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Reagan KA, Chan DM, Vanhoozer G, Bearman G. Estimating the effect of active detection and isolation on Clostridioides difficile infections in a bone marrow transplant unit. Infect Control Hosp Epidemiol 2023; 44:1614-1619. [PMID: 36912338 PMCID: PMC10587385 DOI: 10.1017/ice.2023.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 01/24/2023] [Accepted: 02/07/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE To model the effects of active detection and isolation (ADI) regarding Clostridioides difficile infection (CDI) in the bone marrow transplant (BMT) unit of our hospital. SETTING ADI was implemented in a 21-patient bone marrow unit. PATIENTS Patients were bone marrow recipients on this unit. INTERVENTIONS We compared active ADI, in which patients who tested positive for colonization of C. difficile before their hospital stay were placed under extra contact precautions, with cases not under ADI. RESULTS Within the BMT unit, ADI reduced total cases of CDI by 24.5% per year and reduced hospital-acquired cases by ∼84%. The results from our simulations also suggest that ADI can save ∼$67,600 per year in healthcare costs. CONCLUSIONS Institutions with active BMT units should consider implementing ADI.
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Affiliation(s)
- Kelly A. Reagan
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia
| | - David M. Chan
- Department of Mathematics and Applied Mathematics, Virginia Commonwealth University, Richmond, Virginia
| | - Ginger Vanhoozer
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia
| | - Gonzalo Bearman
- Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia
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Jung J, Park JH, Yang H, Lim YJ, Kim EO, Lim CM, Kim MN, Jo MW, Yun SC, Kim SH. Active surveillance testing to reduce transmission of carbapenem-resistant, gram-negative bacteria in intensive care units: a pragmatic, randomized cross-over trial. Antimicrob Resist Infect Control 2023; 12:16. [PMID: 36869371 PMCID: PMC9983515 DOI: 10.1186/s13756-023-01222-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/21/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND In intensive care unit (ICU) settings, the transmission risk of carbapenem-resistant, gram-negative bacteria (CRGNB) is high. There is a paucity of data regarding the effectiveness of interventions, including active screening, preemptive isolation, and contact precautions, to reduce transmission of CRGNB. METHODS We conducted a pragmatic, cluster-randomized, non-blinded cross-over study in 6 adult ICUs in a tertiary care center in Seoul, South Korea. ICUs were randomly assigned to perform active surveillance testing with preemptive isolation and contact precautions (intervention) or standard precautions (control) during the initial 6-month study period, followed by a 1-month washout period. During a subsequent 6-month period, departments that used standard precautions switched to using interventional precautions and vice versa. The incidence rates of CRGNB were compared between the two periods using Poisson regression analysis. RESULTS During the study period, there were 2268 and 2224 ICU admissions during the intervention and control periods, respectively. Because a carbapenemase-producing Enterobacterales outbreak occurred in a surgical ICU (SICU), we excluded admissions to the SICU during both the intervention and control periods and performed a modified intention-to-treat (mITT) analysis. In mITT analysis, a total of 1314 patients were included. The acquisition rate of CRGNB was 1.75 cases per 1000 person-days during the intervention period versus 3.33 cases per 1000 person-days during the control period (IRR, 0.53 [95% confidence interval (CI) 0.23-1.11]; P = 0.07). CONCLUSIONS Although this study was underpowered and showed borderline significance, active surveillance testing and preemptive isolation could be considered in settings with high baseline prevalence of CRGNB. Trial registration Clinicaltrials.gov Identifier: NCT03980197.
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Affiliation(s)
- Jiwon Jung
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Joung Ha Park
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.,Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
| | - Hyejin Yang
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Young-Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, South Korea
| | - Chae-Man Lim
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Mi-Na Kim
- Department of Laboratory Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Min-Woo Jo
- Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Cheol Yun
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Sung-Han Kim
- Department of Infectious Disease, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. .,Office for Infection Control, Asan Medical Center, Seoul, South Korea.
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Kling K, Rios J, Dirnberger L, Polanco W, Fritz K, Malczynski M, Zembower T, Qi C. Development of a workflow for the detection of vancomycin-resistant Enterococcus faecium and Enterococcus faecalis from rectal swabs using the spectra VRE medium. Ann Clin Microbiol Antimicrob 2023; 22:2. [PMID: 36609280 PMCID: PMC9817359 DOI: 10.1186/s12941-023-00552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 01/03/2023] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Spectra™ VRE agar (Remel, Lenexa, KS) is a chromogenic agar that is FDA approved for screening patients for VRE colonization. The package insert recommends confirming isolates with identification and susceptibility testing, but confirming every culture delays time to result. Given the agar's historic high specificity for E. faecium isolates, we theorized the agar could be utilized as a stand-alone screening to minimize reagents and time. AIM Our laboratory sought to develop a workflow to optimize the use of the medium. METHODS We plated 3,815 rectal swabs to the Spectra VRE agar and compared results to traditional identification and susceptibility testing. RESULTS Dark blue or purple colonies on the agar demonstrated a sensitivity of 98% and specificity of 85% for detection of VRE faecium, but light blue colonies were significantly less specific for E. faecalis. CONCLUSIONS We streamlined our workflow to accept dark blue or purple colonies as VRE faecium and plan to perform additional testing only on light blue colonies. Interestingly, higher quantity of growth increased the accuracy of the agar. In the future, growth quantity may be used to further streamline the workflow once more data is obtained.
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Affiliation(s)
- Kendall Kling
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Javier Rios
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Laura Dirnberger
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Wanda Polanco
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Kevin Fritz
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Michael Malczynski
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
| | - Teresa Zembower
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA ,grid.16753.360000 0001 2299 3507Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, 676 N. St. Clair Street Suite 940, Chicago, IL 60611 USA
| | - Chao Qi
- grid.16753.360000 0001 2299 3507Clinical Microbiology Laboratory, Department of Pathology, Northwestern University Feinberg School of Medicine, 710 N Fairbanks Ct, Chicago, IL 60611 USA
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Kramer S, Omonaiye O, Digby R, Berry D, Considine J, Dunning T, Hutchinson AM, Hutchinson A, Manias E, Rasmussen B, Bucknall T. An evaluation of interventions to improve outcomes for hospitalized patients in isolation: A systematic review. Am J Infect Control 2022; 50:193-202. [PMID: 34525405 DOI: 10.1016/j.ajic.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes. OBJECTIVES To summarize the effects of interventions to improve safety and outcomes for patients in isolation DESIGN: Systematic review (PROSPERO protocol registration - CRD42020222779). SETTING Acute hospital PARTICIPANTS: Intervention studies including patients in preventative or protective isolation in a single room. METHODS MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality. RESULTS We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. Samples sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed. CONCLUSIONS There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients.
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Affiliation(s)
- Sharon Kramer
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia.
| | - Olumuyiwa Omonaiye
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Robin Digby
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
| | - Debra Berry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Trisha Dunning
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Barwon Health Partnership, Nursing Research, Geelong, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Nursing Research, Clayton, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Nursing Research, Melbourne, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Western Health Partnership, Nursing Research, Sunshine, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
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Amato B, Compagna R, De Vivo S, Rocca A, Carbone F, Gentile M, Cirocchi R, Squizzato F, Spertino A, Battocchio P. Groin Surgical Site Infection in Vascular Surgery: Systemic Review on Peri-Operative Antibiotic Prophylaxis. Antibiotics (Basel) 2022; 11:antibiotics11020134. [PMID: 35203737 PMCID: PMC8868080 DOI: 10.3390/antibiotics11020134] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/10/2022] [Accepted: 01/12/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives: Surgical site infections (SSIs) in lower extremity vascular surgeries, post-groin incision, are not only common complications and significant contributors to patient mortality and morbidity, but also major financial burdens on healthcare systems and patients. In spite of recent advances in pre- and post-operative care, SSI rates in the vascular surgery field remain significant. However, compliant antibiotic therapy can successfully reduce the SSI incidence pre- and post-surgery. Methods: In October 2021, we conducted a systematic literature review using OVID, PubMed, and EMBASE databases, centered on studies published between January 1980 and December 2020. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta Analyses checklist. Inclusion/exclusion criteria have been carefully selected and reported in the text. For analyses, we calculated 95% confidence intervals (CI) and weighted odds ratios to amalgamate control and study groups in publications. We applied The Cochrane Collaboration tool to assess bias risk in selected studies. Results: In total, 592 articles were identified. After the removal of duplicates and excluded studies, 36 full-texts were included for review. Conclusions: The review confirmed that antibiotic therapy, administered according to all peri-operative protocols described, is useful in reducing groin SSI rate in vascular surgery.
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Affiliation(s)
- Bruno Amato
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
- Correspondence: ; Tel.: +39-3403604022
| | - Rita Compagna
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Salvatore De Vivo
- Division of Vascular Surgery, Ospedale Pellegrini, 80100 Naples, Italy; (R.C.); (S.D.V.)
| | - Aldo Rocca
- Deparment of Medicine and Health Sciences “V. Tiberio”, University of Campobasso, 86100 Campobasso, Italy;
| | - Francesca Carbone
- Department of Public Health, University Federico II of Naples, 80131 Naples, Italy;
| | - Maurizio Gentile
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80131 Naples, Italy;
| | - Roberto Cirocchi
- Department of General and Oncologic Surgery, University of Perugia, 05100 Terni, Italy;
| | - Francesco Squizzato
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Andrea Spertino
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
| | - Piero Battocchio
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, 35100 Padova, Italy; (F.S.); (A.S.); (P.B.)
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Rasheed H, Diab K, Singh T, Chauhan Y, Haddad P, Zubair MM, Vowels T, Androas E, Rojo M, Auyang P, McFall R, Gomez LF, Mohamed A, Peden E, Rahimi M. Contemporary Review to Reduce Groin Surgical Site Infections in Vascular Surgery. Ann Vasc Surg 2020; 72:578-588. [PMID: 33157243 DOI: 10.1016/j.avsg.2020.09.046] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/20/2020] [Accepted: 09/22/2020] [Indexed: 12/20/2022]
Abstract
Surgical site infection (SSIs) in lower extremity vascular procedures is a major contributor to patient morbidity and mortality. Despite previous advancements in preoperative and postoperative care, the surgical infection rate in vascular surgery remains high, particularly when groin incisions are involved. However, successfully targeting modifiable risk factors reduces the surgical site infection incidence in vascular surgery patients. We conducted an extensive literature review to evaluate the efficacy of various preventive strategies for groin surgical site infections. We discuss the role of preoperative showers, preoperative and postoperative antibiotics, collagen gentamicin implants, iodine impregnated drapes, types of skin incisions, negative pressure wound therapy, and prophylactic muscle flap transposition in preventing surgical site infection in the groin after vascular surgical procedures.
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Affiliation(s)
- Haroon Rasheed
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Kaled Diab
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Tarundeep Singh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Yusuf Chauhan
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Paul Haddad
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - M Mujeeb Zubair
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Travis Vowels
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Edward Androas
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Manuel Rojo
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Phillip Auyang
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Ross McFall
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Luis Felipe Gomez
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Ahmed Mohamed
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Eric Peden
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX
| | - Maham Rahimi
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX.
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Point-Counterpoint: Active Surveillance for Carriers of Toxigenic Clostridium difficile Should Be Performed To Guide Prevention Efforts. J Clin Microbiol 2018; 56:JCM.00782-18. [PMID: 29769275 DOI: 10.1128/jcm.00782-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTIONIn 2017, the Journal of Clinical Microbiology published a Point-Counterpoint on the laboratory diagnosis of Clostridium difficile infection (CDI). At that time, Ferric C. Fang, Christopher R. Polage, and Mark H. Wilcox discussed the strategies for diagnosing Clostridium difficile colitis in symptomatic patients (J Clin Microbiol 55:670-680, 2017, https://doi.org/10.1128/JCM.02463-16). Since that paper, new guidelines from the Infectious Diseases Society of America and the Society for Health Care Epidemiology have been published (L. C. McDonald, D. N. Gerding, S. Johnson, J. S. Bakken, K. C. Carroll, et al., Clin Infect Dis 66:987-994, 2018, https://doi.org/10.1093/cid/ciy149) and health care systems have begun to explore screening asymptomatic patients for C. difficile colonization. The theory behind screening selected patient populations for C. difficile colonization is that these patients represent a substantial reservoir of the bacteria and can transfer the bacteria to other patients. Hospital administrators are taking note of institutional CDI rates because they are publicly reported. They have become an important metric impacting hospital safety ratings and value-based purchasing, and hospitals may have millions of dollars of reimbursement at risk. In this Point-Counterpoint, Cliff McDonald of the U.S. Centers for Disease Control and Prevention discusses the value of asymptomatic C. difficile screening, while Dan Diekema of the University of Iowa discusses why caution should be used.
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Hassan S, Kahn MD, Saraiya N, Nori P. Treatment of a complex orthopaedic infection due to extensively drug-resistant Pseudomonas aeruginosa. BMJ Case Rep 2018; 2018:bcr-2017-223202. [PMID: 29305368 DOI: 10.1136/bcr-2017-223202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
According to the Centers for Disease Control and Prevention (CDC), approximately 51 000 healthcare-associated infections caused by Pseudomonas aeruginosa occur annually in the USA, more than 6000 of which (13%) are caused by multidrug resistant (MDR) strains. Ceftolozane/tazobactam (TOL/TAZ) (Zerbaxa) was approved by the US Food and Drug Administration (FDA) in December 2014 for the treatment of complicated intra-abdominal and urinary tract infections. At this time, clinical data on the role of TOL/TAZ treatment outside of FDA-approved indications is limited. Herein, we present a case of extensively drug-resistant (XDR) P. aeruginosa osteomyelitis of the upper extremity, which was successfully treated with TOL/TAZ for 8 weeks with optimal clinical and laboratory responses. Monotherapy with TOL/TAZ appears effective for treatment of complicated bone and joint infections with XDR P. aeruginosa in combination with comprehensive surgical management, particularly when few antibiotic options exist.
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Affiliation(s)
- Sidra Hassan
- Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Mani D Kahn
- Department of Orthopedic Surgery, Montefiore Medical Center, Bronx, New York, USA
| | - Nidhi Saraiya
- Department of Pharmacy, Montefiore Wakefield Campus, Bronx, New York, USA
| | - Priya Nori
- Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
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Heckel M, Geißdörfer W, Herbst FA, Stiel S, Ostgathe C, Bogdan C. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis. PLoS One 2017; 12:e0188940. [PMID: 29228010 PMCID: PMC5724845 DOI: 10.1371/journal.pone.0188940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/15/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU). AIM The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach. DESIGN Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available. RESULTS 297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%). CONCLUSIONS PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Walter Geißdörfer
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | | | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
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10
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Alhussaini MS. Methicillin-resistant Staphylococcus aureus Nasal Carriage Among Patients Admitted at Shaqra General Hospital in Saudi Arabia. Pak J Biol Sci 2017; 19:233-238. [PMID: 29023028 DOI: 10.3923/pjbs.2016.233.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) have been causing increasing problems in hospitals and nursing homes worldwide. Limited number of studies in Saudi Arabia has attempted to investigate infection and risk factors associated with nosocomial acquired MRSA. The present study was undertaken to determine the occurrence, prevalence, antibiotic susceptibility pattern and genetic characteristics of MRSA among admitted cases at Shaqra General Hospital (Saudi Arabia). METHODOLOGY This study was conducted from October, 2014 to March, 2015. Nasal swabs were taken from 220 patients (105 males and 115 females) admitted at Shaqra General Hospital. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test and mannitol salt agar fermentation. Antibiotic susceptibility testing of MRSA was performed with standard disk diffusion method. All methicillin-resistant isolates were examined for the existence of the mecA gene by PCR technique. RESULTS Of the 220 patients, 90 (40.91%) were found to be nasal carriers of S. aureus. Among these 90 S. aureus isolates, 48 (21.82%) were MRSA. A statistically significant difference was only found for antibiotics usage between those with and without MRSA colonization. Antibiotic susceptibility pattern of isolated MRSA showed high susceptibility to vancomycin, linezolid, rifampicin, teicoplanin, complete resistance to penicillin, ampicillin, oxacillin and cefoxitin and intermediate resistance to amikacin, ciprofloxacin, teicoplanin, tetracycline and vancomycin. CONCLUSION A high prevalence of multidrug-resistant MRSA nasal carriage was found. The identification of MRSA carriers is a step towards establishing a control policy for MRSA and helps to identify measures needed to reduce colonization pressure.
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Affiliation(s)
- Mohammed S Alhussaini
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Shaqra University, Saudi Arabia
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Beresin GA, Wright JM, Rice GE, Jagai JS. Swine exposure and methicillin-resistant Staphylococcus aureus infection among hospitalized patients with skin and soft tissue infections in Illinois: A ZIP code-level analysis. ENVIRONMENTAL RESEARCH 2017; 159:46-60. [PMID: 28772149 PMCID: PMC5862075 DOI: 10.1016/j.envres.2017.07.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/14/2017] [Accepted: 07/18/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA), a bacterial pathogen, is a predominant cause of skin and soft tissue infections (SSTI) in the United States. Swine-production facilities have been recognized as potential environmental reservoirs of MRSA. To better understand how swine production may contribute to MRSA infection, we evaluated the association between MRSA infection among SSTI inpatients and exposure measures derived from national swine inventory data. METHODS Based on adjusted odds ratios from logistic regression models, we evaluated the association between swine exposure metrics and MRSA infections among all Illinois inpatient hospitalizations for SSTI from January 2008 through July 2011. We also assessed if swine exposures had greater association with suspected community-onset MRSA (CO-MRSA) compared to suspected hospital-onset MRSA (HO-MRSA). Exposures were estimated using the Farm Location and Agricultural Production Simulator, generating the number of farms with greater than 1000 swine per residential ZIP code and the residential ZIP code-level swine density (swine/km2). RESULTS For every increase in 100 swine/km2 within a residential ZIP code, the adjusted OR (aOR) for MRSA infection was 1.36 (95% CI: 1.28-1.45). For every additional large farm (i.e., >1000 swine) per ZIP code, the aOR for MRSA infection was 1.06 (95% CI: 1.04-1.07). The aOR for ZIP codes with any large farms compared to those with no large farms was 1.24 (95% CI: 1.19-1.29). We saw no evidence of an increased association for CO-MRSA compared to HO-MRSA with either continuous exposure metric (aORs=0.99), and observed inconsistent results across exposure categories. CONCLUSIONS These publicly-available, ecological exposure data demonstrated positive associations between swine exposure measures and individual-level MRSA infections among SSTI inpatients. Though it is difficult to draw definitive conclusions due to limitations of the data, these findings suggest that the risk of MRSA may increase based on indirect environmental exposure to swine production. Future research can address measurement error related to these data by improving exposure assessment precision, increased specification of MRSA strain, and better characterization of specific environmental exposure pathways.
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Affiliation(s)
- Glennon A Beresin
- Association of Schools and Programs of Public Health Environmental Health Fellowship hosted by Environmental Protection Agency: 1900 M Street NW, Suite 710, Washington, DC 20036, United States.
| | - J Michael Wright
- US Environmental Protection Agency, National Center for Environmental Assessment, 26 West Martin Luther King Dr., Cincinnati, OH 45268, United States
| | - Glenn E Rice
- US Environmental Protection Agency, National Center for Environmental Assessment, 26 West Martin Luther King Dr., Cincinnati, OH 45268, United States
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Tan TY, Jiang B, Ng LSY. Faster and economical screening for vancomycin-resistant enterococci by sequential use of chromogenic agar and real-time polymerase chain reaction. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 50:448-453. [DOI: 10.1016/j.jmii.2015.08.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Revised: 07/07/2015] [Accepted: 08/31/2015] [Indexed: 10/23/2022]
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Huang TS, Lee SSJ, Lee CC, Chen CY, Chen FC, Chen BC, Sy CL, Wu KS. Evaluation of a matrix-assisted laser desorption ionization-time of flight mass spectrometry assisted, selective broth method to screen for vancomycin-resistant enterococci in patients at high risk. PLoS One 2017; 12:e0179455. [PMID: 28609453 PMCID: PMC5469485 DOI: 10.1371/journal.pone.0179455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 05/29/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bile esculin azide with vancomycin (BEAV) medium is a sensitive, but slightly less specific method for vancomycin-resistant enterococci (VRE) screening. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a rapid method for identification of clinical pathogens. This study aimed to assess the performance of a novel combination screening test for VRE, using BEAV broth combined with MALDI-TOF MS. MATERIALS AND METHODS Clinical specimens were collected from patients at risk of VRE carriage, and tested by the novel combination method, using selective BEAV broth culture method followed by MALDI-TOF MS identification (SBEAVM). The reference method used for comparison was the ChromID VRE agar method. RESULTS A total of 135 specimens were collected from 78 patients, and 63 specimens tested positive for VRE positive using the ChromID VRE method (positive rate 46.7%). The sensitivity, specificity, positive predictive value, and negative predictive value of SBEAVM method after an incubation period of 28 hours were 93.7%, 90.3%, 89.4%, and 94.2%, respectively. The SBEAVM method when compared to the ChromID VRE method had a shorter turnaround time (29 vs. 48-72 hours) and lower laboratory cost ($2.11 vs. $3.23 per test). CONCLUSIONS This study demonstrates that SBEAVM is a rapid, inexpensive, and accurate method for use in VRE screening.
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Affiliation(s)
- Tsi-Shu Huang
- Division of Microbiology, Department of pathology and laboratory medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Susan Shin-Jung Lee
- Division of Microbiology, Department of pathology and laboratory medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chia-Chien Lee
- Division of Microbiology, Department of pathology and laboratory medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chiu-Yen Chen
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Fang-Chen Chen
- Department of Nursing, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Infection Control Unit, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bao-Chen Chen
- Division of Microbiology, Department of pathology and laboratory medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Cheng Len Sy
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuan-Sheng Wu
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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An JH, Kim YH, Moon JE, Jeong JH, Kim SH, Kang SJ, Park KH, Jung SI, Jang HC. Active surveillance for carbapenem-resistant Acinetobacter baumannii in a medical intensive care unit: Can it predict and reduce subsequent infections and the use of colistin? Am J Infect Control 2017; 45:667-672. [PMID: 28242072 DOI: 10.1016/j.ajic.2017.01.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 01/11/2017] [Accepted: 01/11/2017] [Indexed: 11/29/2022]
Abstract
BACKGROUND Infection caused by carbapenem-resistant Acinetobacter baumannii (CRAB) has become a major problem in intensive care units (ICUs), with high incidence and mortality. This prospective study investigated the diagnostic value and influence of active surveillance, followed by isolation and enhanced contact precaution (IECP), on the subsequent CRAB infection and colistin use. METHODS The study prospectively enrolled 1,115 patients who were admitted to the medical ICU of Chonnam National University Hwasun Hospital between April 2011 and November 2014. Active surveillance cultures were obtained from the throat or trachea, skin, and urine. IECP was performed beginning April 2013. RESULTS Active surveillance detected CRAB in 168 (15%) patients and CRAB infection developed in 70 (6%) patients. Endotracheal tube was independently associated with both CRAB colonization and infection, whereas IECP was inversely associated with both CRAB colonization and infection in multivariate analysis (all P values <.001). The sensitivity, specificity, and positive and negative predictive values of active surveillance for subsequent CRAB infection were 84%, 90%, 47%, and 98%, respectively. The rate of CRAB acquisition, CRAB infection, and the use of colistin were significantly lower during the IECP period compared with the control period (6.5 vs 34.1, 2.6 vs 14.7, and 19.9 vs 65.5 per 1,000 patient-days, respectively; all P <.001). CONCLUSIONS Active surveillance has good specificity and negative predictive value for subsequent CRAB infection. Active surveillance followed by IECP was inversely associated with the acquisition of CRAB and subsequent CRAB infection, and was associated with a reduction in colistin use in ICU patients.
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Affiliation(s)
- Joon Hwan An
- Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea
| | - Yu-Hyoung Kim
- Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea
| | - Jeong-Eun Moon
- Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea
| | - Jong Hae Jeong
- Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea
| | - Soo-Hyun Kim
- Department of Laboratory Medicine, Chonnam National University Medical School, Gwang-ju, South Korea
| | - Seung-Ji Kang
- Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea
| | - Kyung-Hwa Park
- Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea
| | - Sook-In Jung
- Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea
| | - Hee-Chang Jang
- Departments of Infectious Diseases, Chonnam National University Medical School, Gwang-ju, South Korea; Infection Control Office, Hwasun Chonnam Nationality University Hospital, Hwasun, South Korea.
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Vancomycin-resistant Enterococcus co-colonization rates with methicillin-resistant Staphylococcus aureus and Clostridium difficile in critically ill veterans. Am J Infect Control 2016; 44:1047-9. [PMID: 27067517 DOI: 10.1016/j.ajic.2016.02.005] [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: 10/07/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 12/15/2022]
Abstract
A prospective study was conducted to identify risk factors for vancomycin-resistant Enterococcus, including co-colonization with methicillin-resistant Staphylococcus aureus and Clostridium difficile infection in patients admitted to the intensive care unit in 2 Veterans Affairs facilities. Methicillin-resistant Staphylococcus aureus and Clostridium difficile infection co-colonization were significant risk factors for vancomycin-resistant Enterococcus colonization. Further studies are needed to identify measures for preventing co-colonization of these major organisms in veterans.
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Overview of Molecular Diagnostics in Multiple-Drug-Resistant Organism Prevention: Focus on Multiple-Drug-Resistant Gram-Negative Bacterial Organisms. Mol Microbiol 2016. [DOI: 10.1128/9781555819071.ch17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cost-benefit analysis from the hospital perspective of universal active screening followed by contact precautions for methicillin-resistant Staphylococcus aureus carriers. Infect Control Hosp Epidemiol 2015; 36:2-13. [PMID: 25627755 DOI: 10.1017/ice.2014.1] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To explore the economic impact to a hospital of universal methicillin-resistant Staphylococcus aureus (MRSA) screening. METHODS We used a decision tree model to estimate the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions. Projected costs and benefits were based on literature-derived data. Our model examined outcomes of several strategies including non-nares MRSA screening and comparison of culture versus polymerase chain reaction-based screening. RESULTS Under baseline conditions, the costs of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in economic costs of $104,000 per 10,000 admissions (95% CI, $83,000-$126,000). Cost-savings occurred only when the model used estimates at the extremes of our key parameters. Non-nares screening and polymerase chain reaction-based testing, both of which identified more MRSA-colonized persons, resulted in more MRSA infections averted but increased economic costs of the screening program. CONCLUSIONS We found that universal MRSA screening, although providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome for a hospital. Policy makers should consider the economic burden of MRSA screening and contact precautions in relation to other interventions when choosing programs to improve patient safety and outcomes.
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A Successful Vancomycin-Resistant Enterococci Reduction Bundle at a Singapore Hospital. Infect Control Hosp Epidemiol 2015; 37:107-9. [PMID: 26486456 DOI: 10.1017/ice.2015.251] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a reduction in the vancomycin-resistant enterococci (VRE) rate from a peak of 1.5 cases per 1,000 admissions (95% confidence interval [CI], 1.0-2.1) in August 2012 to 0.5 per 1,000 admissions (95% CI: 0.3-1.0) by January 2015, associated with a bundle of interventions. Infect. Control Hosp. Epidemiol. 2015;37(1):107-109.
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Strict infection control leads to low incidence of methicillin-resistant Staphylococcus aureus bloodstream infection over 20 years. Infect Control Hosp Epidemiol 2015; 36:702-9. [PMID: 25721306 DOI: 10.1017/ice.2015.28] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) is a worldwide issue associated with significant morbidity and mortality. Multiple infection control (IC) approaches have been tested to control its spread; however, the success of the majority of trials has been short-lived and many efforts have failed. We report the long-term success of MRSA control from a prospective observational study over 20 years. SETTING University Hospital Basel is a large tertiary care center with a median bed capacity of 855 and 5 intensive care units (ICUs); currently, the facility has >32,000 admissions per year. METHODS The IC program at the University Hospital Basel was created in 1993, after 2 MRSA outbreaks. The program has included strict contact precautions with single rooms for MRSA-colonized or -infected patients, targeted admission screening of high-risk patients and healthcare workers at risk for carriage, molecular typing of all MRSA strains and routine decolonization of MRSA carriers including healthcare workers. We used the incidence of MRSA bloodstream infections (BSIs) to assess the effectiveness of this program. All MRSA cases were prospectively classified using a standardized case report form in nosocomial and nonnosocomial cases, based on CDC definitions. RESULTS Between 1993 and 2012, 540,669 blood samples were cultured. The number of blood cultures increased from 865 per 10,000 patient days in 1993 to 1,568 per 10,000 patient days in 2012 (P<.001). We identified 1,268 episodes of S. aureus BSI from 1,204 patients. MRSA accounted for 34 episodes (2.7%) and 24 of these (1.9%) were nosocomial. MRSA BSI incidence varied between 0 and 0.27 per 10,000 patient days and remained stable with no significant variation throughout the study period (P=.882). CONCLUSIONS Long-term control of MRSA is feasible when a bundle of IC precautions is strictly enforced over time.
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Rymzhanova R, Thouverez M, Talon D, Bertrand X. Usefulness of Weekly Methicillin-ResistantStaphylococcus aureusScreening. Infect Control Hosp Epidemiol 2015; 30:1113-5. [DOI: 10.1086/644753] [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 the usefulness of adding weekly methicillin-resistantStaphylococcus aureus(MRSA) screening to our established admission screening and clinical sampling in 4 acute care units of a university hospital. Our results suggest that weekly MRSA screening allows the detection of 56.1% of all cases of hospital-acquired MRSA carriage. These cases would have remained undetected had admission screening and clinical sampling been the only types of surveillance in place.
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Cohen AL, Calfee D, Fridkin SK, Huang SS, Jernigan JA, Lautenbach E, Oriola S, Ramsey KM, Salgado CD, Weinstein RA. Recommendations For Metrics For Multidrug-Resistant Organisms In Healthcare Settings: SHEA/HICPAC Position Paper. Infect Control Hosp Epidemiol 2015; 29:901-13. [DOI: 10.1086/591741] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Monitoring multidrug-resistant organisms (MDROs) and the infections they cause in a healthcare setting is important to detect newly emerging antimicrobial resistance profiles, to identify vulnerable patient populations, and to assess the need for and effectiveness of interventions; however, it is unclear which metrics are the best, because most of the metrics are not standardized. This document describes useful and practical metrics and surveillance considerations for measuring MDROs and the infections they cause in the practice of infection prevention and control in healthcare settings. These metrics are designed to aid healthcare workers in documenting trends over time within their facility and should not be used for interfacility comparison.
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Calfee DP, Salgado CD, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Weinstein RA, Wise R, Yokoe DS. Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals. Infect Control Hosp Epidemiol 2015; 29 Suppl 1:S62-80. [DOI: 10.1086/591061] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). Our intent in this document is to highlight practical recommendations in a concise format to assist acute care hospitals in their efforts to prevent transmission of methicillin-resistantStaphylococcus aureus(MRSA). Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary, Introduction, and accompanying editorial for additional discussion.1. Burden of HAIs caused by MRSA in acute care facilitiesa. In the United States, the proportion of hospital-associatedS. aureusinfections that are caused by strains resistant to methicillin has steadily increased. In 2004, MRSA accounted for 63% ofS. aureusinfections in hospitals.b. Although the proportion ofS. aureus–associated HAIs among intensive care unit (ICU) patients that are due to methicillin-resistant strains has increased (a relative measure of the MRSA problem), recent data suggest that the incidence of central line–associated bloodstream infection caused by MRSA (an absolute measure of the problem) has decreased in several types of ICUs since 2001. Although these findings suggest that there has been some success in preventing nosocomial MRSA transmission and infection, many patient groups continue to be at risk for such transmission.c. MRSA has also been documented in other areas of the hospital and in other types of healthcare facilities, including those that provide long-term care.
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Bryan CS, Call TJ, Elliott KC. The Ethics of Infection Control: Philosophical Frameworks. Infect Control Hosp Epidemiol 2015; 28:1077-84. [DOI: 10.1086/519863] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2007] [Accepted: 04/26/2007] [Indexed: 11/03/2022]
Abstract
Recent developments that are relevant to the ethics of infection control include the patient safety movement, the appearance of new diseases (notably, severe acute respiratory syndrome) that pose threats to healthcare workers, data confirming the suspicion that infection control measures such as isolation may compromise patient care, and, in philosophy, renewed interest in virtue ethics and communitarianism. We review general ethical frameworks and relevant vocabulary for infection control practitioners and hospital epidemiologists. Frameworks for the ethics of infection control resemble those of public health more than those of clinical medicine but embrace elements of both. The optimum framework, we suggest, takes into account a virtue-based communitarianism. The virtue ethics movement stresses the need to consider not only rules and outcomes but also the character of the individual(s) involved. Communitarianism emphasizes the well-being and values of local communities, best determined by shared, democratic decision making among stakeholders. Brief discussions of 15 consecutive cases illustrate the extent to which the daily practice of infection control poses problems heavily freighted with ethical overtones.
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Goldsack JC, DeRitter C, Power M, Spencer A, Taylor CL, Kim SF, Kirk R, Drees M. Clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant Staphylococcus aureus positive patients admitted to medical-surgical units. Am J Infect Control 2014; 42:1039-43. [PMID: 25278390 DOI: 10.1016/j.ajic.2014.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/03/2014] [Accepted: 07/07/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND There is a large and growing body of evidence that methicillin-resistant Staphylococcus aureus (MRSA) screening programs are cost effective, but such screening represents a significant cost burden for hospitals. This study investigates the clinical, patient experience and cost impacts of performing active surveillance on known methicillin-resistant S aureus positive (MRSA+) patients admitted to 7 medical-surgical units of a large regional hospital, specifically to allow discontinuation of contact isolation. METHODS We conducted mixed-methods retrospective evaluation of a process improvement project that screened admitted patients with known MRSA+ status for continued MRSA colonization. RESULTS Of those eligible patients on our institution's MRSA+ list who did complete testing, 80.2% (130/162) were found to be no longer colonized, and only 19.8% (32/162) were still colonized. Forty-one percent (13/32) of interviewed patients in contact isolation for MRSA reported that isolation had affected their hospital stay, and 28% (9/32) of patients reported emotional distress resulting from their isolation. Total cost savings of the program are estimated at $101,230 per year across the 7 study units. CONCLUSION Our findings provide supporting evidence that a screening program targeting patients with a history of MRSA who would otherwise be placed in isolation has the potential to improve outcomes and patient experience and reduce costs.
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Gozaydin A, Kose S, Ece G, Ersan G, Gonullu M. Detection of Vancomycin Resistant Enterococci from Rectal Swab Samples by Becton-Dickinson GeneOhm VanR assay and Culture at ICU of a Tertiary Care Center in Turkey. Pak J Med Sci 2013; 29:682-6. [PMID: 24353607 PMCID: PMC3809269 DOI: 10.12669/pjms.292.2567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 12/27/2012] [Accepted: 12/29/2012] [Indexed: 11/23/2022] Open
Abstract
Objectives: Vancomycin resistance is due to change in ligase enzyme that destroys the binding of the drug. The gold standard is culture; but now molecular methods have also been developed. The aim was to detect the VRE rate at ICUs by culture and BD GeneOhm™ VanR and compare the results of both assays. Methodology: 135 perianal swabs were taken from the patients at ICUs between January 1st 2009 and April 30th 2009. Samples were identified by conventional methods and BD GeneOhm VanR assay. Results: In newborn ICU, 41 patients (74.6%) were negative by both methods. Two (3.6%) were positive by both methods. Twelve (21.8%) of them were culture negative and PCR positive. In adult ICU, 73 (91.3%) patients were negative by both methods. Seven patients (8.8%) were positive by molecular method only. Conclusion: This study showed low VRE positivity due to factors like inhibition in PCR or culture negativity due low inoculum for bacterial growth. Early detection of VRE is an important issue especially in ICUs and molecular techniques are important tools; but against all, we still need to confirm this method with culture based techniques and in order to do this further studies with higher number of patients with VRE colonisation are required.
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Affiliation(s)
- Ayhan Gozaydin
- Ayhan Gozaydin, Infectious Diseases and Clinical Microbiology Specialist, Department of Infectious Diseases and Clinical Microbiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Sukran Kose
- Sukran Kose, Infectious Diseases and Clinical Microbiology Specialist, Department of Infectious Diseases and Clinical Microbiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Gulfem Ece
- Gulfem Ece, Clinical Microbiology Specialist, Department of Infectious Diseases and Clinical Microbiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Gursel Ersan
- Gursel Ersan, Infectious Diseases and Clinical Microbiology Specialist, Department of Infectious Diseases and Clinical Microbiology, Tepecik Education and Research Hospital, Izmir, Turkey
| | - Mustafa Gonullu
- Mustafa Gonullu, Anesthesiology and Reanimation Specialist, Department of Anesthesiology and Reanimation, Tepecik Education and Research Hospital, Izmir, Turkey
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Sadsad R, Sintchenko V, McDonnell GD, Gilbert GL. Effectiveness of hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) infection control policies differs by ward specialty. PLoS One 2013; 8:e83099. [PMID: 24340085 PMCID: PMC3858346 DOI: 10.1371/journal.pone.0083099] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 11/05/2013] [Indexed: 11/25/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of preventable nosocomial infections and is endemic in hospitals worldwide. The effectiveness of infection control policies varies significantly across hospital settings. The impact of the hospital context towards the rate of nosocomial MRSA infections and the success of infection control is understudied. We conducted a modelling study to evaluate several infection control policies in surgical, intensive care, and medical ward specialties, each with distinct ward conditions and policies, of a tertiary public hospital in Sydney, Australia. We reconfirm hand hygiene as the most successful policy and find it to be necessary for the success of other policies. Active screening for MRSA, patient isolation in single-bed rooms, and additional staffing were found to be less effective. Across these ward specialties, MRSA transmission risk varied by 13% and reductions in the prevalence and nosocomial incidence rate of MRSA due to infection control policies varied by up to 45%. Different levels of infection control were required to reduce and control nosocomial MRSA infections for each ward specialty. Infection control policies and policy targets should be specific for the ward and context of the hospital. The model we developed is generic and can be calibrated to represent different ward settings and pathogens transmitted between patients indirectly through health care workers. This can aid the timely and cost effective design of synergistic and context specific infection control policies.
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Affiliation(s)
- Rosemarie Sadsad
- Centre for Infectious Diseases and Microbiology – Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School – Westmead, The University of Sydney, Sydney, New South Wales, Australia
- * E-mail:
| | - Vitali Sintchenko
- Centre for Infectious Diseases and Microbiology – Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School – Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - Geoff D. McDonnell
- Centre for Health Informatics, Australian Institute of Health Innovation, University of New South Wales, Sydney, New South Wales, Australia
| | - Gwendolyn L. Gilbert
- Centre for Infectious Diseases and Microbiology – Public Health, Westmead Hospital, Sydney, New South Wales, Australia
- Sydney Medical School – Westmead, The University of Sydney, Sydney, New South Wales, Australia
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Utility of surveillance cultures for antimicrobial resistant organisms in infants transferred to the neonatal intensive care unit. Pediatr Infect Dis J 2013; 32:e443-50. [PMID: 23811747 DOI: 10.1097/inf.0b013e3182a1d77f] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Infections with antibiotic resistant organisms (AROs) are an important source of morbidity and mortality among infants hospitalized in the neonatal intensive care unit (NICU). To identify potential reservoirs of AROs in the NICU, active surveillance strategies have been adopted by many NICUs to detect infants colonized with AROs. However, the yield, risks, benefits and costs of different strategies have not been fully evaluated. METHODS We conducted a retrospective study in 2 level III NICUs from 2004 to 2010 to investigate the yield of surveillance cultures obtained from infants transferred to the NICU from other hospitals. Cultures were processed for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods. Risk factors, selected outcomes and laboratory costs associated with ARO colonization were assessed. RESULTS Among 1751 infants studied, the rate of colonization for methicillin-resistant S. aureus, vancomycin-resistant enterococci and antibiotic-resistant gram-negative rods was 3%, 1.7% and 1%, respectively. Age at transfer was the strongest predictor of ARO colonization; infants transferred at ≥ 7 days of life had 5.8 increased odds of ARO colonization compared with infants <7 days of age. Transferred infants who were colonized had similar rates of mortality, ARO infection and duration of hospitalization compared with those who were not colonized. The laboratory cost of surveillance cultures during the study period was $58,425. CONCLUSIONS The rate of colonization with AROs at transfer was low particularly in infants <7 days old. Future studies should examine the safety of targeted surveillance strategies focused on older infants.
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Methicillin-resistant Staphylococcus aureus in Saarland, Germany: a statewide admission prevalence screening study. PLoS One 2013; 8:e73876. [PMID: 24040103 PMCID: PMC3770647 DOI: 10.1371/journal.pone.0073876] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/23/2013] [Indexed: 11/25/2022] Open
Abstract
Background The screening of hospital admission patients for methicillin resistant Staphylococcus aureus (MRSA) is of undisputed value in controlling and reducing the overall MRSA burden; yet, a concerted parallel universal screening intervention throughout all hospitals of an entire German Federal State has not yet been performed. Methodology/Principal Findings During a four-week period, all 24 acute care hospitals of the State of Saarland participated in admission prevalence screening. Overall, 436/20,027 screened patients revealed MRSA carrier status (prevalence, 2.2/100 patients) with geriatrics and intensive care departments associated with highest prevalence (7.6/100 and 6.3/100, respectively). Risk factor analysis among 17,975 admission patients yielded MRSA history (OR, 4.3; CI95 2.7–6.8), a skin condition (OR, 3.2; CI95 2.1–5.0), and/or an indwelling catheter (OR, 2.2; CI95 1.4–3.5) among the leading risks. Hierarchical risk factor ascertainment of the six risk factors associated with highest odd’s ratios would require 31% of patients to be laboratory screened to allow for detection of 67% of all MRSA positive admission patients in the State. Conclusions/Significance State-wide admission prevalence screening in conjunction with risk factor ascertainment yields important information on the distribution of the MRSA burden for hospitals, and allows for data-based decisions on local or institutional MRSA screening policies considering risk factor prevalence and expected MRSA identification rates.
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Eveillard M, Bruna T, Kouatchet A, Dubé L, Poiroux L, Dabin E, Hitoto H, Mercat A, Joly-Guillou ML, Desfontaines H. Using a qualitative study to understand the failure of a strategy implemented for improving hand hygiene adherence in 4 intensive care units. Infect Control Hosp Epidemiol 2013; 34:447-8. [PMID: 23466926 DOI: 10.1086/669875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Orsi GB, Falcone M, Venditti M. Surveillance and management of multidrug-resistant microorganisms. Expert Rev Anti Infect Ther 2013; 9:653-79. [PMID: 21819331 DOI: 10.1586/eri.11.77] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Multidrug-resistant organisms are an established and growing worldwide public health problem and few therapeutic options remain available. The traditional antimicrobials (glycopeptides) for multidrug-resistant Gram-positive infections are declining in efficacy. New drugs that are presently available are linezolid, daptomicin and tigecycline, which have well-defined indications for severe infections, and talavancin, which is under Phase III trial for hospital-acquired pneumonia. Unfortunately the therapies available for multidrug-resistant Gram-negatives, including carbapenem-resistant Pseudomonas aeruginosa, Acinetobacter baumannii and Enterobacteriaceae, are limited to only colistin and tigecycline. Both of these drugs are still not registered for severe infections, such as hospital acquired pneumonia. Consequently, as confirmed by scientific evidence, a multidisciplinary approach is needed. Surveillance, infection control procedures, isolation and antimicrobial stewardship should be implemented to reduce multidrug-resistant organism diffusion.
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Affiliation(s)
- Giovanni Battista Orsi
- Dipartimento di Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, P.le Aldo Moro 5, 00185 Roma, Italy
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de Toledo Piza FM, Marra AR, Silva M, Sampaio Camargo TZ, de Oliveira Figueiredo RA, Edmond MB. Contact precautions in the intensive care unit setting: 12 years of surveillance. Am J Infect Control 2013; 41:371-2. [PMID: 23062660 DOI: 10.1016/j.ajic.2012.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 03/26/2012] [Accepted: 03/26/2012] [Indexed: 11/25/2022]
Abstract
The utilization of isolation precautions has increased in tertiary care hospitals due to the increase in colonization with multidrug-resistant organisms over time. We assessed the frequency of multidrug-resistant microorganisms responsible for implementation of contact precautions in the ICU of a tertiary care hospital over a 12-year period.
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Day HR, Perencevich EN, Harris AD, Gruber-Baldini AL, Himelhoch SS, Brown CH, Morgan DJ. Depression, anxiety, and moods of hospitalized patients under contact precautions. Infect Control Hosp Epidemiol 2013; 34:251-8. [PMID: 23388359 DOI: 10.1086/669526] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association between contact precautions and depression or anxiety as well as feelings of anger, sadness, worry, happiness, or confusion. DESIGN Prospective frequency-matched cohort study. SETTING The University of Maryland Medical Center, a 662-bed tertiary care hospital in Baltimore, Maryland. PARTICIPANTS A total of 1,876 medical and surgical patients over the age of 18 years were approached; 528 patients were enrolled from January through November 2010, and 296 patients, frequency matched by hospital unit, completed follow-up on hospital day 3. RESULTS The primary outcome was Hospital Anxiety and Depression Scale (HADS) scores on hospital day 3, controlling for baseline HADS scores. Secondary moods were measured with visual analog mood scale diaries. Patients under contact precautions had baseline symptoms of depression 1.3 points higher (P<.01) and anxiety 0.8 points higher (P=.08) at hospital admission using HADS. Exposure to contact precautions was not associated with increased depression (P=.42) or anxiety (P=.25) on hospital day 3. On hospital day 3, patients under contact precautions were no more likely than unexposed patients to be angry (20% vs 20%; P=.99), sad (33% vs 38%; P=.45), worried (51% vs 46%; P=.41), happy (58% vs 67%; P=.14), or confused (23% vs 24%; P=.95). CONCLUSIONS Patients under contact precautions have more symptoms of depression and anxiety at hospital admission but do not appear to be more likely to develop depression, anxiety, or negative moods while under contact precautions. The use of contact precautions should not be restricted by the belief that contact precautions will produce more depression or anxiety.
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Affiliation(s)
- Hannah R Day
- University of Maryland School of Medicine, Baltimore, Maryland 21201, USA.
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Bearman G, Stevens MP. Control of Drug-Resistant Pathogens in Endemic Settings: Contact Precautions, Controversies, and a Proposal for a Less Restrictive Alternative. Curr Infect Dis Rep 2012; 14:620-6. [DOI: 10.1007/s11908-012-0299-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Freeman JT, Williamson DA, Anderson DJ. When should contact precautions and active surveillance be used to manage patients with multidrug-resistant enterobacteriaceae? Infect Control Hosp Epidemiol 2012; 33:753-6. [PMID: 22669239 DOI: 10.1086/666333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Joshua T Freeman
- Department of Microbiology and Infection Prevention and Control, Auckland City Hospital, Auckland, New Zealand.
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Jarvis WR, Jarvis AA, Chinn RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012; 40:194-200. [PMID: 22440670 DOI: 10.1016/j.ajic.2012.02.001] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 02/07/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most prevalent multidrug-resistant organisms causing health care-associated infections. Limited data are available about how the prevalence of MRSA has changed over the past several years and what MRSA prevention practices have been implemented since the 2006 Association for Professionals in Infection Control and Epidemiology, Inc, MRSA survey. METHODS We conducted a national prevalence survey of MRSA colonization or infection in inpatients at US health care facilities. The survey was developed, received institutional review board approval, and then was distributed to all US Association for Professionals in Infection Control and Epidemiology, Inc, members. Members were asked to complete the survey on 1 day during the period August 1 to December 30, 2010, reporting the number of inpatients with MRSA infection or colonization and facility- and patient-specific information. RESULTS Personnel at 590 facilities indicated a state and responded to the survey. All states were represented, except for Alaska and Washington, DC (mean, 12 facilities per state; range, 1-38). Respondents reported 4,476 MRSA-colonized/infected patients in 67,412 inpatients; the overall MRSA prevalence rate was 66.4 per 1,000 inpatients (25.3 infections and 41.1 colonizations per 1,000 inpatients). Active surveillance testing was conducted by 75.7% of the respondents; 39.6% used nonselective media, 37.2% used selective media, and 23.3% used polymerase chain reaction. Detailed data were provided on 3,176 MRSA-colonized/infected patients. Of those in whom colonization/infection status was reported (1,908/3,086 [61.8%] were MRSA colonized and 1,778/3,086 [38.2%] were MRSA infected), most MRSA-colonized or infected patients (78.3%) were detected within 48 hours of admission; the most common site of infection was skin and soft tissue (42.9%); and, using the Centers for Disease Control and Prevention's definitions, approximately 50% would be classified as health care-associated infections. CONCLUSION Our survey documents that the MRSA prevalence in 2010 is higher than that reported in our 2006 survey. However, the majority of facilities currently are performing active surveillance testing, and, compared with 2006, the rate of MRSA infection has decreased while the rate of MRSA colonization has increased. In addition, compared with 2006, the proportion of MRSA strains recovered from MRSA-colonized/infected patients that are health care-associated strains has deceased, and community-associated strains have increased.
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A Hidden Reservoir of Methicillin-resistantStaphylococcus aureusand Vancomycin-resistantEnterococcusin Patients Newly Admitted to an Acute Rehabilitation Hospital. PM R 2012; 4:18-22. [DOI: 10.1016/j.pmrj.2011.09.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 08/29/2011] [Accepted: 09/12/2011] [Indexed: 11/21/2022]
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McLemore A, Bearman G, Edmond MB. Effect of contact precautions on wait time from emergency room disposition to inpatient admission. Infect Control Hosp Epidemiol 2011; 32:298-9. [PMID: 21460519 DOI: 10.1086/658913] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Marner ES, Wolk DM, Carr J, Hewitt C, Dominguez LL, Kovacs T, Johnson DR, Hayden RT. Diagnostic accuracy of the Cepheid GeneXpert vanA/vanB assay ver. 1.0 to detect the vanA and vanB vancomycin resistance genes in Enterococcus from perianal specimens. Diagn Microbiol Infect Dis 2011; 69:382-9. [PMID: 21396533 DOI: 10.1016/j.diagmicrobio.2010.11.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Revised: 11/05/2010] [Accepted: 11/07/2010] [Indexed: 11/30/2022]
Abstract
Rapid detection of vancomycin-resistant enterococci (VRE) carriers could be useful to health care facilities to minimize transmission. To that end, we compared the performance of the Cepheid GeneXpert vanA/vanB assay with that of direct and broth-enriched culture methods for detection of VRE from perianal swabs. Enterococci were cultivated on Enterococcosel™ agar with 8 μg/mL vancomycin, Bile Esculin Azide Agar with 6 μg/mL vancomycin, and Bile Esculin Azide Enterococcosel Broth. Compared to the reference standard (combination of direct agar plating, broth-enriched culture, and clinical chart review), the sensitivity, specificity, positive predictive value, and negative predictive value of the vanA/vanB assay were 96.4%, 93.0%, 92.0%, and 96.9%, respectively (n=184). The 95% limit of detection was 100 colony-forming units (CFU)/mL for vanA and 114 CFU/mL for vanB. In summary, the GeneXpert vanA/vanB assay is a rapid and accurate method to identify vanA/vanB-colonized patients for VRE screening programs that use perianal swab specimens.
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Meticillin-resistant Staphylococcus aureus (MRSA): screening and decolonisation. Int J Antimicrob Agents 2011; 37:195-201. [DOI: 10.1016/j.ijantimicag.2010.10.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 10/18/2010] [Indexed: 11/20/2022]
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Lee AS, Huttner B, Harbarth S. Control of Methicillin-resistant Staphylococcus aureus. Infect Dis Clin North Am 2011; 25:155-79. [DOI: 10.1016/j.idc.2010.11.002] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Murthy A, De Angelis G, Pittet D, Schrenzel J, Uckay I, Harbarth S. Cost-effectiveness of universal MRSA screening on admission to surgery. Clin Microbiol Infect 2010; 16:1747-53. [DOI: 10.1111/j.1469-0691.2010.03220.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santos HB, Machado DP, Camey SA, Kuchenbecker RS, Barth AL, Wagner MB. Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil. BMC Infect Dis 2010; 10:328. [PMID: 21073755 PMCID: PMC2992537 DOI: 10.1186/1471-2334-10-328] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution. METHODS A cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization. RESULTS After screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days). CONCLUSIONS The identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.
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Affiliation(s)
- Helena B Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Suzi A Camey
- Instituto de Matemática- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo S Kuchenbecker
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Afonso L Barth
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mário B Wagner
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Morgan DJ, Day HR, Furuno JP, Young A, Johnson JK, Bradham DD, Perencevich EN. Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission. Infect Control Hosp Epidemiol 2010; 31:1230-5. [PMID: 21028966 DOI: 10.1086/657335] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Mandatory active surveillance culturing of all patients admitted to Veterans Affairs (VA) hospitals carries substantial economic costs. Clinical prediction rules have been used elsewhere to identify patients at high risk of colonization with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE). We aimed to derive and evaluate the clinical efficacy of prediction rules for MRSA and VRE colonization in a VA hospital. Design and setting. Prospective cohort of adult inpatients admitted to the medical and surgical wards of a 119-bed tertiary care VA hospital. METHODS Within 48 hours after admission, patients gave consent, completed a 44-item risk factor questionnaire, and provided nasal culture samples for MRSA testing. A subset provided perirectal culture samples for VRE testing. RESULTS Of 598 patients enrolled from August 30, 2007, through October 30, 2009, 585 provided nares samples and 239 provided perirectal samples. The prevalence of MRSA was 10.4% (61 of 585) (15.0% in patients with and 5.6% in patients without electronic medical record (EMR)-documented antibiotic use during the past year; P < .01). The prevalence of VRE was 6.3% (15 of 239) (11.3% in patients with and 0.9% in patients without EMR-documented antibiotic use; P < .01). The use of EMR-documented antibiotic use during the past year as the predictive rule for screening identified 242.8 (84%) of 290.6 subsequent days of exposure to MRSA and 60.0 (98%) of 61.0 subsequent days of exposure to VRE, respectively. EMR documentation of antibiotic use during the past year identified 301 (51%) of 585 patients as high-risk patients for whom additional testing with active surveillance culturing would be appropriate. CONCLUSIONS EMR documentation of antibiotic use during the year prior to admission identifies most MRSA and nearly all VRE transmission risk with surveillance culture sampling of only 51% of patients. This approach has substantial cost savings compared with the practice of universal active surveillance.
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Affiliation(s)
- Daniel J Morgan
- Veterans Affairs Maryland Healthcare System, Baltimore, Maryland, USA.
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Methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococcus: Recognition and prevention in intensive care units. Crit Care Med 2010; 38:S335-44. [DOI: 10.1097/ccm.0b013e3181e6ab12] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Which screening is needed in intensive care units: MRSA or Pseudomonas aeruginosa? J Hosp Infect 2010; 75:329-30. [DOI: 10.1016/j.jhin.2010.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/05/2010] [Indexed: 11/17/2022]
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Patrick S, James C, Ali A, Lawson S, Mary E, Modak A. Vascular Surgical Antibiotic Prophylaxis Study (VSAPS). Vasc Endovascular Surg 2010; 44:521-8. [PMID: 20675336 DOI: 10.1177/1538574410373837] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This prospective, randomized study was performed at a single institution. Low-risk patients undergoing elective vascular procedures were enrolled (August 2007 to June 2009). Participants were randomized into 3 separate arms. They received cefazolin, cefazolin + vancomycin, or cefazolin + daptomycin prior to surgery. In total, 169 patients were included in the analysis. Mean age was 64 (range, 26-85), and the patients’ comorbidities were similar across all groups. Only Szilagyi II and III infections were analyzed. Any infection/methicillin-resistant Staphylococcus aureus (MRSA) infections was seen in 8 (12.9%)/2 (3.23%) in the cefazolin group, 7 (12.5%)/4 (7.14%) in the cefazolin + vancomycin group, and 2 (3.92%)/(0%) in the cefazolin + daptomycin group. In this study, population of low-risk patients undergoing elective vascular procedures, there was a trend toward fewer infectious complications in the cefazolin + daptomycin group. Adding anti-MRSA agents to the current standard prophylaxis regimen does not appear to reduce the incidence of MRSA infection in low-risk patients.
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Affiliation(s)
- Stone Patrick
- Charleston Division, Vascular Surgery, West Virginia University, WV, USA
| | | | - AbuRahma Ali
- Division of Surgery, West Virginia University, WV, USA
| | - Safley Lawson
- Division of Surgery, West Virginia University, WV, USA
| | - Emmett Mary
- Center for Health Services and Outcomes Research
| | - Asmita Modak
- Center for Health Services and Outcomes Research
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Bearman G, Rosato AE, Duane TM, Elam K, Sanogo K, Haner C, Kazlova V, Edmond MB. Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit. Infect Control Hosp Epidemiol 2010; 31:491-7. [PMID: 20350197 DOI: 10.1086/651671] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the efficacy of universal gloving with emollient-impregnated gloves with standard contact precautions for the control of multidrug-resistant organisms (MDROs) and to measure the effect on healthcare workers' (HCWs') hand skin health. DESIGN Prospective before-after trial. SETTING An 18-bed surgical intensive care unit. METHODS During phase 1 (September 2007 through March 2008) standard contact precautions were used. During phase 2 (March 2008 through September 2008) universal gloving with emollient-impregnated gloves was used, and no contact precautions. Patients were screened for vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA). HCW hand hygiene compliance and hand skin health and microbial contamination were assessed. The incidences of device-associated infection and Clostridium difficile infection (CDI) were determined. RESULTS The rate of compliance with contact precautions (phase 1) was 67%, and the rate of compliance with universal gloving (phase 2) was 78% (P = .01). Hand hygiene compliance was higher during phase 2 than during phase 1 (before patient care, 40% vs 35% of encounters; P = .001; after patient care, 63% vs 51% of encounters; P < .001). No difference was observed in MDRO acquisition. During phases 1 and 2, incidences of device-related infections, in number of infections per 1,000 device-days, were, respectively, 3.7 and 2.6 for bloodstream infection (P = .10), 8.9 and 7.8 for urinary tract infection (P = .10), and 1.0 and 1.1 for ventilator-associated pneumonia (P = .09). The CDI incidence in phase 1 and in phase 2 was, respectively, 2.0 and 1.4 cases per 1,000 patient-days (P = .53). During phase 1, 29% of HCW hand cultures were MRSA positive, compared with 13% during phase 2 (P = .17); during phase 1, 2% of hand cultures were VRE positive, compared with 0 during phase 2 (P = .16). Hand skin health improved during phase 2. CONCLUSIONS Compared with contact precautions, universal gloving with emollient-impregnated gloves was associated with improved hand hygiene compliance and skin health. No statistically significant change in the rates of device-associated infection, CDI, or patient MDRO acquisition was observed. Universal gloving may be an alternative to contact precautions.
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Affiliation(s)
- Gonzalo Bearman
- Division of Infectious Diseases, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia 23298-0019, USA.
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Carling PC, Bartley JM. Evaluating hygienic cleaning in health care settings: what you do not know can harm your patients. Am J Infect Control 2010; 38:S41-50. [PMID: 20569855 DOI: 10.1016/j.ajic.2010.03.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Revised: 03/28/2010] [Accepted: 03/29/2010] [Indexed: 01/11/2023]
Abstract
Recent studies using direct covert observation or a fluorescent targeting method have consistently confirmed that most near patient surfaces are not being cleaned in accordance with existing hospital policies while other studies have confirmed that patients admitted to rooms previously occupied by patients with hospital pathogens have a substantially greater risk of acquiring the same pathogen than patients not occupying such rooms. These findings, in the context recent studies that have shown disinfection cleaning can be improved on average more than 100% over baseline, and that such improvement has been associated with a decrease in environmental contamination of high touch surfaces, support the benefit of decreasing environmental contamination of such surfaces. This review clarifies the differences between measuring cleanliness versus cleaning practices; describes and analyzes conventional and enhanced monitoring programs; addresses the critical aspects of evaluating disinfection hygiene in light of guidelines and standards; analyzes current hygienic practice monitoring tools; and recommends elements that should be included in an enhanced monitoring program.
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Affiliation(s)
- Philip C Carling
- Infectious Diseases Section, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
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