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Jacques J, Martin-Huyghe H, Lemtiri-Florek J, Taillard J, Jourdan L, Dhaenens C, Delerue D, Hansske A, Leclercq V. The detection of hospitalized patients at risk of testing positive to multi-drug resistant bacteria using MOCA-I, a rule-based "white-box" classification algorithm for medical data. Int J Med Inform 2020; 142:104242. [PMID: 32853975 DOI: 10.1016/j.ijmedinf.2020.104242] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 07/19/2020] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Multi-drug resistant (MDR) bacteria are a major health concern. In this retrospective study, a rule-based classification algorithm, MOCA-I (Multi-Objective Classification Algorithm for Imbalanced data) is used to identify hospitalized patients at risk of testing positive for multidrug-resistant (MDR) bacteria, including Methicillin-resistant Staphylococcus aureus (MRSA), before or during their stay. METHODS Applied to a data set of 48,945 hospital stays (including known cases of carriage) with up to 16,325 attributes per stay, MOCA-I generated alert rules for risk of carriage or infection. A risk score was then computed from each stay according to the triggered rules.Recall and precision curves were plotted. RESULTS The classification can be focused on specifically detecting high risk of having a positive test, or identifying large numbers of at-risk patients by modulating the risk score cut-off level. For a risk score above 0.85,recall (sensitivity) is 62 % with 69 % precision (confidence) for MDR bacteria, recall is 58 % with 88 % precision for MRSA. In addition, MOCA-I identifies 38 and 21 cases of previously unknown MDR and MRSA respectively. CONCLUSIONS MOCA-I generates medically pertinent alert rules. This classification algorithm can be used to detect patients with high risk of testing positive to MDR bacteria (including MRSA). Classification can be modulated by appropriately setting the risk score cut-off level to favor specific detection of small numbers of patients at very high risk or identification of large numbers of patients at risk. MOCA-I can thus contribute to more adapted treatments and preventive measures from admission, depending on the clinical setting or management strategy.
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Affiliation(s)
- Julie Jacques
- Lille Catholic University, Faculté de Gestion, Economie et Sciences, France; Univ. Lille, CNRS, Centrale Lille, UMR 9189, CRIStAL, Centre de Recherche en Informatique Signal et Automatique de Lille, F-59000 Lille, France.
| | - Hélène Martin-Huyghe
- Lille Catholic Hospitals, Infection Control Department, Lille Catholic University, KASHMIR, Lille, France; CH Arras, Pharmacy Department, Arras, France
| | - Justine Lemtiri-Florek
- Lille Catholic Hospitals, Infection Control Department, Lille Catholic University, KASHMIR, Lille, France; CH Valenciennes, Intensive Care Department, F-59322 Valenciennes, France
| | | | - Laetitia Jourdan
- Univ. Lille, CNRS, Centrale Lille, UMR 9189, CRIStAL, Centre de Recherche en Informatique Signal et Automatique de Lille, F-59000 Lille, France
| | - Clarisse Dhaenens
- Univ. Lille, CNRS, Centrale Lille, UMR 9189, CRIStAL, Centre de Recherche en Informatique Signal et Automatique de Lille, F-59000 Lille, France
| | | | - Arnaud Hansske
- Lille Catholic Hospitals, IT System Department, Lille Catholic University, KASHMIR, Lille, France
| | - Valérie Leclercq
- Lille Catholic Hospitals, Infection Control Department, Lille Catholic University, KASHMIR, Lille, France
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Time-Gated Luminescent In Situ Hybridization (LISH): Highly Sensitive Detection of Pathogenic Staphylococcus aureus. Molecules 2019; 24:molecules24112083. [PMID: 31159269 PMCID: PMC6600140 DOI: 10.3390/molecules24112083] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 05/29/2019] [Accepted: 05/29/2019] [Indexed: 11/18/2022] Open
Abstract
We describe simple direct conjugation of a single TEGylated Europium chelate to DNA that binds to intracellular rRNA and is then detected using a homogeneous luminescent in situ hybridisation (LISH) technique. As a proof-of-principle, Staphylococcus aureus (S. aureus) was selected as a model for our study to show the ability of this probe to bind to intracellular 16S ribosomal rRNA. A highly purified Europium chelate conjugated oligonucleotide probe complementary to an rRNA sequence-specific S. aureus was prepared and found to be soluble and stable in aqueous solution. The probe was able to bind specifically to S. aureus via in situ hybridisation to differentiate S. aureus from a closely related but less pathogenic Staphylococcus species (S. epidermidis). A time-gated luminescent (TGL) microscope system was used to generate the high signal-to-noise ratio (SNR) images of the S. aureus. After excitation (365 nm, Chelate λmax = 335 nm), the long-lived (Eu3+) luminescent emission from the probe was detected without interference from natural background autofluorescence typically seen in biological samples. The luminescent images were found to have 6 times higher SNR or sensitivity compared to the fluorescent images using conventional fluorophore Alexa Fluor 488. The TEGylated Europium chelate -oligo probe stained S. aureus with mean signal intensity 3.5 times higher than the threshold level of signal from S. epidermidis (with SNR 8 times higher). A positive control probe (EUB338–BHHTEGST–Eu3+) has mean signal intensity for S. aureus and S. epidermidis equally 3.2 times higher than the threshold of signal for a negative NON-EUB338 control probe. The direct conjugation of a single Europium chelate to DNA provides simplicity and improvement over existing bovine serum albumin (BSA)/streptavidin/biotinylated DNA platforms for multi-attachment of Europium chelate per DNA and more importantly makes it feasible for hybridisation to intracellular RNA targets. This probe has great potential for highly sensitive homogeneous in situ hybridisation detection of the vast range of intracellular DNA targets.
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Lin SY, Lin NY, Huang YY, Hsieh CC, Huang YC. Methicillin-resistant Staphylococcus aureus nasal carriage and infection among patients with diabetic foot ulcer. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 53:292-299. [PMID: 29907536 DOI: 10.1016/j.jmii.2018.03.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 02/13/2018] [Accepted: 03/15/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To evaluate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in patients with diabetic foot ulcer (DFU) in Taiwan, and to assess the concordance between colonizing and clinical MRSA isolates from the patients. METHOD A total of 354 nasal specimens were collected from 112 to 242 diabetic patients with and without foot ulcer, respectively. MRSA clinical isolates from DFU wound cultures were collected for comparison. RESULTS Nasal carriage rate of S. aureus and MRSA was similar between diabetic patients with and without foot ulcer (15.2% vs. 16.9% for S. aureus and 5.4% vs. 1.7% for MRSA). Nasal S. aureus colonization was an independent predictor for wound S. aureus infection (Odds ratio [OR]: 5.33, 95% confidence interval [CI]: 1.61-17.59), so did nasal MRSA colonization (OR: 19.09, 95% CI: 2.12-171.91). The levels of glycated hemoglobin, and the usage with immunosuppressant agent were associated with S. aureus nasal colonization while oral hypoglycemic agent usage a protective factor. Sequence type 59/staphylococcal chromosome cassette mec IV or V, the local endemic community-associated clone, accounted for 42% and 70% of the clinical and colonizing isolates, respectively. Six of 10 patients with paired colonizing and clinical isolates, either MRSA or methicillin-sensitive S. aureus, had a genetically identical strain from a single patient. CONCLUSION Less than one-fifth of patients with DFU have nasal S. aureus, including MRSA, colonization; however, the colonization is significantly associated with S. aureus diabetic foot infection. Screening for S. aureus colonizing status in DFU patients might have a potential clinical implication.
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Affiliation(s)
- Shin-Yi Lin
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Nai-Yu Lin
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan
| | - Yu-Yao Huang
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan
| | | | - Yhu-Chering Huang
- School of Medicine, Chang Gung University, Kweishan, Taoyuan, Taiwan; Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Kweishan, Taoyuan, Taiwan.
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Hospital-Onset Bloodstream Infection Rates After Discontinuing Active Surveillance Cultures for Methicillin-Resistant Staphylococcus aureus in a Regional Burn Center. Infect Control Hosp Epidemiol 2016; 38:371-372. [DOI: 10.1017/ice.2016.280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Fore SE, Munchel EC, Goldstein S, Mills J, Vanderwagen S, Stewart D, Colombani P. Comparison of Pediatric Burn Wound Colonization and the Surrounding Environment. Compr Child Adolesc Nurs 2016. [DOI: 10.3109/24694193.2016.1167986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sara E. Fore
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Emily C. Munchel
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Seth Goldstein
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Joanne Mills
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Sarah Vanderwagen
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Dylan Stewart
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Paul Colombani
- Burn Wound Colonization, The Johns Hopkins Hospital, Baltimore, Maryland, USA
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Ericson JE, Popoola VO, Smith PB, Benjamin DK, Fowler VG, Benjamin DK, Clark RH, Milstone AM. Burden of Invasive Staphylococcus aureus Infections in Hospitalized Infants. JAMA Pediatr 2015; 169:1105-11. [PMID: 26502073 PMCID: PMC4694042 DOI: 10.1001/jamapediatrics.2015.2380] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
IMPORTANCE Staphylococcus aureus is a frequent cause of infection in hospitalized infants. These infections are associated with increased mortality and morbidity and longer hospital stays, but data on the burden of S aureus disease in hospitalized infants are limited. OBJECTIVES To compare demographics and mortality of infants with invasive methicillin-resistant S aureus (MRSA) and methicillin-susceptible S aureus (MSSA), to determine the annual proportion of S aureus infections that were MRSA, and to contrast the risk of death after an invasive MRSA infection with the risk after an invasive MSSA infection. DESIGN, SETTING, AND PARTICIPANTS Multicenter retrospective study of a large, nationally representative cohort at 348 neonatal intensive care units managed by the Pediatrix Medical Group. Participants were 3888 infants with an invasive S aureus infection who were discharged from calendar year 1997 through calendar year 2012. EXPOSURE Invasive S aureus infection. MAIN OUTCOMES AND MEASURES The incidence of invasive S aureus infections, as well as infant characteristics and mortality after MRSA or MSSA infection. RESULTS The 3888 infants had 3978 invasive S aureus infections (2868 MSSA and 1110 MRSA). The incidence of invasive S aureus infection was 44.8 infections per 10,000 infants. The yearly proportion of invasive infections caused by MRSA increased from calendar year 1997 through calendar year 2006 and has moderately decreased since then. Infants with invasive MRSA or MSSA infections had similar gestational ages and birth weights. Invasive MRSA infections occurred more often at a younger postnatal age. For infants with available mortality data, more infants with invasive MSSA infections (n = 237) died before hospital discharge than infants with invasive MRSA infections (n = 110). The proportions of infants who died after invasive MSSA and MRSA infections were similar at 237 of 2474 (9.6%) and 110 of 926 (11.9%), respectively (P = .05). The adjusted risk of death before hospital discharge was similar after invasive MSSA and MRSA infections (risk ratio, 1.19; 95% CI, 0.96-1.49). The risks of death at 7 and 30 days after invasive infection were similar between infants with invasive MSSA infection and infants with invasive MRSA infection. CONCLUSIONS AND RELEVANCE Infant mortality after invasive MRSA and MSSA infections is similar, but MSSA causes more infections and more deaths in infants than MRSA. Measures to prevent S aureus infection should include MSSA in addition to MRSA.
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Affiliation(s)
- Jessica E. Ericson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Victor O. Popoola
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
| | - P. Brian Smith
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Vance G. Fowler
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Daniel K. Benjamin
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | | | - Aaron M. Milstone
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins University, Baltimore, MD
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Jinadatha C, Hussain Z, Erickson TA, Villamaria FC, Copeland LA, Huber TW. Origin of methicillin-resistant Staphylococcus aureus health care-associated infections: evaluation of the role of anterior nares. Am J Infect Control 2015; 43:1125-7. [PMID: 26139000 DOI: 10.1016/j.ajic.2015.05.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/18/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections (HAIs) are a cause of extended hospitalizations and escalating health care costs. We typed 49 MRSA HAIs and their corresponding admission nasal MRSA isolates to determine strain-relatedness and better define the role of anterior nares in the causation of HAI and the value of decolonization. Based on repetitive extragenic palindromic sequencing polymerase chain reaction results, the majority of our patients possibly acquired MRSA HAI from nonnasal sources (36 out of 49; 74%). Among the remaining patients (13 out of 49; 26%) the nasal and clinical HAI isolates matched, indicating potential benefit of decolonization among this subsegment of patients. These findings may be relevant to institutions such as Veterans Health Administration hospitals that already have universal screening programs but are looking at ways to further reduce MRSA HAI incidence.
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Aiken AM, Mutuku IM, Sabat AJ, Akkerboom V, Mwangi J, Scott JAG, Morpeth SC, Friedrich AW, Grundmann H. Carriage of Staphylococcus aureus in Thika Level 5 Hospital, Kenya: a cross-sectional study. Antimicrob Resist Infect Control 2014; 3:22. [PMID: 25057351 PMCID: PMC4107749 DOI: 10.1186/2047-2994-3-22] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 06/23/2014] [Indexed: 11/17/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is an important nosocomial pathogen but little is known about its circulation in hospitals in developing countries. We aimed to describe carriage of S.aureus amongst inpatients in a mid-sized Kenyan government hospital. Methods We determined the frequency of S.aureus and MRSA carriage amongst inpatients in Thika Hospital, Kenya by means of repeated cross-sectional ward surveys. For all S.aureus isolates, we performed antibiotic susceptibility tests, genomic profiling using a DNA microarray and spa typing and MLST. Results In this typical mid-sized Kenyan Government hospital, we performed 950 screens for current carriage of S.aureus amongst inpatients over a four month period. We detected S.aureus carriage (either MSSA or MRSA) in 8.9% (85/950; 95%CI 7.1-10.8) of inpatient screens, but patients with multiple screens were more likely have detection of carriage. MRSA carriage was rare amongst S.aureus strains carried by hospital inpatients – only 7.0% (6/86; 95%CI 1.5-12.5%) of all isolates were MRSA. Most MRSA (5/6) were obtained from burns patients with prolonged admissions, who only represented a small proportion of the inpatient population. All MRSA strains were of the same clone (MLST ST239; spa type t037) with concurrent resistance to multiple antibiotic classes. MSSA isolates were diverse and rarely expressed antibiotic resistance except against benzyl-penicillin and co-trimoxazole. Conclusions Although carriage rates for S.aureus and the MRSA prevalence in this Kenyan hospital were both low, burns patient were identified as a high risk group for carriage. The high frequency of genetically indistinguishable isolates suggests that there was local transmission of both MRSA and MSSA.
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Affiliation(s)
- Alexander M Aiken
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK ; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Irene M Mutuku
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Artur J Sabat
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Viktoria Akkerboom
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - J Anthony G Scott
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK ; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Susan C Morpeth
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK ; Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi, Kenya
| | - Alexander W Friedrich
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hajo Grundmann
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hernández-Porto M, Castro B, Ramos MJ, Arias A, Aguirre-Jaime A, Lecuona M. Risk factors for development of methicillin-resistant Staphylococcus aureus-positive clinical culture in nasal carriers after decolonization treatment. Am J Infect Control 2014; 42:e75-9. [PMID: 24855930 DOI: 10.1016/j.ajic.2014.03.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 03/08/2014] [Accepted: 03/10/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Active surveillance systems are effective in reducing health care-associated infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Nonetheless, some patients develop MRSA infection despite control measures. We tried to identify risk factors related to the appearance of MRSA at sites other than the nasal fossa in patients who were nasal carriers of MRSA. METHODS A retrospective case-control study was conducted in an active surveillance program for MRSA between January 2009 and December 2010 at a Spanish teaching hospital. Cases were patients with MRSA in the anterior nares and a length of stay of at least 5 days who developed MRSA-positive clinical culture after decolonization treatment had started. Controls were patients with the same characteristics as the case group, except that they did not develop MRSA-positive clinical culture as verified by negative clinical cultures. RESULTS After intrinsic and extrinsic risk factors were analyzed, the emergence of mupirocin-resistant MRSA clones after decolonization treatment, and residence in a nursing home were marginally significant in the univariate analysis. The detection of the emergence of mupirocin-resistant MRSA clones was independently associated with the detection of MRSA in other clinical locations. CONCLUSIONS In an active surveillance program for MRSA it is important to determine the mupirocin susceptibility of the isolates to determine appropriate treatment and to verify negativity after decolonizing treatment has been completed.
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Affiliation(s)
- Miriam Hernández-Porto
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain.
| | - Beatriz Castro
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Maria Jose Ramos
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
| | - Angeles Arias
- Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Canary Islands, Spain
| | - Armando Aguirre-Jaime
- Unidad de Investigación, Hospital Universitario Nuestra Señora de la Candelaria Carretera del Rosario, Santa Cruz de Tenerife, Canary Islands, Spain
| | - Maria Lecuona
- Hospital Universitario de Canarias, Servicio de Microbiología y Medicina Preventiva, La Laguna, Canary Islands, Spain
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Sim BLH, McBryde E, Street AC, Marshall C. Multiple site surveillance cultures as a predictor of methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 2013; 34:818-24. [PMID: 23838222 DOI: 10.1086/671273] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the relationship between methicillin-resistant Staphylococcus aureus (MRSA) colonization density, colonization site, and probability of infection in a frequently screened cohort of intensive care unit (ICU) patients. METHODS Patients had swab samples tested for MRSA at admission to the ICU, discharge from the ICU, and twice weekly during their ICU stay, and they were followed up for development of MRSA infection. Swab test results were analyzed to determine the proportion of patients colonized and the proportion colonized at each screening site. Hazard of MRSA infection (rate of infection per day at risk) was calculated using a Cox proportional hazards analysis, and risk factors for MRSA infection, including presence of MRSA, degree of colonization, and pattern of colonization were determined. RESULTS Among the 4,194 patient episodes, 238 (5.7%) had screening results that were positive for MRSA, and there were 34 cases of MRSA infection. The hazard ratio (HR) for developing an infection increased as more sites were colonized (HR, 3.4 for being colonized at more than 1 site compared with colonization at 1 site [95% confidence interval, 1.2-9.9]). Colonization site was predictive of developing infection (HR for nose or throat colonization compared with no colonization, 168 [95% confidence interval, 69-407]). CONCLUSION This study demonstrated that the hazard of developing an infection was higher when more sites were colonized and that certain sites were more predictive of infection than others. These results may be useful for predicting infection in ICU patients and may influence treatment.
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Affiliation(s)
- Benedict Lim Heng Sim
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
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Impact of strain typing methods on assessment of relationship between paired nares and wound isolates of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2012; 51:224-31. [PMID: 23135945 DOI: 10.1128/jcm.02423-12] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The anterior nares are the site of choice for the Veterans Administration methicillin-resistant Staphylococcus aureus (MRSA) surveillance program; however, a correlation between nares colonization and concomitant wound infections has not been well established. The purpose of this study was 3-fold: to determine the relatedness of MRSA isolates from 40 paired wound and nares specimens by four different strain typing methods, to determine concordance of typing methods, and to establish a baseline of MRSA types at this medical center. Isolates were typed by repetitive PCR (rep-PCR) (DiversiLab System; DL) and SpectraCell Raman analysis (SCRA) (commercially available methods that can be performed within a clinical lab), pulsed-field gel electrophoresis (PFGE), and an antibiotic susceptibility profile (AB). Whole-genome optical mapping (WGM) (OpGen, Inc.) was performed on selected isolates. All methods agreed that 26 pairs were indistinguishable and four pairs were different. Discrepant results were as follows: 4 where only SCRA was discordant, 3 where only AB was discordant, 2 where both DL and AB were discordant, and 1 where both DL and SCRA were discordant. All WGM agreed with PFGE. After discrepancy resolution, 80% of the pairs were indistinguishable and 20% were different. A total of 56% of nares results were nonpredictive if negative nares and positive wound cultures are included. Methods agreed 85 to 93% of the time; however, congruence of isolates to a clade was lower. Baseline analysis of types showed that 15 pairs were unique to single patients (30 strains, 38%; 47% of the matching pairs). Twenty-five strains (30%) represented a single clade identical by PFGE, SCRA, and DL, decreasing specificity. Typing method and institutional type frequency are important in assessing MRSA strain relatedness.
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Wu Q, Li Y, Hu H, Wang M, Wu Z, Xu W. Rapid Identification ofStaphylococcus aureus: FISH Versus PCR Methods. Lab Med 2012. [DOI: 10.1309/lmdpo72qowxo9wzo] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Schweizer M, Ward M, Cobb S, McDanel J, Leder L, Wibbenmeyer L, Latenser B, Diekema D, Herwaldt L. The epidemiology of methicillin-resistant Staphylococcus aureus on a burn trauma unit. Infect Control Hosp Epidemiol 2012; 33:1118-25. [PMID: 23041810 DOI: 10.1086/668032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We assessed the frequency and relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients. DESIGN Prospective cohort study and surveillance for MRSA carriage. SETTING BTU of a Midwestern academic medical center. PATIENTS AND PARTICIPANTS Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period. METHODS Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers' nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis. RESULTS Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25-24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64-35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93-79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment. CONCLUSIONS Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.
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Affiliation(s)
- Marin Schweizer
- University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa, USA.
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Kutlu SS, Cevahir N, Akalin S, Akin F, Dirgen Caylak S, Bastemir M, Tekin K. Prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in a diabetic outpatient population: a prospective cohort study. Am J Infect Control 2012; 40:365-8. [PMID: 21864943 DOI: 10.1016/j.ajic.2011.05.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2010] [Revised: 05/11/2011] [Accepted: 05/11/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND Diabetes mellitus is a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection. We attempted to determine the prevalence and risk factors for MRSA colonization in a population of outpatients with diabetes. METHODS This prospective cohort study enrolled patients with diabetes. Anterior nares cultures were obtained from patients with diabetes admitted to outpatient endocrinology and metabolism clinics, and risk factors for MRSA colonization were analyzed. RESULTS Out of the 304 patients evaluated, 127 (41.9%) were colonized with S aureus and 30 (9.9%) were colonized with MRSA. Overall, 23.6% of all S aureus isolates were MRSA. In multivariate analysis, factors independently associated with an increased risk of MRSA colonization included the presence of connective tissue disease (odds ratio, 7.075; 95% confidence interval, 2.157-23.209; P = .001) and insulin therapy (odds ratio, 3.910; 95% confidence interval, 1.652-9.251; P = .002). CONCLUSIONS The prevalence of MRSA colonization in our sample of diabetic outpatients was 9.9%. Independent risk factors for MRSA colonization were the presence of connective tissue disease and insulin use. A better understanding of the epidemiology and risk factors for nasal MRSA colonization in the persons with diabetes may have significant implications for the treatment and prevention of MRSA infections.
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Abstract
Staphylococcus aureus has been recognized as an important human pathogen for more than 100 years. S aureus has been able to adapt and evolve in terms of its resistance traits and virulence factors; it is among the most important causes of human infections in the twenty-first century. Rapid molecular identification in the clinical microbiology laboratory of these resistance and virulence factors expressed by S aureus will play an important role in the future in decreasing the morbidity and mortality of infections. This article addresses the emerging aspects of infections caused by S aureus, including microbiology, epidemiology, clinical presentation, pathogenesis, diagnosis, treatment and prognosis, and immunity.
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Mathai E, Allegranzi B, Kilpatrick C, Pittet D. Prevention and control of health care-associated infections through improved hand hygiene. Indian J Med Microbiol 2010; 28:100-6. [PMID: 20404452 DOI: 10.4103/0255-0857.62483] [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
Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both developed and developing countries worldwide. The final version of the WHO Guidelines on Hand Hygiene in Health Care was issued in March 2009 and includes recommendations on indications, techniques, and products for hand hygiene. In this review, we discuss the role of hands in the transmission of health care-associated infection, the benefits of improved compliance with hand hygiene, and the recommendations, implementation strategies and tools recommended by WHO. We also stress the need for action to increase the pace with which these recommendations are implemented in facilities across India.
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Affiliation(s)
- E Mathai
- World Health Organization Patient Safety, World Health Organization, Avenue Appia, 1211 Geneva 27, Switzerland
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Popovich KJ. Staphylococcus aureus: Not always right under your nose. Infect Control Hosp Epidemiol 2009; 30:727-9. [PMID: 19580439 DOI: 10.1086/598339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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