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Kusama Y, Miyahara M, Ishikane M, Suzuki K, Gu Y, Sasaki J, Ohmagari N. Physician practices in the diagnosis and treatment of infectious diseases in home care settings: A questionnaire study. Glob Health Med 2022; 4:268-272. [PMID: 36381570 PMCID: PMC9619115 DOI: 10.35772/ghm.2022.01123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 10/15/2022] [Accepted: 10/22/2022] [Indexed: 06/16/2023]
Abstract
To elucidate the current practices of infectious disease management in home care settings in Japan, we sent a questionnaire to 36 physicians working at 13 clinics that specialize in providing care to patients in their homes or residential care facilities. The questionnaire described three hypothetical scenarios (aspiration pneumonia, pyelonephritis, and neoplastic fever) in older patients with terminal cancer, and 25 respondents answered questions on testing and treatment strategies. Most respondents chose to obtain cultures for aspiration pneumonia (sputum) and for pyelonephritis (urine), although fewer respondents chose to obtain blood cultures. For neoplastic fever, most of respondents elected to continue observation without antibiotic treatment. The most frequently selected antibiotics were cephalosporins and quinolones. The results indicated that most respondents would perform bacterial culture tests before prescribing antibiotics and observe patients when bacterial infections are not suspected. Standardized guidelines are needed to optimize infectious disease management in home care.
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Affiliation(s)
- Yoshiki Kusama
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Division of General Pediatrics, Department of Pediatrics, Hyogo Prefectural Amagasaki Medical General Center, Hyogo, Japan
| | | | - Masahiro Ishikane
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Kumiko Suzuki
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Gu
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Infectious Diseases, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Jun Sasaki
- Yushoukai Medical Corporation, Tokyo, Japan
| | - Norio Ohmagari
- AMR Clinical Reference Center, Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
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Mork RL, Hogan PG, Muenks CE, Boyle MG, Thompson RM, Sullivan ML, Morelli JJ, Seigel J, Orscheln RC, Bubeck Wardenburg J, Gehlert SJ, Burnham CAD, Rzhetsky A, Fritz SA. Longitudinal, strain-specific Staphylococcus aureus introduction and transmission events in households of children with community-associated meticillin-resistant S aureus skin and soft tissue infection: a prospective cohort study. THE LANCET. INFECTIOUS DISEASES 2019; 20:188-198. [PMID: 31784369 DOI: 10.1016/s1473-3099(19)30570-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 07/01/2019] [Accepted: 08/21/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Devising effective, targeted approaches to prevent recurrent meticillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection requires an understanding of factors driving MRSA acquisition. We comprehensively defined household longitudinal, strain-level S aureus transmission dynamics in households of children with community-associated MRSA skin and soft tissue infection. METHODS From 2012-15, otherwise healthy paediatric patients with culture-confirmed, community-onset MRSA infections were recruited for the Household Observation of MRSA in the Environment (HOME) prospective cohort study from hospitals and community practices in metropolitan St Louis (MO, USA). Children with health-care-related risk factors were excluded, as determined by evidence of recent hospital admission, an invasive medical device, or residence in a long-term care facility. Household contacts (individuals sleeping in the home ≥four nights per week) and indoor dogs and cats were also enrolled. A baseline visit took place at the index patient's primary home, followed by four quarterly visits over 12 months. At each visit, interviews were done and serial cultures were collected, to detect S aureus from three anatomic sites of household members, two anatomic sites on dogs and cats, and 21 environmental surfaces. Molecular typing was done by repetitive-sequence PCR to define distinct S aureus strains within each household. Longitudinal, multivariable generalised mixed-effects logistic regression models identified factors associated with S aureus acquisition. FINDINGS Across household members, pets, and environmental surfaces, 1267 strain acquisition events were observed. Acquisitions were driven equally by 510 introductions of novel strains into households and 602 transmissions within households, each associated with distinct factors. Frequent handwashing decreased the likelihood of novel strain introduction into the household (odds ratio [OR] 0·86, credible interval [CrI] 0·74-1·01). Transmission recipients were less likely to own their homes (OR 0·77, CrI 0·63-0·94) and were more likely to share bedrooms with strain-colonised individuals (OR 1·33, CrI 1·12-1·58), live in homes with higher environmental S aureus contamination burden (OR 3·97, CrI 1·96-8·20), and report interval skin and soft tissue infection (OR 1·32, CrI 1·07-1·64). Transmission sources were more likely to share bath towels (OR 1·25, CrI 1·01-1·57). Pets were often transmission recipients, but rarely the sole transmission source. INTERPRETATION The household environment plays a key role in transmission, a factor associated with skin and soft tissue infection. Future interventions should inclusively target household members and the environment, focusing on straightforward changes in hand hygiene and household sharing behaviours. FUNDING National Institutes of Health, Agency for Healthcare Research and Quality, Children's Discovery Institute, Burroughs Wellcome Foundation, Defense Advanced Research Projects Agency.
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Affiliation(s)
- Ryan L Mork
- Institute for Genomics and Systems Biology, University of Chicago, Chicago, IL, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Carol E Muenks
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Mary G Boyle
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Ryley M Thompson
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Melanie L Sullivan
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - John J Morelli
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Jennifer Seigel
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - Rachel C Orscheln
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | | | - Sarah J Gehlert
- Department of Surgery, Washington University School of Medicine, St Louis, MO, USA
| | - Carey-Ann D Burnham
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA; Department of Pathology & Immunology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrey Rzhetsky
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA.
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Barcudi D, Sosa EJ, Lamberghini R, Garnero A, Tosoroni D, Decca L, Gonzalez L, Kuyuk MA, Lopez T, Herrero I, Cortes P, Figueroa M, Egea AL, Gagetti P, Fernandez Do Porto DA, Corso A, Turjanski AG, Bocco JL, Sola C. MRSA dynamic circulation between the community and the hospital setting: New insights from a cohort study. J Infect 2019; 80:24-37. [PMID: 31606351 DOI: 10.1016/j.jinf.2019.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 09/09/2019] [Accepted: 10/03/2019] [Indexed: 12/21/2022]
Abstract
Dissemination of methicillin-resistant-Staphylococcus aureus/(MRSA) is a worldwide concern both in hospitals [healthcare-associated-(HA)-MRSA] and communities [community-associated-(CA)-MRSA]. Knowledge on when and where MRSA colonization is acquired and what clones are involved is necessary, to focus efforts for prevention of hospital-acquired MRSA-infections. METHODS A prospective/longitudinal cohort study was performed in eight Argentina hospitals (Cordoba/ October-December/2014). Surveillance cultures for MRSA (nose-throat-inguinal) were obtained on admission and at discharge. MRSA strains were genetically typed as CA-MRSAG and HA-MRSAG genotypes. RESULTS Overall, 1419 patients were screened and 534 stayed at hospital for ≥3 days. S. aureus admission prevalence was 30.9% and 4.2% for MRSA. Overall MRSA acquisition rate was 2.3/1000 patient-days-at-risk with a MRSA acquisition prevalence of 1.96% (95%CI: 1.0%-3.4%); 3.2% of patients were discharged back to community with MRSA. CA-MRSAG accounted for 84.6% of imported, 100.0% of hospital-acquired and 94% of discharged MRSA strains. Most imported and acquired MRSA strains belonged to two major epidemic CA-MRSA clones spread in Argentina: PFGEtypeI-ST5-IVa-t311-PVL+ and PFGEtypeN/ST30-IVc-t019-PVL+. CONCLUSIONS CA-MRSA clones, particularly ST5-IV-PVL+ and ST30-IV-PVL+, with main reservoir in the community, not only enter but also are truly acquired within hospital, causing healthcare-associated-hospital-onset infections, having a transmission capacity greater or similar than HA-MRSAG. This information is essential to develop appropriate MRSA infection prevention-control programs, considering hospital and community.
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Affiliation(s)
- Danilo Barcudi
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Ezequiel J Sosa
- Instituto de Cálculo, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina; Instituto de Química Biológica de La Facultad de Ciencias Exactas y Naturales (IQUIBICEN)-CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
| | - Ricardo Lamberghini
- Facultad de Ciencias Médicas, Universidad Nacional de Córdoba, Bajada Pucará 2025, X5000 Córdoba, Argentina; Hospital Guillermo Rawson, Bajada Pucará 2025, X5000 Córdoba, Argentina
| | - Analía Garnero
- Hospital de Niños de la Santísima Trinidad de Córdoba, Córdoba, Bajada Pucará 787, X5000 ANN, Argentina
| | - Dario Tosoroni
- Facultad de Medicina, Universidad Católica de Córdoba, Jacinto Ríos 555, X5004ASK Córdoba, Argentina
| | - Laura Decca
- Clínica Regional del SUD-Río IV, Av. Italia 1262, X5800 Río Cuarto, Córdoba, Argentina
| | - Liliana Gonzalez
- Hospital Infantil Municipal de Córdoba, Juan Antonio Lavalleja 3050, X5000 Córdoba, Argentina
| | - María A Kuyuk
- Hospital Militar Córdoba, Cruz Roja Argentina 1114, X5000 Córdoba, Argentina
| | - Teresa Lopez
- Hospital Guillermo Rawson, Bajada Pucará 2025, X5000 Córdoba, Argentina
| | - Ivana Herrero
- Hospital de Urgencias, Catamarca 441, X5000 Córdoba, Argentina
| | - Paulo Cortes
- Hospital Pediátrico del Niño Jesús, Av. Castro Barros 650, X5000HTT Córdoba, Argentina
| | - Myrian Figueroa
- Hospital Misericordia, Nuevo Siglo, Belgrano 1502, X5000 Córdoba, Argentina
| | - Ana L Egea
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Paula Gagetti
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, C1282AFF Ciudad Autónoma de Buenos Aires, Argentina
| | - Darío A Fernandez Do Porto
- Instituto de Cálculo, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, CONICET, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina; Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
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- The members of the Study Group are listed in the Acknowledgments section, where the participants of each hospital and their affiliations are described
| | - Alejandra Corso
- Servicio Antimicrobianos, Instituto Nacional de Enfermedades Infecciosas (INEI)-ANLIS "Dr. Carlos G. Malbrán", Av. Vélez Sarsfield 563, C1282AFF Ciudad Autónoma de Buenos Aires, Argentina
| | - Adrián G Turjanski
- Departamento de Química Biológica, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Ciudad Universitaria, Pabellón 2, C1428EHA Ciudad de Buenos Aires, Argentina
| | - José L Bocco
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina
| | - Claudia Sola
- Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI) CONICET and Universidad Nacional de Córdoba; Departamento de Bioquímica Clínica; Facultad de Ciencias Químicas; Haya de La Torre y Medina Allende, Ciudad Universitaria, X5000-Córdoba, Argentina.
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Are methicillin-susceptible Staphylococcus aureus carriers protected from methicillin-resistant Staphylococcus aureus infections? Clin Microbiol Infect 2019; 25:4-5. [DOI: 10.1016/j.cmi.2018.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 06/16/2018] [Accepted: 06/18/2018] [Indexed: 11/20/2022]
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Kotloff KL, Shirley DAT, Creech CB, Frey SE, Harrison CJ, Staat M, Anderson EJ, Dulkerian S, Thomsen IP, Al-Hosni M, Pahud BA, Bernstein DI, Yi J, Petrikin JE, Haberman B, Stephens K, Stephens I, Oler RE, Conrad TM. Mupirocin for Staphylococcus aureus Decolonization of Infants in Neonatal Intensive Care Units. Pediatrics 2019; 143:peds.2018-1565. [PMID: 30587533 PMCID: PMC6317770 DOI: 10.1542/peds.2018-1565] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2018] [Indexed: 12/22/2022] Open
Abstract
UNLABELLED : media-1vid110.1542/5849573989001PEDS-VA_2018-1565Video Abstract BACKGROUND AND OBJECTIVES: Staphylococcus aureus (SA) is the second leading cause of late-onset sepsis among infants in the NICU. Because colonization of nasal mucosa and/or skin frequently precedes invasive infection, decolonization strategies, such as mupirocin application, have been attempted to prevent clinical infection, but data supporting this approach in infants are limited. We conducted a phase 2 multicenter, open-label, randomized trial to assess the safety and efficacy of intranasal plus topical mupirocin in eradicating SA colonization in critically ill infants. METHODS Between April 2014 and May 2016, infants <24 months old in the NICU at 8 study centers underwent serial screening for nasal SA. Colonized infants who met eligibility criteria were randomly assigned to receive 5 days of mupirocin versus no mupirocin to the intranasal, periumbilical, and perianal areas. Mupirocin effects on primary (day 8) and persistent (day 22) decolonization at all three body sites were assessed. RESULTS A total of 155 infants were randomly assigned. Mupirocin was generally well tolerated, but rashes (usually mild and perianal) occurred significantly more often in treated versus untreated infants. Primary decolonization occurred in 62 of 66 (93.9%) treated infants and 3 of 64 (4.7%) control infants (P < .001). Twenty-one of 46 (45.7%) treated infants were persistently decolonized compared with 1 of 48 (2.1%) controls (P < .001). CONCLUSIONS Application of mupirocin to multiple body sites was safe and efficacious in eradicating SA carriage among infants in the NICU; however, after 2 to 3 weeks, many infants who remained hospitalized became recolonized.
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Affiliation(s)
- Karen L. Kotloff
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - Debbie-Ann T. Shirley
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
| | - C. Buddy Creech
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - Mary Staat
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Evan J. Anderson
- Departments of Medicine and,Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Isaac P. Thomsen
- Vanderbilt Vaccine Research Program, Department of
Pediatrics, School of Medicine, Vanderbilt University, Nashville,
Tennessee
| | | | | | - David I. Bernstein
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Jumi Yi
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | | | - Beth Haberman
- Department of Pediatrics, Cincinnati
Children’s Hospital Medical Center and University of Cincinnati,
Cincinnati, Ohio
| | - Kathy Stephens
- Pediatrics, School of Medicine, Emory University,
Atlanta, Georgia; and
| | - Ina Stephens
- Department of Pediatrics and,Center for Vaccine Development and Global Health,
School of Medicine, University of Maryland, Baltimore, Maryland
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Olofsson M, Matussek A, Ehricht R, Lindgren PE, Östgren CJ. Differences in molecular epidemiology of Staphylococcus aureus and Escherichia coli in nursing home residents and people in unassisted living situations. J Hosp Infect 2018; 101:76-83. [PMID: 30237119 DOI: 10.1016/j.jhin.2018.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/10/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND The usefulness of colonization pressure as a working model and proxy for infection transmission is limited due to the inability to grade or quantify the specific risk within environments that are subject to change. AIM To elaborate on the colonization pressure model by comparing the molecular epidemiology of two bacteria, Staphylococcus aureus and Escherichia coli, among residents in a nursing home and people in unassisted living situations. METHODS A cross-sectional study of 73 elderly residents from a village in south-central Sweden was conducted. Of these, 35 were residents of a nursing home, and 34 lived in an own place of residence in the same geographical area. Samples of two representative bacterial species were collected from multiple body sites and analysed for molecular diversity. FINDINGS Combining all body sites, 47% of the participants were colonized with S. aureus and 93% with E. coli. The nursing home group, the group in unassisted living situations, and both units combined, held 16, 17, and 29 different S. aureus spa types, respectively. The corresponding numbers of different E. coli serogenotypes were 34, 28, and 48. Diabetes mellitus was associated with more frequent colonization with S. aureus. CONCLUSION The molecular diversity of bacteria found within different forms of accommodation was within the same range. Hospital quality hygiene might have contributed to the absence of homogenization of the molecular diversity within the nursing home group. Diabetes mellitus might have played a role in a patient selection characterized by advanced age.
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Affiliation(s)
- M Olofsson
- Ödeshög Health Care Centre, Ödeshög, Sweden; Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - A Matussek
- Department of Laboratory Medicine, Region Jönköping County, Sweden; Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm, Sweden; Karolinska University Laboratory, Stockholm, Sweden
| | - R Ehricht
- Abbott (Alere Technologies GmbH), Jena, Germany; InfectoGnostics Research Campus, Jena, Germany; Leibniz Institute of Photonic Technology, Jena, Germany
| | - P-E Lindgren
- Department of Laboratory Medicine, Region Jönköping County, Sweden; Division of Medical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - C J Östgren
- Ödeshög Health Care Centre, Ödeshög, Sweden; Division of Community Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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A prospective surveillance study for multidrug-resistant bacteria colonization in hospitalized patients at a Thai University Hospital. Antimicrob Resist Infect Control 2018; 7:102. [PMID: 30167108 PMCID: PMC6102905 DOI: 10.1186/s13756-018-0393-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 08/07/2018] [Indexed: 11/10/2022] Open
Abstract
Background Colonization with multidrug-resistant (MDR) bacteria is a major risk factor for developing subsequent MDR infections. Methods We performed a prospective surveillance study in hospitalized patients at Siriraj Hospital. Nasal cavity, throat, inguinal area and rectal swabs were obtained within the first 48-h after admission, on day-5 after hospitalization and then every 7 days until discharge. Target bacteria included extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL), carbapenem-resistant-P.aeruginosa (CR-PA), carbapenem-resistant-A.baumannii (CR-AB) and methicillin-resistant S.aureus (MRSA). Results From January 2013–December 2014, 487 patients were enrolled. The baseline prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA at any site was 52.2%, 6.8%, 4.7% and 7.2%, respectively. After 3-week of hospitalization, the prevalence of colonization by ESBL, CR-PA, CR-AB and MRSA increased to 71.7%, 47.2%, 18.9% and 18.9%, respectively. Multivariable analysis revealed that diabetes mellitus and recent cephalosporin exposure were the independent risk factors for baseline colonization by ESBL. The independent risk factors for CR-AB and/or CR-PA colonization were cerebrovascular diseases, previous hospitalization, transfer from another hospital/a LTCF and previous nasogastric tube use, whereas those for MRSA colonization were previous fluoroquinolone exposure and previous nasogastric tube use. Conclusions The baseline prevalence of colonization by ESBL was relatively high, whereas the baseline prevalence of colonization by CR-PA, CR-AB and MRSA was comparable to previous studies. There was an increasing trend in MDR bacteria colonization after hospitalization.
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Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study. Infect Control Hosp Epidemiol 2017; 39:46-52. [PMID: 29157314 DOI: 10.1017/ice.2017.234] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE To determine risk factors independent of length of stay (LOS) for Staphylococcus aureus acquisition in infants admitted to the neonatal intensive care unit (NICU). DESIGN Retrospective matched case-case-control study. SETTING Quaternary-care referral NICU at a large academic children's hospital. METHODS Infants admitted between January 2014 and March 2016 at a level IV NICU who acquired methicillin resistant (MRSA) or susceptible (MSSA) S. aureus were matched with controls by duration of exposure to determine risk factors for acquisition. A secondary post hoc analysis was performed on the entire cohort of at-risk infants for risk factors identified in the primary analysis to further quantify risk. RESULTS In total, 1,751 infants were admitted during the study period with 199 infants identified as having S. aureus prevalent on admission. There were 246 incident S. aureus acquisitions in the remaining at-risk infant cohort. On matched analysis, infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA (P=.03) and MSSA (P=.01) acquisition compared with infants housed in multibed pods. Across the entire cohort, pooled S. aureus acquisition was significantly lower in infants housed in single-bed units (hazard ratio,=0.46; confidence interval, 0.34-0.62). CONCLUSIONS NICU bed design is significantly associated with S. aureus acquisition in hospitalized infants independent of LOS. Infect Control Hosp Epidemiol 2018;39:46-52.
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Cho OH, Park KH, Song JY, Hong JM, Kim T, Hong SI, Kim S, Bae IG. Prevalence and Microbiological Characteristics of qacA/B-Positive Methicillin-Resistant Staphylococcus aureus Isolates in a Surgical Intensive Care Unit. Microb Drug Resist 2017; 24:283-289. [PMID: 28799881 DOI: 10.1089/mdr.2017.0072] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The increasing use of chlorhexidine for methicillin-resistant Staphylococcus aureus (MRSA) decolonization has raised concerns about the emergence of resistance to or tolerance of this antiseptic. We examined the frequency and characteristics of qacA/B chlorhexidine tolerance genes among MRSA isolates in a surgical intensive care unit (ICU) where MRSA-colonized patients are decolonized by chlorhexidine bathing. The MRSA isolates were evaluated for chlorhexidine susceptibility, mupirocin resistance, molecular typing, agr functionality, and the heterogeneous vancomycin-intermediate S. aureus (hVISA) phenotype according to the presence of the qacA/B genes. Overall, 119 MRSA isolates were obtained from active surveillance cultures (93, 78.2%) and clinical cultures (26, 21.8%) between 2012 and 2014. Among these isolates, 39 (32.8%) carried the qacA/B genes, and 23 (19.3%) exhibited mupirocin resistance. Most qacA/B-positive isolates (36/39, 92.3%) were identified as ST5-SCCmecII (69.2%) and ST239-SCCmecIII (23.1%), which are common healthcare-associated (HA)-MRSA strains in Korea. Multivariate analysis found that qacA/B-positive MRSA isolates were associated with agr dysfunction (OR, 4.87; 95% CI, 1.71-13.87) and the hVISA phenotype (OR, 4.09; 95% CI, 1.48-11.34). In conclusion, our study showed that qacA/B carriage was common among MRSA isolates in an ICU where chlorhexidine is commonly used for decolonization. qacA/B carriage was significantly associated with agr dysfunction and the hVISA phenotype. These features may confer a selective advantage on HA-MRSA strains, including ST5-SCCmecII and ST239-SCCmecIII, in the ICU setting.
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Affiliation(s)
- Oh-Hyun Cho
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Ki-Ho Park
- 2 Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University School of Medicine , Seoul, Republic of Korea
| | - Ji Young Song
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Jeong Min Hong
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Taeeun Kim
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - Sun In Hong
- 3 Department of Internal Medicine, Gyeongsang National University Changwon Hospital , Changwon, Republic of Korea
| | - Sunjoo Kim
- 4 Department of Laboratory Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea.,5 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
| | - In-Gyu Bae
- 1 Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine , Jinju, Republic of Korea.,5 Gyeongsang Institute of Health Sciences, Gyeongsang National University School of Medicine , Jinju, Republic of Korea
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Lyles RD, Trick WE, Hayden MK, Lolans K, Fogg L, Logan LK, Shulman ST, Weinstein RA, Lin MY. Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Critically Ill Children in a State With Mandated Active Surveillance. J Pediatric Infect Dis Soc 2016; 5:409-416. [PMID: 26407280 PMCID: PMC8376206 DOI: 10.1093/jpids/piv050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/18/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND In theory, active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) reduces MRSA spread by identifying all MRSA-colonized patients and placing them under contact precautions. In October 2007, Illinois mandated active MRSA surveillance in all intensive care units, including neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). We evaluated MRSA trends in a large metropolitan region in the wake of this law. METHODS Chicago hospitals with a NICU or PICU were recruited for 8 single-day point prevalence surveys that occurred twice-yearly between June 2008 and July 2011 and then yearly in 2012 to 2013. Samples from all patients were cultured for MRSA (nose and umbilicus for neonates, nose and groin for pediatric patients). Hospital-reported admission MRSA-screening results also were obtained. Point prevalence cultures were screened for MRSA by using broth enrichment, chromogenic agar, and standard confirmatory methods. RESULTS All eligible hospitals (N = 10) participated (10 NICUs, 6 PICUs). Hospital-reported adherence to state-mandated MRSA screening at admission was high (95% for NICUs, 94% for PICUs). From serial point prevalence surveys, overall MRSA prevalences in the NICUs and PICUs were 4.2% (89 of 2101) and 5.7% (36 of 632), respectively. MRSA colonization prevalences were unchanged in the NICUs (year-over-year risk ratio [RR], 0.93 [95% confidence interval (CI), 0.78-1.12]; P = .45) and trended toward an increase in the PICUs (RR, 1.25 [95% CI, 0.72-2.12]; P = .053). We estimated that 81% and 40% of MRSA-positive patients in the NICUs and PICUs, respectively, had newly acquired MRSA. CONCLUSIONS In a region with mandated active MRSA surveillance, we found ongoing unchanged rates of MRSA colonization and acquisition among NICU and PICU patients.
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Affiliation(s)
- Rosie D. Lyles
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
| | - William E. Trick
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Department of Medicine, Rush University Medical Center, Chicago, Illinois;,Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Karen Lolans
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Latania K. Logan
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Stanford T. Shulman
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Robert A. Weinstein
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
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Pierce R, Lessler J, Popoola VO, Milstone AM. Meticillin-resistant Staphylococcus aureus (MRSA) acquisition risk in an endemic neonatal intensive care unit with an active surveillance culture and decolonization programme. J Hosp Infect 2016; 95:91-97. [PMID: 27887754 DOI: 10.1016/j.jhin.2016.10.022] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 10/23/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND Meticillin-resistant Staphylococcus aureus (MRSA) is a leading cause of healthcare-associated infection in the neonatal intensive care unit (NICU). Decolonization may eliminate bacterial reservoirs that drive MRSA transmission. AIM To measure the association between colonization pressure from decolonized and non-decolonized neonates and MRSA acquisition to inform use of this strategy for control of endemic MRSA. METHODS An eight-year retrospective cohort study was conducted in a level-4 NICU that used active surveillance cultures and decolonization for MRSA control. Weekly colonization pressure exposures were defined as the number of patient-days of concurrent admission with treated (decolonized) and untreated (non-decolonized) MRSA carriers in the preceding seven days. Poisson regression was used to estimate risk of incident MRSA colonization associated with colonization pressure exposures. The population-attributable fraction was calculated to assess the proportion of overall unit MRSA incidence attributable to treated or untreated patients in this setting. FINDINGS Every person-day increase in exposure to an untreated MRSA carrier was associated with a 6% increase in MRSA acquisition risk [relative risk (RR): 1.06; 95% confidence interval (CI): 1.01-1.11]. Risk of acquisition was not influenced by exposure to treated, isolated MRSA carriers (RR: 1.01; 95% CI: 0.98-1.04). In the context of this MRSA control programme, 22% (95% CI: 4.0-37) of MRSA acquisition could be attributed to exposures to untreated MRSA carriers. CONCLUSION Untreated MRSA carriers were an important reservoir for transmission. Decolonized patients on contact isolation posed no detectable transmission threat, supporting the hypothesis that decolonization may reduce patient-to-patient transmission. Non-patient reservoirs may contribute to unit MRSA acquisition and require further investigation.
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Affiliation(s)
- R Pierce
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - J Lessler
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - V O Popoola
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA
| | - A M Milstone
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, MA, USA; Department of Hospital Epidemiology and Infection Control, Johns Hopkins Hospital, Baltimore, MA, USA.
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Expanding the statistical toolbox: analytic approaches for cohort studies with healthcare-associated infectious outcomes. Curr Opin Infect Dis 2016; 28:384-91. [PMID: 26098502 DOI: 10.1097/qco.0000000000000179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE OF REVIEW Healthcare-associated infections (HAIs) are a leading cause of adverse patient outcomes. Further elucidation of the etiology of these infections and the pathogens that cause them has been a primary goal of research in infection control and healthcare epidemiology. Longitudinal studies, in particular, afford a range of statistical methods to better understand the process of pathogen acquisition or HAI development. This review intends to convey the scope of available statistical methodology. RECENT FINDINGS Despite the range of methods available, logistic regression remains the dominant statistical approach in use. Poisson regression, survival methods, and mechanistic (mathematical) models remain underutilized. Recent studies that use these approaches are looking beyond associations to answer questions about the timing, duration, and mechanism of infectious risk. SUMMARY Logistic regression remains an important approach to the study of HAIs, but in the context of cohort studies, it is most appropriate for short observation periods, during which mechanism is not of primary interest. Additional statistical methodologies are available to build upon risk factor analysis to better inform the process of risk and infection in the hospital setting.
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Goodman KE, Simner PJ, Tamma PD, Milstone AM. Infection control implications of heterogeneous resistance mechanisms in carbapenem-resistant Enterobacteriaceae (CRE). Expert Rev Anti Infect Ther 2015; 14:95-108. [PMID: 26535959 DOI: 10.1586/14787210.2016.1106940] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The Centers for Disease Control and Prevention (CDC) defines carbapenem-resistant Enterobacteriaceae (CRE) based upon a phenotypic demonstration of carbapenem resistance. However, considerable heterogeneity exists within this definitional umbrella. CRE may mechanistically differ by whether they do or do not produce carbapenemases. Moreover, patients can acquire CRE through multiple pathways: endogenously through antibiotic selective pressure on intestinal microbiota, exogenously through horizontal transmission or through a combination of these factors. Some evidence suggests that non-carbapenemase-producing CRE may be more frequently acquired by antibiotic exposure and carbapenemase-producing CRE via horizontal transmission, but definitive data are lacking. This review examines types of CRE resistance mechanisms, antibiotic exposure and horizontal transmission pathways of CRE acquisition, and the implications of these heterogeneities to the development of evidence-based CRE healthcare epidemiology policies. In our Expert Commentary & Five-Year View, we outline specific nosocomial CRE knowledge gaps and potential methodological approaches for their resolution.
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Affiliation(s)
- K E Goodman
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA
| | - P J Simner
- b Department of Pathology, Division of Medical Microbiology , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - P D Tamma
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Department of Pediatrics, Division of Pediatric Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - A M Milstone
- a Department of Epidemiology , The Johns Hopkins Bloomberg School of Public Health , Baltimore , MD , USA.,c Department of Pediatrics, Division of Pediatric Infectious Diseases , Johns Hopkins University School of Medicine , Baltimore , MD , USA.,d Department of Hospital Epidemiology and Infection Control , The Johns Hopkins Hospital , Baltimore , MD , USA
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Whole-genome sequencing for outbreak investigations of methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit: time for routine practice? Infect Control Hosp Epidemiol 2015; 36:777-85. [PMID: 25998499 DOI: 10.1017/ice.2015.73] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Infants in the neonatal intensive care unit (NICU) are at increased risk for methicillin-resistant Staphylococcus aureus (MRSA) acquisition. Outbreaks may be difficult to identify due in part to limitations in current molecular genotyping available in clinical practice. Comparison of genome-wide single nucleotide polymorphisms (SNPs) may identify epidemiologically distinct isolates among a population sample that appears homogenous when evaluated using conventional typing methods. OBJECTIVE To investigate a putative MRSA outbreak in a NICU utilizing whole-genome sequencing and phylogenetic analysis to identify recent transmission events. DESIGN Clinical and surveillance specimens collected during clinical care and outbreak investigation. PATIENTS A total of 17 neonates hospitalized in a 43-bed level III NICU in northeastern Florida from December 2010 to October 2011 were included in this study. METHODS We assessed epidemiological data in conjunction with 4 typing methods: antibiograms, PFGE, spa types, and phylogenetic analysis of genome-wide SNPs. RESULTS Among the 17 type USA300 isolates, 4 different spa types were identified using pulsed-field gel electrophoresis. Phylogenetic analysis identified 5 infants as belonging to 2 clusters of epidemiologically linked cases and excluded 10 unlinked cases from putative transmission events. The availability of these results during the initial investigation would have improved infection control interventions. CONCLUSION Whole-genome sequencing and phylogenetic analysis are invaluable tools for epidemic investigation; they identify transmission events and exclude cases mistakenly implicated by traditional typing methods. When routinely applied to surveillance and investigation in the clinical setting, this approach may provide actionable intelligence for measured, appropriate, and effective interventions.
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Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors. Am J Infect Control 2015; 43:476-81. [PMID: 25726131 DOI: 10.1016/j.ajic.2014.12.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 12/23/2014] [Accepted: 12/23/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To describe epidemiologic features and identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a level III neonatal intensive care unit (NICU). SETTING A prospective, cohort study in a university-affiliated NICU with an infection control program including weekly nasal cultures of all neonates. METHODS Demographic, clinical, and microbiologic data were prospectively collected between June 2009 and June 2013. Molecular characterization of MRSA isolates was done by multilocus variable number tandem repeat fingerprinting, staphylococcal cassette chromosome mec typing, and on representative isolates by multilocus sequence typing and spa typing. RESULTS Of 949 neonates, 217 (22.87%) had a culture growing MRSA, including 117 neonates testing positive at their first sampling. Of these latter infants, 96 (82.05%) were inborn and 59 (50.43%) had been transferred from the nursery. Length of stay and colonization pressure were strong independent predictors of MRSA acquisition. Among MRSA isolates, 7 sequence types were identified, with ST22-IVa, spa type t223, being the predominant strain. CONCLUSIONS In an endemic area, early MRSA acquisition and high colonization pressure, likely related to an influx of colonized infants from a well-infant nursery, can support persistence of MRSA in NICUs. Surveillance, molecular tracking of strains, and reinforcement of infection control practices, involving well-infant nurseries in a comprehensive infection control program, could be helpful in containing MRSA transmission.
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Cluzet VC, Gerber JS, Nachamkin I, Metlay JP, Zaoutis TE, Davis MF, Julian KG, Royer D, Linkin DR, Coffin SE, Margolis DJ, Hollander JE, Mistry RD, Gavin LJ, Tolomeo P, Wise JA, Wheeler MK, Bilker WB, Han X, Hu B, Fishman NO, Lautenbach E. Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus. Clin Infect Dis 2015; 60:1489-96. [PMID: 25648237 DOI: 10.1093/cid/civ075] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/02/2015] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear. METHODS We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization. RESULTS Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06). CONCLUSIONS With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.
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Affiliation(s)
| | - Jeffrey S Gerber
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | | | - Joshua P Metlay
- Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Theoklis E Zaoutis
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - Meghan F Davis
- Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - David Royer
- Department of Biology, Lincoln University, Pennsylvania
| | - Darren R Linkin
- Division of Infectious Diseases, Department of Medicine Philadelphia Veterans Administration Medical Center
| | - Susan E Coffin
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia
| | - David J Margolis
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Dermatology, Perelman School of Medicine, University of Pennsylvania
| | - Judd E Hollander
- Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia
| | - Rakesh D Mistry
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora
| | - Laurence J Gavin
- Department of Emergency Medicine, Penn Presbyterian Medical Center
| | - Pam Tolomeo
- Center for Clinical Epidemiology and Biostatistics
| | | | | | - Warren B Bilker
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
| | - Xiaoyan Han
- Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
| | - Baofeng Hu
- Department of Pathology and Laboratory Medicine
| | | | - Ebbing Lautenbach
- Division of Infectious Diseases, Department of Medicine Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology
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Low Prevalence of Mupirocin Resistance Among Hospital-Acquired Methicillin-Resistant Staphylococcus aureus Isolates in a Neonatal Intensive Care Unit with an Active Surveillance Cultures and Decolonization Program. Infect Control Hosp Epidemiol 2014; 36:232-4. [DOI: 10.1017/ice.2014.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Popoola VO, Budd A, Wittig SM, Ross T, Aucott SW, Perl TM, Carroll KC, Milstone AM. Methicillin-resistant Staphylococcus aureus transmission and infections in a neonatal intensive care unit despite active surveillance cultures and decolonization: challenges for infection prevention. Infect Control Hosp Epidemiol 2014; 35:412-8. [PMID: 24602947 DOI: 10.1086/675594] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) transmission and infections in a level IIIC neonatal intensive care unit (NICU) and identify barriers to MRSA control. SETTING AND DESIGN Retrospective cohort study in a university-affiliated NICU with an MRSA control program including weekly nares cultures of all neonates and admission nares cultures for neonates transferred from other hospitals or admitted from home. METHODS Medical records were reviewed to identify neonates with NICU-acquired MRSA colonization or infection between April 2007 and December 2011. Compliance with hand hygiene and an MRSA decolonization protocol were monitored. Relatedness of MRSA strains were assessed using pulsed-field gel electrophoresis (PFGE). RESULTS Of 3,536 neonates, 74 (2.0%) had a culture grow MRSA, including 62 neonates with NICU-acquired MRSA. Nineteen of 74 neonates (26%) had an MRSA infection, including 8 who became infected before they were identified as MRSA colonized, and 11 of 66 colonized neonates (17%) developed a subsequent infection. Of the 37 neonates that underwent decolonization, 6 (16%) developed a subsequent infection, and 7 of 14 (50%) that remained in the NICU for 21 days or more became recolonized with MRSA. Using PFGE, there were 14 different strain types identified, with USA300 being the most common (31%). CONCLUSIONS Current strategies to prevent infections-including active identification and decolonization of MRSA-colonized neonates-are inadequate because infants develop infections before being identified as colonized or after attempted decolonization. Future prevention efforts would benefit from improving detection of MRSA colonization, optimizing decolonization regimens, and identifying and interrupting reservoirs of transmission.
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Affiliation(s)
- Victor O Popoola
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Decolonization to prevent Staphylococcus aureus transmission and infections in the neonatal intensive care unit. J Perinatol 2014; 34:805-10. [PMID: 25010222 DOI: 10.1038/jp.2014.128] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 03/26/2014] [Accepted: 05/05/2014] [Indexed: 01/03/2023]
Abstract
Staphylococcus aureus (S. aureus) continues to be a leading cause of outbreaks and health-care-associated infections in neonatal intensive care units. In the first few months of life, many neonates acquire S. aureus as part of their delicate and evolving microbiota. Neonates that asymptomatically acquire S. aureus colonization are at increased risk of developing a subsequent S. aureus infection. This review discusses the epidemiology and prevention of S. aureus disease in neonates and how decolonization to eradicate S. aureus may decrease S. aureus transmission and infections in the neonatal intensive care unit.
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New patterns of methicillin-resistant Staphylococcus aureus (MRSA) clones, community-associated MRSA genotypes behave like healthcare-associated MRSA genotypes within hospitals, Argentina. Int J Med Microbiol 2014; 304:1086-99. [PMID: 25240872 DOI: 10.1016/j.ijmm.2014.08.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/30/2014] [Accepted: 08/04/2014] [Indexed: 01/22/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) burden is increasing worldwide in hospitals [healthcare-associated (HA)-MRSA] and in communities [community-associated (CA)-MRSA]. However, the impact of CA-MRSA within hospitals remains limited, particularly in Latin America. A countrywide representative survey of S. aureus infections was performed in Argentina by analyzing 591 clinical isolates from 66 hospitals in a prospective cross-sectional, multicenter study (Nov-2009). This work involved healthcare-onset infections-(HAHO, >48 hospitalization hours) and community-onset (CO) infections [including both, infections (HACO) in patients with healthcare-associated risk-factors (HRFs) and infections (CACO) in those without HRFs]. MRSA strains were genetically typed as CA-MRSA and HA-MRSA genotypes (CA-MRSAG and HA-MRSAG) by SCCmec- and spa-typing, PFGE, MLST and virulence genes profile by PCR. Considering all isolates, 63% were from CO-infections and 55% were MRSA [39% CA-MRSAG and 16% HA-MRSAG]. A significantly higher MRSA proportion among CO- than HAHO-S. aureus infections was detected (58% vs 49%); mainly in children (62% vs 43%). The CA-MRSAG/HA-MRSAG have accounted for 16%/33% of HAHO-, 39%/13% of HACO- and 60.5%/0% of CACO-infections. Regarding the epidemiological associations identified in multivariate models for patients with healthcare-onset CA-MRSAG infections, CA-MRSAG behave like HA-MRSAG within hospitals but children were the highest risk group for healthcare-onset CA-MRSAG infections. Most CA-MRSAG belonged to two major clones: PFGE-type N-ST30-SCCmecIVc-t019-PVL(+) and PFGE-type I-ST5-IV-SCCmecIVa-t311-PVL(+) (45% each). The ST5-IV-PVL(+)/ST30-IV-PVL(+) clones have caused 31%/33% of all infections, 20%/4% of HAHO-, 43%/23% of HACO- and 35%/60% of CACO- infections, with significant differences by age groups (children/adults) and geographical regions. Importantly, an isolate belonging to USA300-0114-(ST8-SCCmecIVa-spat008-PVL(+)-ACME(+)) was detected for the first time in Argentina. Most of HA-MRSAG (66%) were related to the Cordobes/Chilean clone-(PFGE-type A-ST5-SCCmecI-t149) causing 18% of all infections (47% of HAHO- and 13% of HACO-infections). Results strongly suggest that the CA-MRSA clone ST5-IV-PVL(+) has begun to spread within hospitals, replacing the traditional Cordobes/Chilean-HA-MRSA clone ST5-I-PVL(-), mainly in children. Importantly, a growing MRSA reservoir in the community was associated with spreading of two CA-MRSA clones: ST5-IV-PVL(+), mainly in children with HRFs, and ST30-IV-PVL(+) in adults without HRFs. This is the first nationwide study in Argentina providing information about the molecular and clinical epidemiology of CA-MRSA, particularly within hospitals, which is essential for designing effective control measures in this country and worldwide.
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