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Wong SC, Chen JHK, So SYC, Ho PL, Yuen KY, Cheng VCC. Gastrointestinal colonization of methicillin-resistant Staphylococcus aureus: an unrecognized burden in the hospital infection control. J Hosp Infect 2021; 121:65-74. [PMID: 34953945 DOI: 10.1016/j.jhin.2021.12.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 12/15/2021] [Accepted: 12/15/2021] [Indexed: 12/22/2022]
Abstract
The incidence, risk factors, outcomes, and genomic relatedness of patients with newly diagnosed gastrointestinal colonization of meticillin-resistant Staphylococcus aureus (MRSA) were analyzed epidemiologically and genetically by whole genome sequencing (WGS) in a hospital network in Hong Kong. Between 1 October 2015 and 31 December 2018, 919 (2.7%) of 34,667 patients had newly diagnosed gastrointestinal MRSA colonization by admission screening. The incidence was 0.67±0.32 per 1,000-patient-days-per-quarter. Including patients with gastrointestinal MRSA colonization, the overall burden of MRSA increased by 59.2% (from 1.13±0.13 to 1.80±0.36 case per 1,000-patient-days-per-quarter), with an addition of MRSA 4,727 patient-days during the study period. Patients referred from residential care home for the elderly [odds ratio (95% confidential interval): 4.18 (3.50-4.99), p<0.001], with history of hospitalization in the past 6 months [1.90 (1.56-2.30), p<0.001], and consumption of fluoroquinolones [1.76 (1.34-2.30), p<0.001], cephalosporins [1.61 (1.11-2.31), p=0.011], and proton pump inhibitors [1.31 (1.10-1.56), p=0.002] in the preceding 6 months were found to be independent risk factors by multivariable analysis in the case-control analysis. The median survival of case was significantly shorter than control (860 vs 1507 days, p<0.001). 127 (13.8%) of 919 patients developed symptomatic MRSA infection in 112 days (median, range: 2-712 days). Of 19 patients with paired MRSA faecal and blood culture isolates subjected to WGS, clonality was found in 16 (84.2%) pairs of MRSA isolates. MRSA ST45 constituted 44.7% (17/38) of MRSA isolates. Gastrointestinal MRSA colonization may contribute to adverse clinical outcomes and pose an unrecognized burden to the hospital infection control.
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Affiliation(s)
- Shuk-Ching Wong
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China
| | - Jonathan Hon-Kwan Chen
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Simon Yung-Chun So
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pak-Leung Ho
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Vincent Chi-Chung Cheng
- Infection Control Team, Queen Mary Hospital, Hong Kong West Cluster, Hong Kong Special Administrative Region, China; Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
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Alhussaini MS. Methicillin-resistant Staphylococcus aureus Nasal Carriage Among Patients Admitted at Shaqra General Hospital in Saudi Arabia. Pak J Biol Sci 2017; 19:233-238. [PMID: 29023028 DOI: 10.3923/pjbs.2016.233.238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) have been causing increasing problems in hospitals and nursing homes worldwide. Limited number of studies in Saudi Arabia has attempted to investigate infection and risk factors associated with nosocomial acquired MRSA. The present study was undertaken to determine the occurrence, prevalence, antibiotic susceptibility pattern and genetic characteristics of MRSA among admitted cases at Shaqra General Hospital (Saudi Arabia). METHODOLOGY This study was conducted from October, 2014 to March, 2015. Nasal swabs were taken from 220 patients (105 males and 115 females) admitted at Shaqra General Hospital. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test and mannitol salt agar fermentation. Antibiotic susceptibility testing of MRSA was performed with standard disk diffusion method. All methicillin-resistant isolates were examined for the existence of the mecA gene by PCR technique. RESULTS Of the 220 patients, 90 (40.91%) were found to be nasal carriers of S. aureus. Among these 90 S. aureus isolates, 48 (21.82%) were MRSA. A statistically significant difference was only found for antibiotics usage between those with and without MRSA colonization. Antibiotic susceptibility pattern of isolated MRSA showed high susceptibility to vancomycin, linezolid, rifampicin, teicoplanin, complete resistance to penicillin, ampicillin, oxacillin and cefoxitin and intermediate resistance to amikacin, ciprofloxacin, teicoplanin, tetracycline and vancomycin. CONCLUSION A high prevalence of multidrug-resistant MRSA nasal carriage was found. The identification of MRSA carriers is a step towards establishing a control policy for MRSA and helps to identify measures needed to reduce colonization pressure.
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Affiliation(s)
- Mohammed S Alhussaini
- Department of Clinical Laboratory Science, College of Applied Medical Sciences, Shaqra University, Saudi Arabia
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Daeschlein G, von Podewils S, Bloom T, Assadian O, Napp M, Haase H, Jünger M. Risk factors for MRSA colonization in dermatologic patients in Germany. J Dtsch Dermatol Ges 2016; 13:1015-22. [PMID: 26408465 DOI: 10.1111/ddg.12705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Detection of methicillin-resistant Staphylococcus aureus (MRSA) carriage requires well-defined risk factors (RFs). Except for "chronic wounds", RFs are mostly specified in national recommendations. To avoid ineffective and expensive screening, we divided the entity "wounds" into different categories and calculated further RFs in dermatologic patients. PATIENTS AND METHODS After a surveillance period with general MRSA screening, we correlated MRSA results with wound categories and dermatologically relevant diagnoses. We analyzed the screening efficacy by adding potential new RFs. RESULTS Ulcers (pressure, arterial, combined pressure/arterial ulcers, ulcers otherwise unclassified), type 2 diabetes mellitus (DM), and atopic dermatitis (AD) were significantly associated with MRSA carriage. Tumors (subgroup basal and squamous cell carcinoma) were also significantly associated with MRSA carriage but had a protective odds ratio. Differentiation of wound types did not provide added benefit. In all MRSA-positive patients with chronic wounds, other RKI-listed RFs or type 2 DM were found. Screening sensitivity was increased combining classic RFs (except wounds) with type 2 DM and AD. CONCLUSIONS In dermatologic patients, AD and type 2 DM were identified as new RFs. Distinct wound types were also found to be significant RFs, but differentiated screening offers no benefit. When screening patients according to national recommendations, excluding wounds but including type 2 DM and AD, there is no loss of sensitivity.
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Affiliation(s)
- Georg Daeschlein
- Department of Dermatology of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Sebastian von Podewils
- Department of Dermatology of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Tina Bloom
- Department of Dermatology of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Ojan Assadian
- Clinical Institute for Hospital -Hygiene, Medical University of Vienna, Vienna, Austria
| | - Matthias Napp
- Department of Surgery of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Hermann Haase
- Department of Dermatology of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
| | - Michael Jünger
- Department of Dermatology of the Ernst Moritz Arndt University, Greifswald, Mecklenburg-Vorpommern, Germany
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Jahn B, Wassenaar TM, Stroh A. Integrated MRSA-Management (IMM) with prolonged decolonization treatment after hospital discharge is effective: a single centre, non-randomised open-label trial. Antimicrob Resist Infect Control 2016; 5:25. [PMID: 27307987 PMCID: PMC4908775 DOI: 10.1186/s13756-016-0124-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 06/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Guidelines for the control of hospital-acquired MRSA include decolonization measures to end MRSA carrier status in colonized and infected patients. Successful decolonization typically requires up to 22 days of treatment, which is longer than the average hospital length of stay (LOS). Incomplete decolonization is therefore common, with long-term MRSA carriage as a consequence. To overcome this, we developed an integrated MRSA Management (IMM) by extending MRSA decolonization to the outpatient and domestic setting. The protocol makes use of polyhexanide-based products, in view of reported qac-mediated resistance to chlorhexidine in S. aureus and MRSA. METHODS This is a prospective, single centre, controlled, non-randomized, open-label study to evaluate the efficiency of the IMM concept. The outcome of guideline-approved decolonization during hospital stay only (control group; n = 201) was compared to the outcome following IMM treatment whereby decolonization was continued after discharge in the domestic setting or in a long-term care facility (study group; n = 99). As a secondary outcome, the effect of MRSA-status of skin alterations was assessed. RESULTS The overall decolonization rate was 47 % in the IMM patient group compared to 12 % in the control group (p < 0.01). The continued treatment after hospital discharge was as effective as treatment completed during hospitalization, with microbiologically-confirmed decolonization (patients with completed regimes only) obtained with 55 % for the IMM group and 43 % for the control group (p > 0.05). For patients with skin alterations (e.g. wounds and entry sites), decolonization success was 50 % if the skin alterations were MRSA-negative at baseline, compared to 22 % success for patients entering the study with MRSA-positive skin alterations (p < 0.01). CONCLUSIONS The IMM strategy offers an MRSA decolonization protocol that is feasible in the domestic setting and is equally effective compared with inpatient decolonization treatment when hospital LOS is long enough to complete the treatment. Moreover, for patients with average LOS, decolonization rates obtained with IMM are significantly higher than for in-hospital treatment. IMM is a promising concept to improve decolonization rates of MRSA-carriers for patients who leave the hospital before decolonization is completed.
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Affiliation(s)
- Bernhard Jahn
- />Frankfurter Diakonie Kliniken, Wilhelm-Epstein-Strasse 4, Frankfurt am Main, D-60431 Germany
- />AGAPLESION HYGIENE, Institute of Hygiene and Environmental Medicine, Ginnheimer Landstrasse 86, Frankfurt am Main, D-60487 Germany
| | - Trudy M. Wassenaar
- />Molecular Microbiology and Genomics Consultants, Tannenstrasse 7, Zotzenheim, D-55576 Germany
| | - Annemarie Stroh
- />Frankfurter Diakonie Kliniken, Wilhelm-Epstein-Strasse 4, Frankfurt am Main, D-60431 Germany
- />AGAPLESION HYGIENE, Institute of Hygiene and Environmental Medicine, Ginnheimer Landstrasse 86, Frankfurt am Main, D-60487 Germany
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Daeschlein G, von Podewils S, Bloom T, Assadian O, Napp M, Haase H, Jünger M. [Risk factors for MRSA colonization in dermatologic patients in Germany]. J Dtsch Dermatol Ges 2015; 13:1015-23. [PMID: 26408464 DOI: 10.1111/ddg.50_12705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Georg Daeschlein
- Abteilung für Dermatologie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
| | - Sebastian von Podewils
- Abteilung für Dermatologie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
| | - Tina Bloom
- Abteilung für Dermatologie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
| | - Ojan Assadian
- Klinisches Institut für Krankenhaushygiene, Medizinische Universität Wien, Wien, Österreich
| | - Matthias Napp
- Abteilung für Chirurgie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
| | - Hermann Haase
- Abteilung für Dermatologie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
| | - Michael Jünger
- Abteilung für Dermatologie der Ernst-Moritz-Arndt-Universität, Greifswald, Mecklenburg-Vorpommern, Deutschland
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Harris PNA, Le BD, Tambyah P, Hsu LY, Pada S, Archuleta S, Salmon S, Mukhopadhyay A, Dillon J, Ware R, Fisher DA. Antiseptic Body Washes for Reducing the Transmission of Methicillin-Resistant Staphylococcus aureus: A Cluster Crossover Study. Open Forum Infect Dis 2015; 2:ofv051. [PMID: 26125031 PMCID: PMC4462889 DOI: 10.1093/ofid/ofv051] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 04/14/2015] [Indexed: 12/16/2022] Open
Abstract
In a cluster cross-over trial, targeted decolonization with octenidine body washes was not associated with reduction in MRSA transmission or infection Background. Limiting the spread of methicillin-resistant Staphylococcus aureus (MRSA) within healthcare facilities where the organism is highly endemic is a challenge. The use of topical antiseptic agents may help interrupt the transmission of MRSA and reduce the risk of clinical infection. Octenidine dihydrochloride is a topical antiseptic that exhibits in vitro efficacy against a wide variety of bacteria, including S aureus. Methods. We conducted a prospective cluster crossover study to compare the use of daily octenidine body washes with soap and water in patients identified by active surveillance cultures to be MRSA-colonized, to prevent the acquisition of MRSA in patients with negative screening swabs. Five adult medical and surgical wards and 2 intensive care units were selected. The study involved an initial 6-month phase using octenidine or soap washes followed by a crossover in each ward to the alternative product. The primary and secondary outcomes were the rates of new MRSA acquisitions and MRSA clinical infections, respectively. Results. A total of 10 936 patients admitted for ≥48 hours was included in the analysis. There was a small reduction in MRSA acquisition in the intervention group compared with controls (3.0% vs 3.3%), but this reduction was not significant (odds ratio, 0.89; 95% confidence interval, .72–1.11; P = .31). There were also no significant differences in clinical MRSA infection or incidence of MRSA bacteremia. Conclusions. This study suggests that the targeted use of routine antiseptic washes may not in itself be adequate to reduce the transmission of MRSA in an endemic hospital setting.
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Affiliation(s)
- Patrick N A Harris
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore ; UQ Centre for Clinical Research , University of Queensland , Brisbane , Australia
| | - Bich Diep Le
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital
| | - Paul Tambyah
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Li Yang Hsu
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Surinder Pada
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore ; Department of Medicine , Alexandra Hospital, Jurong Health Services
| | - Sophia Archuleta
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Sharon Salmon
- Nursing Administration , National University Hospital , Singapore
| | - Amartya Mukhopadhyay
- Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
| | - Jasmine Dillon
- School of Medicine , University of Queensland , St Lucia
| | - Robert Ware
- School of Population Health , University of Queensland , Brisbane , Australia
| | - Dale A Fisher
- Division of Infectious Diseases , University Medicine Cluster, National University Hospital ; Department of Medicine , Yong Loo Lin School of Medicine, National University of Singapore
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Linda Barratt R, Shaban R, Moyle W. Patient experience of source isolation: Lessons for clinical practice. Contemp Nurse 2014. [DOI: 10.5172/conu.2011.39.2.180] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Brandt C, Makarewicz O, Fischer T, Stein C, Pfeifer Y, Werner G, Pletz MW. The bigger picture: the history of antibiotics and antimicrobial resistance displayed by scientometric data. Int J Antimicrob Agents 2014; 44:424-30. [PMID: 25216545 DOI: 10.1016/j.ijantimicag.2014.08.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 06/18/2014] [Accepted: 08/12/2014] [Indexed: 11/25/2022]
Abstract
Monitoring the rapid global spread of antimicrobial resistance requires an over-regional and fast surveillance tool. Data from major surveillance studies based on aggregated results of selected sentinel laboratories or retrospective strain collections are not available for the whole scientific community and are limited by time and region. Thus, we tested an alternative approach to monitor resistance trends by automated semantic and scientometric analysis of all (>100000) related PubMed entries. A semantic search was done using 'Gene Ontology' and MeSH vocabulary and additional search terms for further data refinement. Data extraction was performed using the semantic search engine 'GoPubMed'. The timely relationship between introduction of novel β-lactam antibiotic classes into the market and emergence of respective resistance was investigated using nearly 22300 publications over the last 70 years. Further analysis was done with around 54000 publications related to 'infectious diseases' and an additional 50000 publications related to 'antimicrobial resistance' to estimate current trends in publication interest regarding resistance development since 1940. Scientometric results were compared with data from the major surveillance network EARS-Net. Furthermore, the relationship between micro-organism, year and antibiotic market introduction was investigated for eight key antibiotics using nearly 37500 publications. Owing to influencing factors such as availability of alternative antibiotics, scientometric analysis correlated only partly with resistance development. However, it provides a fast, reliable and global overview of the clinical and public health importance of a specific resistance including the period of the 1940s-1980s, when resistance surveillance studies were not yet established.
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Affiliation(s)
- Christian Brandt
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany.
| | - Oliwia Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
| | - Thomas Fischer
- Department of Business Informatics, Friedrich Schiller University, Jena, Germany
| | - Claudia Stein
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
| | - Yvonne Pfeifer
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Guido Werner
- Nosocomial Pathogens and Antibiotic Resistance, Robert Koch Institute, Wernigerode, Germany
| | - Mathias W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740 Jena, Germany
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Barratt RL, Shaban R, Moyle W. Patient experience of source isolation: lessons for clinical practice. Contemp Nurse 2012; 39:180-93. [PMID: 22551431 DOI: 10.5172/conu.2011.180] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation; (2) coping with isolation; (3) social isolation; (4) communication and information provision; and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.
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Green BN, Johnson CD, Egan JT, Rosenthal M, Griffith EA, Evans MW. Methicillin-resistant Staphylococcus aureus: an overview for manual therapists(). J Chiropr Med 2012; 11:64-76. [PMID: 22942844 PMCID: PMC3315869 DOI: 10.1016/j.jcm.2011.12.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2011] [Revised: 11/30/2011] [Accepted: 12/02/2011] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Methicillin-resistant Staphylococcus aureus (MRSA) is associated with difficult-to-treat infections and high levels of morbidity. Manual practitioners work in environments where MRSA is a common acquired infection. The purpose of this review is to provide a practical overview of MRSA as it applies to the manual therapy professions (eg, physical and occupational therapy, athletic training, chiropractic, osteopathy, massage, sports medicine) and to discuss how to identify and prevent MRSA infections in manual therapy work environments. METHODS PubMed and CINAHL were searched from the beginning of their respective indexing years through June 2011 using the search terms MRSA, methicillin-resistant Staphylococcus aureus, and Staphylococcus aureus. Texts and authoritative Web sites were also reviewed. Pertinent articles from the authors' libraries were included if they were not already identified in the literature search. Articles were included if they were applicable to ambulatory health care environments in which manual therapists work or if the content of the article related to the clinical management of MRSA. RESULTS Following information extraction, 95 citations were included in this review, to include 76 peer-reviewed journal articles, 16 government Web sites, and 3 textbooks. Information was organized into 10 clinically relevant categories for presentation. Information was organized into the following clinically relevant categories: microbiology, development of MRSA, risk factors for infection, clinical presentation, diagnostic tests, screening tests, reporting, treatment, prevention for patients and athletes, and prevention for health care workers. CONCLUSION Methicillin-resistant S aureus is a health risk in the community and to patients and athletes treated by manual therapists. Manual practitioners can play an essential role in recognizing MRSA infections and helping to control its transmission in the health care environment and the community. Essential methods for protecting patients and health care workers include being aware of presenting signs, patient education, and using appropriate hand and clinic hygiene.
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Affiliation(s)
- Bart N. Green
- Chiropractor, Chiropractic Division, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego, CA
- Associate Editor, Publications Department, National University of Health Sciences, Lombard, IL
- Graduate Student, Walden University, Minneapolis, MN
| | - Claire D. Johnson
- Graduate Student, Walden University, Minneapolis, MN
- Professor and Editor-in-Chief, Publications Department, National University of Health Sciences, Lombard, IL
| | - Jonathon Todd Egan
- Graduate Student, Walden University, Minneapolis, MN
- Chief of Staff, Campus Health Center and Assistant Professor, New York Chiropractic College, Seneca Falls, NY
- Consultant, Canandaigua VA Medical Center, Canandaigua, NY
| | - Michael Rosenthal
- Department Head, Department of Physical and Occupational Therapy, Naval Medical Center, San Diego, CA
- Associate Professor, Rocky Mountain University of the Health Professions, Provo, UT
| | - Erin A. Griffith
- Emergency Medicine Staff Physician, Emergency Department, Naval Hospital Twentynine Palms, Twentynine Palms, CA
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Sustained low prevalence of meticillin-resistant Staphylococcus aureus upon admission to hospital in The Netherlands. J Hosp Infect 2011; 79:198-201. [DOI: 10.1016/j.jhin.2011.05.009] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Accepted: 05/12/2011] [Indexed: 11/22/2022]
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12
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Ceylan Koydemir H, Külah H, Özgen C, Alp A, Hasçelik G. MEMS biosensors for detection of methicillin resistant Staphylococcus aureus. Biosens Bioelectron 2011; 29:1-12. [DOI: 10.1016/j.bios.2011.07.071] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Revised: 07/18/2011] [Accepted: 07/29/2011] [Indexed: 01/28/2023]
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Santos HB, Machado DP, Camey SA, Kuchenbecker RS, Barth AL, Wagner MB. Prevalence and acquisition of MRSA amongst patients admitted to a tertiary-care hospital in Brazil. BMC Infect Dis 2010; 10:328. [PMID: 21073755 PMCID: PMC2992537 DOI: 10.1186/1471-2334-10-328] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Accepted: 11/14/2010] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND There are few studies in Brazil that address baseline prevalence of MRSA colonization and associated risk factors at hospital admission, or the incidence of nosocomial colonization. We report a prospective study in a tertiary-care, university-affiliated hospital to implement a new MRSA control policy at the institution. METHODS A cohort of randomly selected patients admitted to emergency and clinical wards at our hospital was followed until discharge. Nasal swabs were taken for identification of MRSA-colonized patients and detection of SCCmecA in positive cultures, at admission and weekly thereafter. Multivariate analysis using a log-binomial analysis was used to identify risk factors for colonization. RESULTS After screening 297 adult patients and 176 pediatric patients, the prevalence of MRSA at admission was 6.1% (95%CI, 3.6% to 9.4%), in the adult population and 2.3% (95%CI, 0.6% to 5.7%), for children. From multivariate analysis, the risk factors associated with colonization in adults were: age above 60 years (P = 0.019) and hospitalization in the previous year (P = 0.022). Incidence analysis was performed in 276 MRSA-negative patients (175 adults and 101 children). Acquisition rate was 5.5/1,000 patient-days for adults (95%CI, 3.4 to 8.5/1,000 patients-days), and 1.1/1,000 patient-days for children (95%CI, 0.1 to 4.0/1,000 patients-days). CONCLUSIONS The identification of MRSA carriers is a step towards establishing a control policy for MRSA, and helps to identify measures needed to reduce colonization pressure and to decrease the high acquisition rate in hospitalized patients.
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Affiliation(s)
- Helena B Santos
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Suzi A Camey
- Instituto de Matemática- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo S Kuchenbecker
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Afonso L Barth
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Mário B Wagner
- Pós-Graduação em Epidemiologia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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Gilligan P, Quirke M, Winder S, Humphreys H. Impact of admission screening for methicillin-resistant Staphylococcus aureus on the length of stay in an emergency department. J Hosp Infect 2010; 75:99-102. [PMID: 20381911 PMCID: PMC7132503 DOI: 10.1016/j.jhin.2010.01.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 01/13/2010] [Indexed: 11/27/2022]
Abstract
Preventing and controlling meticillin-resistant Staphylococcus aureus (MRSA) includes early detection and isolation. In the emergency department (ED), such measures have to be balanced with the requirement to treat patients urgently and transfer quickly to an acute hospital bed. We assessed, in a busy and overcrowded ED, the contribution made to a patient's stay by previous MRSA risk group identification and by selective rescreening of those patients who were previously documented in the research hospital as being MRSA positive. Patients with a previous diagnosis of MRSA colonisation were flagged automatically as ‘risk group’ (RG) on their arrival in the ED and were compared with ‘non-risk group’ (NRG), i.e. not previously demonstrated in the research hospital to be infected or colonised with MRSA. Over an 18 month period, there were 16 456 admissions via the ED, of which 985 (6%) were RG patients. The expected median times to be admitted following a request for a ward bed for NRG and RG patients were 10.4 and 12.9 h, respectively. Female sex, age >65 years, and RG status all independently predicted a statistically significantly longer stay in the ED following a request for a hospital bed. We consider that national and local policies for MRSA need to balance the welfare of patients in the ED with the need to comply with best practice, when there are inadequate ED and inpatient isolation facilities. Patients with MRSA requiring emergency admission must have a bed available for them.
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Affiliation(s)
- P Gilligan
- Emergency Department, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
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15
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Humphreys H. Do guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus make a difference? Clin Microbiol Infect 2010; 15 Suppl 7:39-43. [PMID: 19951333 DOI: 10.1111/j.1469-0691.2009.03095.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Many countries have national guidelines for the prevention and control of methicillin-resistant Staphylococcus aureus (MRSA) that are similar in approach. The evidence base for many recommendations is variable, and often, in the drafting of such guidelines, the evidence is either not analysed or not specifically reviewed. Guidelines usually recommend screening and early detection, hand hygiene, patient isolation or cohorting, and decolonization. Although many components of a prevention and control programme appear to be self-evident, e.g. patient isolation, the scientific base underpinning these is poor, and scientifically rigorous studies are required. Nonetheless, where measures, based on what evidence there is and on common sense, are implemented, and where the necessary resources are provided, MRSA can be controlled. In The Netherlands and in other low-prevalence countries, these measures have largely kept healthcare facilities MRSA-free. In MRSA-endemic countries, such as Spain and Ireland, national guidelines are often not fully implemented, owing to apparently inadequate resources or a lack of will. However, recent studies from France and Australia demonstrate what is possible in high-prevalence countries when best practice is effectively implemented, with potentially major benefits for patients, the respective health services, and society.
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Affiliation(s)
- H Humphreys
- Department of Clinical Microbiology, The Royal College of Surgeons in Ireland and Beaumont Hospital, Dublin, Ireland.
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Kramer A, Wagenvoort H, Ahrén C, Daniels-Haardt I, Hartemann P, Kobayashi H, Kurcz A, Picazo J, Privitera G, Assadian O. Epidemiology of MRSA and current strategies in Europe and Japan. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2010; 5:Doc01. [PMID: 20204100 PMCID: PMC2831258 DOI: 10.3205/dgkh000144] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The prevalence of health-care associated infections caused by multi-drug resistant organisms has significantly increased over the past decade. Among these organisms, Methicillin-resistant Staphylococcus aureus (MRSA) plays a prominent and increasing role. Because of consequences for patients and the economic burden in course of prolonged treatment following MRSA infections and additional indirect costs for e.g. isolation or antiseptic treatment, this trend will further damage European health-care systems. In 2006, a workshop was initiated at the 8th International Congress of the German Society of Hospital Hygiene held in Berlin. The aim of this workshop was to give an overview of the current situation of MRSA in selected European countries and to elaborate on potential strategies to prevent MRSA-infections and dissemination. A questionnaire encompassing 20 questions addressed topics such as epidemiology, current measures and future prospects was distributed to representatives from various European countries and Japan. A variety of widely different answers was obtained. It was shown that in all countries prevalence of MRSA is on a rising tide. This trend is observable in all European countries, albeit less strong in The Netherlands, Slovenia, France, Austria and Scandinavian countries. It was conclude that prevention strategies in a united and expanding European Community will become of utmost importance and that rapid screening strategies, e.g. PCR, might be of assistance in such an approach. A potential strategy to improve infection control measures could be the requirement of health-insurance providers to sign contracts only with hospitals able to proof having an infection control management in place.
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Affiliation(s)
- Axel Kramer
- Institute for Hygiene and Environmental Medicine, University Greifswald, Germany
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17
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Another small step on the long way to control methicillin-resistant Staphylococcus aureus cross-transmission. Crit Care Med 2010; 38:311-2. [PMID: 20023477 DOI: 10.1097/ccm.0b013e3181b782eb] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Brady RRW, McDermott C, Cameron F, Graham C, Gibb AP. UK healthcare workers' knowledge of meticillin-resistant Staphylococcus aureus practice guidelines; a questionnaire study. J Hosp Infect 2009; 73:264-70. [PMID: 19783068 DOI: 10.1016/j.jhin.2009.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 07/14/2009] [Indexed: 11/30/2022]
Abstract
Effective infection control practice requires knowledge of and adherence to contemporary infection control guidelines. Utilising a novel questionnaire tool, we evaluated knowledge of recently published guidelines on meticillin-resistant Staphylococcus aureus (MRSA) precautions in a number of relevant healthcare worker (HCW) populations. The questionnaire was developed from national UK MRSA practice guidelines and consisted of 10 'true or false' statements. The questionnaire was utilised to assess knowledge in 293 participants from HCW and control populations. The participants included 188 doctors attending the British Medical Association's Annual Representatives Meeting, 52 trainee surgeons attending the Association of Surgeons in Training annual conference, 30 members of a non-clinical control population and 23 infection control nurses (ICNs). The mean (SD) score for knowledge levels obtained from doctors was 6.6 (1.68), for non-clinical control population was 4.7 (1.8) and for ICNs, 8.4 (1.12). There were significant differences in knowledge levels between different population groups (P<0.001), UK employment region of the participant (P=0.01) and the doctors' medical specialty (P=0.02). Career seniority and gender of the participant were not significantly associated with differences in levels of knowledge. This questionnaire study evaluates a novel discriminatory questionnaire tool which differentiates knowledge levels of MRSA practice guidelines among a non-clinical population, HCWs and specialist infection control staff, thus providing a means for the rapid assessment of MRSA educational interventions. We identify demographics within HCW target populations which are associated with low levels of such knowledge. Consideration towards revising current HCW educational programmes to improve knowledge and best practice in MRSA prevention is required.
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Affiliation(s)
- R R W Brady
- Academic Coloproctology, University of Edinburgh, UK.
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Guidelines and indicators for methicillin-resistant Staphylococcus aureus control in hospitals: toward international agreement? Curr Opin Infect Dis 2009; 22:337-8. [PMID: 19491673 DOI: 10.1097/qco.0b013e32832dbae9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Goering RV, Larsen AR, Skov R, Tenover FC, Anderson KL, Dunman PM. Comparative genomic analysis of European and Middle Eastern community-associated methicillin-resistant Staphylococcus aureus (CC80:ST80-IV) isolates by high-density microarray. Clin Microbiol Infect 2009; 15:748-55. [PMID: 19523053 DOI: 10.1111/j.1469-0691.2009.02850.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infections as a result of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are an issue of increasing global healthcare concern. In Europe, this principally involves strains of multi-locus sequence type clonal complex 80 sequence type 80 with methicillin resistance in a staphylococcal chromosomal cassette (SCCmec) type IV arrangement (CC80:ST80-IV). As with other CA-MRSA strains, CC80:ST80-IV isolates tend to appear uniform when analysed by common molecular typing methods (e.g. pulsed field gel electrophoresis, multi-locus sequence type, SCCmec). To explore whether DNA sequence-based differences exist, we compared the genetic composition of six CC80:ST80-IV isolates of diverse chronological and geographic origin (i.e. Denmark and the Middle East) using an Affymetrix high-density microarray that was previously used to analyse CA-MRSA USA300 isolates. The results revealed a high degree of homology despite the diversity in isolation date and origin, with isolate differences primarily in conserved hypothetical open reading frames and intergenic sequences, but also including regions of known function. This included the confirmed loss of SCCmec recombinase genes in two Danish isolates representing potentially new SCCmec types. Microarray analysis grouped the six isolates into three relatedness pairs, also identified by pulsed field gel electrophoresis, which were consistent with both the clinical and molecular data.
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Affiliation(s)
- R V Goering
- Deparatment of Medical Microbiology and Immunology, Creighton University School of Medicine, Omaha, NE 68178, USA.
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21
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Baldwin NS, Gilpin DF, Hughes CM, Kearney MP, Gardiner DA, Cardwell C, Tunney MM. Prevalence of methicillin-resistant Staphylococcus aureus colonization in residents and staff in nursing homes in Northern Ireland. J Am Geriatr Soc 2009; 57:620-6. [PMID: 19392953 DOI: 10.1111/j.1532-5415.2009.02181.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the prevalence of, and factors associated with, methicillin-resistant Staphylococcus aureus (MRSA) colonization in residents and staff in nursing homes in one geographically defined health administration area of Northern Ireland. DESIGN Point prevalence study. SETTING Nursing homes. PARTICIPANTS Residents and staff in nursing homes. MEASUREMENTS Nasal swabs were taken from all consenting residents and staff. If relevant, residents also provided urine samples, and swabs were taken from wounds and indwelling devices. RESULTS A total of 1,111 residents (66% of all residents) and 553 staff (86% of available staff) in 45 nursing homes participated. The combined prevalence rate of MRSA in the resident population was 23.3% (95% confidence interval (CI)=18.8-27.7%) and 7.5% in staff (95% CI=5.1-9.9%). Residents who lived in nursing homes that were part of a chain were more likely to be colonized with MRSA (odds ratio (OR)=1.91, 95% CI=1.21-3.02) than those living in independently owned facilities. Residents were also more likely to be colonized if they lived in homes in which more than 12.5% of all screened healthcare staff (care assistants and nurses) were colonized with MRSA (OR=2.46, 95% CI=1.41-4.29) or if they lived in homes in which more than 15% of care assistants were colonized with MRSA (OR=2.64, 95% CI=1.58-4.42). CONCLUSION The findings suggest that there is substantial colonization of MRSA in nursing home residents and staff in this one administrative health area. Implementation of infection control strategies should be given high priority in nursing homes.
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Affiliation(s)
- Naomi S Baldwin
- Clinical and Practice Research Group, School of Pharmacy, Queen's University Belfast, Belfast, UK
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Struelens MJ, Hawkey PM, French GL, Witte W, Tacconelli E. Laboratory tools and strategies for methicillin-resistant Staphylococcus aureus screening, surveillance and typing: state of the art and unmet needs. Clin Microbiol Infect 2009; 15:112-9. [PMID: 19291142 DOI: 10.1111/j.1469-0691.2009.02698.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The public health burden caused by methicillin-resistant Staphylococcus aureus (MRSA) infections is now widely recognized, and is a cause of public alarm. Effective MRSA risk management in the healthcare system as well as in the community should rely on accurate detection of reservoirs and sources of transmission, as well as on close monitoring of the impact of interventions on disease incidence and bacterial dissemination. MRSA carrier screening and disease surveillance, coupled with molecular typing, are key information tools for integrated MRSA control and individual risk assessment. These tools should be tailored to the distinct needs of local interventions and national prevention programmes. Surveillance schemes should primarily inform local staff and serve as quality assurance about MRSA risk management. New technologies, including the use of selective culture media and real-time PCR assays, allow faster detection of MRSA carriers upon admission or during stay in healthcare institutions. More research is needed to ascertain their cost-effectiveness for MRSA control. Likewise, tremendous progress has been made concerning molecular typing methods, with optimization and standardization of sequence-based technologies offering broad applicability and high throughput. However, no single S. aureus typing method is yet providing fully reliable information within the range of discrimination needed for public health action. Further refinement of genotyping methods and international harmonization of surveillance and typing schemes must be achieved to facilitate global MRSA control.
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Affiliation(s)
- M J Struelens
- Department of Clinical Microbiology, Université Libre de Bruxelles-Hopital Erasme, Brussels, Belgium.
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Orsi G, Mastroianni C, Giordano A, Monaco M, Venditti M. Lack of community-associated MRSA in Rome. J Hosp Infect 2009; 71:374-6. [DOI: 10.1016/j.jhin.2008.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2008] [Accepted: 11/11/2008] [Indexed: 11/26/2022]
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Matouskova I, Janout V. Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2009; 152:191-202. [PMID: 19219207 DOI: 10.5507/bp.2008.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Bacterial strains that are oxacillin and methicillin-resistant, historically termed methicillin-resistant Staphylococcus aureus (MRSA) are resistant to all beta-lactam agents, including cephalosporins and carbapenems. MRSA are pathogenic and have a number of virulence factors that enable them to result in disease. They are transmissible and important causes of nosocomial infections worldwide. An MRSA outbreak can occur when one strain is transmitted to other patients or through close contacts of infected persons in the community. Hospital-associated MRSA (HA-MRSA) isolates are also frequent causes of healthcare-associated bloodstream and catheter-related infections. Community-associated MRSA (CA-MRSA) isolates are often only resistant to beta-lactam agents and erythromycin but they are an emerging cause of community-associated infections, especially skin and soft tissue infections (SSTI) and necrotizing pneumonia. METHODS Current possibilities for detecting MRSA strains in the laboratory are reviewed and discussed in the context of the recent literature. RESULTS AND CONCLUSION The active surveillance and prevention of MRSA occurrence and spreading in hospitals are discussed in the context of recent literature.
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Affiliation(s)
- Ivanka Matouskova
- Department of Preventive Medicine, Faculty of Medicine and Dentistry, Palacky University, Hnevotinska 3, Olomouc, Czech Republic.
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Humphreys H, Grundmann H, Skov R, Lucet JC, Cauda R. Prevention and control of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2009; 15:120-4. [DOI: 10.1111/j.1469-0691.2009.02699.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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26
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Cauda R, Garau J. New insights concerning methicillin-resistant Staphylococcus aureus disease. Clin Microbiol Infect 2009; 15:109-11. [DOI: 10.1111/j.1469-0691.2009.02700.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Zimmerli M, Widmer AF, Dangel M, Filippi A, Frei R, Meyer J. Methicillin-resistant Staphylococcus aureus (MRSA) among dental patients: a problem for infection control in dentistry? Clin Oral Investig 2008; 13:369-73. [PMID: 19104851 DOI: 10.1007/s00784-008-0244-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2008] [Accepted: 12/08/2008] [Indexed: 11/25/2022]
Abstract
We assessed the frequency of carriers of methicillin-resistant Staphylococcus aureus (MRSA) among 500 dental patients of a university clinic. From each participant, two specimens were taken from the anterior nares and the pharynx and analysed by culture. The participants completed a questionnaire on possible risk factors of MRSA infection. Two hundred ten individuals carried S. aureus, 90 in the nares only, 51 in the throat only and 69 in nares and throat. Isolates of 208 patients were methicillin-sensitive; two isolates were methicillin-resistant, both carried in the throat exclusively. In conclusion, the frequency of nasal and/or throat carriers of MRSA among dental patients was low and suggests few opportunities of exposure in the dental clinic assessed.
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Affiliation(s)
- Melanie Zimmerli
- Department of Oral Surgery, Oral Radiology and Oral Medicine, School of Dental Medicine, University of Basel, Basel, Switzerland
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