, increased severity of illness, previous hospitalization or residence in a chronic care facility and prolonged duration of invasive mechanical ventilation. Methicillin-resistant Staphylococcus aureus and several different species of Gram-negative bacteria can cause MDR VAP. Especially difficult Gram-negative bacteria include Pseudomonas aeruginosa, Acinetobacter baumannii, carbapenemase-producing Enterobacteraciae and extended-spectrum β-lactamase producing bacteria. Proper management includes selecting appropriate antibiotics, optimizing dosing and using timely de-escalation based on antiimicrobial sensitivity data. Evidence-based strategies to prevent VAP that incorporate multidisciplinary staff education and collaboration are essential to reduce the burden of this disease and associated healthcare costs.
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Affiliation(s)
- Philip E Grgurich
- Department of Pharmacy, Lahey Clinic Medical Center, Burlington, MA 01805, USA
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Davis MF, Iverson SA, Baron P, Vasse A, Silbergeld EK, Lautenbach E, Morris DO. Household transmission of meticillin-resistant Staphylococcus aureus and other staphylococci. THE LANCET. INFECTIOUS DISEASES 2012; 12:703-16. [PMID: 22917102 DOI: 10.1016/s1473-3099(12)70156-1] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Although the role of pets in household transmission of meticillin-resistant Staphylococcus aureus (MRSA) has been examined previously, only minor attention has been given to the role of the abiotic household environment independent of, or in combination with, colonisation of pets and human beings to maintain transmission cycles of MRSA within the household. This report reviews published work about household transmission of S aureus and other staphylococci and describes contamination of household environmental surfaces and colonisation of pets and people. Household microbial communities might have a role in transfer of antimicrobial resistance genes and could be reservoirs for recolonisation of people, although additional research is needed regarding strategies for decontamination of household environments. Household-based interventions should be developed to control recurrent S aureus infections in the community, and coordination between medical and veterinary providers could be beneficial.
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Affiliation(s)
- Meghan F Davis
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
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Post-discharge mortality in patients hospitalized with MRSA infection and/or colonization. Epidemiol Infect 2012; 141:1187-98. [PMID: 22971269 DOI: 10.1017/s0950268812001963] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is known to increase in-hospital mortality, but little is known about its association with long-term health. Two hundred and thirty-seven deaths occurred among 707 patients with MRSA infection at the time of hospitalization and/or nasal colonization followed for almost 4 years after discharge from the Atlanta Veterans Affairs Medical Center, USA. The crude mortality rate in patients with an infection and colonization (23·57/100 person-years) was significantly higher than the rate in patients with only colonization (15·67/100 person-years, P = 0·037). MRSA infection, hospitalization within past 6 months, and histories of cancer or haemodialysis were independent risk factors. Adjusted mortality rates in patients with infection were almost twice as high compared to patients who were only colonized: patients infected and colonized [hazard ratio (HR) 1·93, 95% confidence interval (CI) 1·31-2·84]; patients infected but not colonized (HR 1·96, 95% CI 1·22-3·17). Surviving MRSA infection adversely affects long-term mortality, underscoring the importance of infection control in healthcare settings.
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MRSA decolonization: success rate, risk factors for failure and optimal duration of follow-up. Infection 2012; 41:33-40. [DOI: 10.1007/s15010-012-0290-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 06/19/2012] [Indexed: 10/28/2022]
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Peterson AE, Davis MF, Julian KG, Awantang G, Greene WH, Price LB, Waters A, Doppalapudi A, Krain LJ, Nelson K, Silbergeld EK, Whitener CJ. Molecular and phenotypic characteristics of healthcare- and community-associated methicillin-resistant Staphylococcus aureus at a rural hospital. PLoS One 2012; 7:e38354. [PMID: 22719880 PMCID: PMC3376098 DOI: 10.1371/journal.pone.0038354] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 05/07/2012] [Indexed: 01/03/2023] Open
Abstract
Background While methicillin-resistant Staphylococcus aureus (MRSA) originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve. Methods To characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST) classification schemes to 94 case-patients. Results By MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs)–CC5 (51 isolates), historically associated with hospitals, and CC8 (27 isolates), historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin. Conclusions Hospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains.
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Affiliation(s)
- Amy E. Peterson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Meghan F. Davis
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- * E-mail:
| | - Kathleen G. Julian
- Penn State Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Grace Awantang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Wallace H. Greene
- Penn State Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Lance B. Price
- The Translational Genomics Research Institute, Flagstaff, Arizona, United States of America
| | - Andrew Waters
- The Translational Genomics Research Institute, Flagstaff, Arizona, United States of America
| | - Avanthi Doppalapudi
- Penn State Hershey Medical Center, Hershey, Pennsylvania, United States of America
| | - Lisa J. Krain
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kenrad Nelson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Ellen K. Silbergeld
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cynthia J. Whitener
- Penn State Hershey Medical Center, Hershey, Pennsylvania, United States of America
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Sieber S, Gerber V, Jandova V, Rossano A, Evison JM, Perreten V. Evolution of multidrug-resistant Staphylococcus aureus infections in horses and colonized personnel in an equine clinic between 2005 and 2010. Microb Drug Resist 2012; 17:471-8. [PMID: 21875361 DOI: 10.1089/mdr.2010.0188] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A total of 70 Staphylococcus aureus isolates from postoperative infections in hospitalized horses were isolated between January 2005 and January 2011. Among them, 12 isolates were methicillin-susceptible S. aureus (MSSA), 18 were borderline-oxacillin-resistant S. aureus (BORSA), and 40 were methicillin-resistant S. aureus (MRSA). During the same period, the equine clinic personnel were screened for nasal carriage of BORSA and MRSA. Genotyping revealed that BORSA ST1(MLST)-t2863(spa) isolates were responsible for most equine infections and were the main isolates found in colonized members of the personnel between 2005 and 2007, and that in 2007, MRSA ST398-t011-IVa(SCCmec) emerged in infection sites and personnel, replacing BORSA. Besides decreased susceptibility to oxacillin, all MRSA and BORSA of these two major clonal lineages displayed resistance to gentamicin and kanamycin conferred by the aac(6')-Ie-aph(2')-Ia gene and to trimethoprim conferred by dfr(K) in MRSA and dfr(A) in BORSA. All MRSA had additional resistance to tetracycline conferred by tet(M), whereas BORSA generally also display resistance to streptomycin conferred by str. The number of hospital-acquired MRSA infections in horses could be limited after the introduction of basic hygiene measures and personnel decolonization. Two MRSA carriers could not be decolonized using mupirocin, and a year after decolonization, additional members were recolonized with MRSA. Hygiene measures should, therefore, be maintained to limit the transmission of S. aureus between personnel and horses.
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Affiliation(s)
- Sandra Sieber
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
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Morris DO, Lautenbach E, Zaoutis T, Leckerman K, Edelstein PH, Rankin SC. Potential for pet animals to harbour methicillin-resistant Staphylococcus aureus when residing with human MRSA patients. Zoonoses Public Health 2012; 59:286-93. [PMID: 22233337 DOI: 10.1111/j.1863-2378.2011.01448.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Colonization by methicillin-resistant Staphylococcus aureus (MRSA) may be persistent in people and is horizontally transmissible. The scientific literature suggests that domestic pets may also participate in cross-transmission of MRSA within households. The objectives of this study were to evaluate the prevalence of and risk factors for MRSA carriage by pets residing in households with an MRSA-infected person. From 66 households in which an MRSA-infected patient resided, we screened 47 dogs and 52 cats using a swab protocol. Isolates from pets and humans were genotyped using two techniques and compared for concordance. Human participants completed a 22-question survey of demographic and epidemiologic data relevant to staphylococcal transmission. Eleven of 99 pets (11.5%) representing 9 (13.6%) of households were MRSA-positive, but in only six of these households were the human and animal-source strains genetically concordant. Human infection by strain USA 100 was significantly associated with pet carriage [OR = 11.4 (95% CI 1.7, 76.9); P = 0.013]. Yet, for each day of delay in sampling the pet after the person's MRSA diagnosis, the odds of isolating any type of MRSA from the pet decreased by 13.9% [(95% CI 2.6, 23.8); P = 0.017)]. It may be concluded that pets can harbour pandemic strains of MRSA while residing in a household with an infected person. However, the source of MRSA to the pet cannot always be attributed to the human patient. Moreover, the rapid attrition of the odds of obtaining a positive culture from pets over time suggests that MRSA carriage may be fleeting.
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Affiliation(s)
- D O Morris
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Kollef MH, Micek ST. Patients hospitalized with pneumonia: determining the need for broad-spectrum antibiotic therapy. Clin Infect Dis 2011; 54:479-82. [PMID: 22109952 DOI: 10.1093/cid/cir848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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Abstract
Healthcare-associated pneumonia patients have worse outcomes and a different microbiologic profile than those with community-acquired pneumonia, including a greater risk for multidrug-resistant (MDR) organism infection. Risks include hospitalization for 2 or more days within 90 days, presentation from a nursing home or long-term care facility, attending a hospital or hemodialysis clinic, receiving intravenous therapy within 30 days, and immunosuppression. Ability to predict infection with MDR organisms varies, and the relative frequency of MDR organisms varies by geographic region. Initial treatment is broad-spectrum empiric antibiotics.
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Affiliation(s)
- Andrew Labelle
- Division of Pulmonary and Critical Care, Washington University School of Medicine, St Louis, MO 63110, USA.
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50
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Ammerlaan HSM, Kluytmans JAJW, Berkhout H, Buiting A, de Brauwer EIGB, van den Broek PJ, van Gelderen P, Leenders S(ACAP, Ott A, Richter C, Spanjaard L, Spijkerman IJB, van Tiel FH, Voorn GP, Wulf MWH, van Zeijl J, Troelstra A, Bonten MJM, van de Berg CMF, Bosman J, Bremer A, Bril W, Commeren D, van Essen G, Gigengack-Baars A, van Kasteren MME, Lommerse EJM, Mascini E, Renders NHM, van Rijen M, Schellekens J, Smeets E, Sprangers T, Vandenbroucke-Grauls CMJE, Verbon A, Verduin K, Wagenvoort JHT, van Wijngaarden P. Eradication of carriage with methicillin-resistant Staphylococcus aureus: effectiveness of a national guideline. J Antimicrob Chemother 2011; 66:2409-17. [DOI: 10.1093/jac/dkr243] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Heidi S. M. Ammerlaan
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Jan A. J. W. Kluytmans
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
- Laboratory for Microbiology and Infection Control, Amphia Hospital Breda, Molengracht 21, 4818 CK Breda, The Netherlands
| | - Hanneke Berkhout
- Department of Medical Microbiology, Immunology and Hygiene and Infection Prevention, VieCuri Medical Centre, Tegelseweg 210, 5912 BL Venlo, The Netherlands
| | - Anton Buiting
- Department of Medical Microbiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Els I. G. B. de Brauwer
- Department of Medical Microbiology, Atrium Medical Centre, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Peterhans J. van den Broek
- Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Paula van Gelderen
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | | | - Alewijn Ott
- Laboratory for Infectious Diseases, Van Ketwich Verschuurlaan 92, 9721 SW Groningen, The Netherlands
| | - Clemens Richter
- Department of Internal Medicine, Rijnstate Hospital, Wagnerlaan 55, 6815 AD Arnhem, The Netherlands
| | - Lodewijk Spanjaard
- Department of Medical Microbiology and Centre for Infection and Immunity Amsterdam, Academic Medical Centre, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Ingrid J. B. Spijkerman
- Department of Medical Microbiology and Infection Control, VUmc Medical University, Boelelaan 1117, 1081 HV Amsterdam, The Netherlands
| | - Frank H. van Tiel
- Department of Medical Microbiology, Academic Hospital Maastricht, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - G. Paul Voorn
- Department of Medical Microbiology and Immunology, St Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands
| | - Mireille W. H. Wulf
- PAMM Laboratory for Medical Microbiology, De Run 6250, 5504 DL Veldhoven, The Netherlands
| | - Jan van Zeijl
- Izore, Centre Infectious Diseases Friesland, Jelsumerstraat 6, 8917 EN Leeuwarden, The Netherlands
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
| | - Marc J. M. Bonten
- Department of Medical Microbiology, University Medical Centre Utrecht, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
- Julius Centre for Healthcare Science and First line Medicine, Heidelberglaan 100, 3584 CX Utrecht, The Netherlands
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