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Madsen AM, Phan HUT, Laursen M, White JK, Uhrbrand K. Evaluation of Methods for Sampling of Staphylococcus aureus and Other Staphylococcus Species from Indoor Surfaces. Ann Work Expo Health 2021; 64:1020-1034. [PMID: 32968799 PMCID: PMC7750978 DOI: 10.1093/annweh/wxaa080] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 07/03/2020] [Accepted: 07/14/2020] [Indexed: 11/26/2022] Open
Abstract
Objectives Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing public and occupational health concern. As transmission of MRSA can occur via contact with fomites, it is crucial to have sensitive methods for sampling of bacteria. The overall aim of this study was to obtain knowledge about methods and strategies for quantitative sampling Staphylococcus species on surfaces. Methods The study was designed as a comparative sampling experiment with different samplers [dipslide (two agar types), swabs (three brands, used wet and dry, and elution from swabs or plate diluted)] on smooth stainless steel surfaces spiked with MRSA and methicillin-sensitive S. aureus (MSSA). Furthermore, bacteria sampled from indoor surfaces with frequent or infrequent contact with hands were quantified and identified using matrix-assisted laser desorption-ionization time-of-flight (MALDI-TOF) mass spectrometry (MS). Results Pre-moistened swabs in combination with dilution plating and dipslides were more sensitive than dry swabs. For recovery of MRSA and MSSA from surfaces with eSwabs, at least 0.3–100 CFU MRSA cm−2 and 5.3–8.6 CFU MSSA cm−2 should be present. The sensitivities of pre-moistened eSwabs were approximately 10-fold higher than those of dipslides and pre-moistened viscose and cotton swabs. The variation in concentrations of Staphylococcus species in replicate sampling of adjacent squares on indoor surfaces was higher for surfaces frequently touched by hands than for surfaces infrequently touched. In total 16 different Staphylococcus species were identified, and S. aureus was found only in 2 of 66 surface samples. A considerable overlap was found between species in replicate sampling within an environment and between the air and surfaces within an environment. Conclusions Pre-moistened eSwabs in combination with dilution plating were found to be the best method for surface sampling of MSSA and MRSA. The method can be used for assessing the risk of exposure and transmission of MRSA from environmental surfaces. To obtain a reliable measure of concentrations and the presence of Staphylococccus species a higher number of samples should be taken from surfaces with hand contact than from surfaces dominated by sedimented bacteria.
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Affiliation(s)
- Anne Mette Madsen
- National Research Centre for the Working Environment, Lersø Parkallé, Copenhagen Ø, Denmark
| | - Hoang U T Phan
- National Research Centre for the Working Environment, Lersø Parkallé, Copenhagen Ø, Denmark
| | - Mathias Laursen
- National Research Centre for the Working Environment, Lersø Parkallé, Copenhagen Ø, Denmark
| | - John K White
- National Research Centre for the Working Environment, Lersø Parkallé, Copenhagen Ø, Denmark
| | - Katrine Uhrbrand
- National Research Centre for the Working Environment, Lersø Parkallé, Copenhagen Ø, Denmark
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Impact of doffing errors on healthcare worker self-contamination when caring for patients on contact precautions. Infect Control Hosp Epidemiol 2019; 40:559-565. [PMID: 30890193 DOI: 10.1017/ice.2019.33] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE We assessed the impact of personal protective equipment (PPE) doffing errors on healthcare worker (HCW) contamination with multidrug-resistant organisms (MDROs). DESIGN Prospective, observational study. SETTING The study was conducted at 4 adult ICUs at 1 tertiary-care teaching hospital. PARTICIPANTS HCWs who cared for patients on contact precautions for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci, or multidrug-resistant gram-negative bacilli were enrolled. Samples were collected from standardized areas of patient body, garb sites, and high-touch environmental surfaces in patient rooms. HCW hands, gloves, PPE, and equipment were sampled before and after patient interaction. Research personnel observed PPE doffing and coded errors based on CDC guidelines. RESULTS We enrolled 125 HCWs; most were nurses (66.4%) or physicians (19.2%). During the study, 95 patients were on contact precautions for MRSA. Among 5,093 cultured sites (HCW, patient, environment), 652 (14.7%) yielded the target MDRO. Moreover, 45 HCWs (36%) were contaminated with the target MDRO after patient interactions, including 4 (3.2%) on hands and 38 (30.4%) on PPE. Overall, 49 HCWs (39.2%) made multiple doffing errors and were more likely to have contaminated clothes following a patient interaction (risk ratio [RR], 4.69; P = .04). All 4 HCWs with hand contamination made doffing errors. The risk of hand contamination was higher when gloves were removed before gowns during PPE doffing (RR, 11.76; P = .025). CONCLUSION When caring for patients on CP for MDROs, HCWs appear to have differential risk for hand contamination based on their method of doffing PPE. An intervention as simple as reinforcing the preferred order of doffing may reduce HCW contamination with MDROs.
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Sabbagh P, Riahi SM, Gamble HR, Rostami A. The global and regional prevalence, burden, and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV-infected people: A systematic review and meta-analysis. Am J Infect Control 2019; 47:323-333. [PMID: 30170767 DOI: 10.1016/j.ajic.2018.06.023] [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: 04/01/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important opportunistic pathogens in HIV+ patients, resulting in considerable morbidity and mortality. METHODS The MEDLINE, Scopus, Web of Science, and EMBASE databases were comprehensively searched for studies that investigated the prevalence of MRSA colonization in HIV+ patients. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CI) and analyzed data based on World Health Organization regions. RESULTS Among 9,772 records identified, 69 were included in the meta-analysis, comprising 30,050 HIV+ patients from 21 countries. We estimated the pooled worldwide prevalence of MRSA in people living with HIV to be 7% (95% CI 5%-9%, 1,623/30,050), with the highest prevalence in Southeast Asia (16%, 95% CI 9%-24%) and the region of the Americas (10%; 95% CI 7%-13%) and lowest prevalence in the European region (1%; 95% CI 0%-1%). Globally, we estimated approximately 2,659,000 (95% CI 1,835,000-3,303,000) HIV+ patients with colonized MRSA. Potential risk factors for MRSA colonization in HIV+ patients included previous MRSA infection (OR, 7.5; 95% CI, 3.91-14.37), hospitalization in the past year (OR, 1.87; 95% CI 1.11-3.16), and use of antibiotics (OR, 2.52; 95% CI 1.39-4.58). CONCLUSIONS Our findings emphasize the importance of routine screening for MRSA among all HIV+ patients throughout the world, especially in regions that have a high burden of disease.
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Guest JL, Moanna A, Schlueter Wirtz S, Caruth EC, Rentsch C, Marconi VC, Rimland D. Cohort Profile: The HIV Atlanta Veterans Affairs Cohort Study (HAVACS). Int J Epidemiol 2018; 46:790-791g. [PMID: 27272185 DOI: 10.1093/ije/dyw071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jodie L Guest
- Atlanta VA Medical Center, Decatur, GA, USA.,Rollins School of Public Health at Emory University, Atlanta, GA, USA.,Emory School of Medicine, Atlanta, GA, USA
| | - Abeer Moanna
- Atlanta VA Medical Center, Decatur, GA, USA.,Emory School of Medicine, Atlanta, GA, USA
| | - Susan Schlueter Wirtz
- Atlanta VA Medical Center, Decatur, GA, USA.,Emory School of Medicine, Atlanta, GA, USA
| | | | - Christopher Rentsch
- VA Connecticut Healthcare System, West Haven, CT, USA.,Yale School of Medicine, New Haven, CT, USA
| | - Vince C Marconi
- Atlanta VA Medical Center, Decatur, GA, USA.,Rollins School of Public Health at Emory University, Atlanta, GA, USA.,Emory School of Medicine, Atlanta, GA, USA
| | - David Rimland
- Atlanta VA Medical Center, Decatur, GA, USA.,Emory School of Medicine, Atlanta, GA, USA
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Antri K, Akkou M, Bouchiat C, Bes M, Martins-Simoes P, Dauwalder O, Tristan A, Meugnier H, Rasigade JP, Etienne J, Vandenesch F, Laurent F, Ramdani-Bouguessa N. High levels of Staphylococcus aureus and MRSA carriage in healthy population of Algiers revealed by additional enrichment and multisite screening. Eur J Clin Microbiol Infect Dis 2018; 37:1521-1529. [PMID: 29948361 DOI: 10.1007/s10096-018-3279-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/09/2018] [Indexed: 11/30/2022]
Abstract
The purpose of the research is to characterize Staphylococcus aureus colonization in healthy population of Algiers, to assess the impact on diagnostic performance of systematic additional broth enrichment, and to ascertain the additional benefits of multiple site screening. In order to more accurately determine the prevalence of S. aureus colonization, the swab specimens from multiple screening sites were incubated in brain-heart broth before agar plating. From 2009 to 2011, 1176 samples were collected from 459 participants (201 adults and 258 children). The additional enrichment detection step significantly increased S. aureus detection rates (p < 0.0001). S. aureus nasal detection was positive in 37.8% of adults, and the addition of throat samplings significantly increased the S. aureus detection rate up to 54.7% (p < 0.001). S. aureus nasal detection was positive in 37.6% of children. The addition of throat samplings in children significantly increased the S. aureus detection rate up to 53.1% (p < 0.001) and that of anal samplings up to 59.7%. The overall prevalence of methicillin-resistant S. aureus was 5.2% (3% of adults and 7% of children). spa typing of all isolates revealed a diverse but strongly clonal S. aureus population structure. This approach involving multiple anatomical sampling sites and an additional enrichment of the swabs before conventional culture significantly increases the detection rate of S. aureus carriers and may prove valuable to improve global S. aureus infection prevention.
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Affiliation(s)
- Kenza Antri
- Service de Microbiologie, Centre Hospitalo-Universitaire Mustapha Bacha, Algiers, Algeria.,Département de Biologie Cellulaire et Moléculaire, Faculté des Sciences Biologiques, Université des Sciences et de la Technologie Houari-Boumediène, Algiers, Algeria
| | - Madjid Akkou
- Institut des Sciences Vétérinaires, Université Blida1, 09000, Blida, Algeria.
| | - Coralie Bouchiat
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Michèle Bes
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Patricia Martins-Simoes
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Olivier Dauwalder
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Anne Tristan
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Hélène Meugnier
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Jean-Philippe Rasigade
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Jerome Etienne
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - François Vandenesch
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Frédéric Laurent
- CIRI, International Center for Infectiology Research, Université de Lyon, Lyon, France.,Centre National de Référence des Staphylocoques, Hospices Civils de Lyon, Lyon, France
| | - Nadjia Ramdani-Bouguessa
- Service de Microbiologie, Centre Hospitalo-Universitaire Mustapha Bacha, Algiers, Algeria.,Laboratoire d'analyses Médicales, Baraki, Algiers, Algeria
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Tsang STJ, McHugh MP, Guerendiain D, Gwynne PJ, Boyd J, Simpson AHRW, Walsh TS, Laurenson IF, Templeton KE. Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone Joint Res 2018; 7:79-84. [PMID: 29330346 PMCID: PMC5805824 DOI: 10.1302/2046-3758.71.bjr-2017-0175.r1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Nasal carriers of Staphylococcus (S.) aureus (MRSA and MSSA) have an increased risk for healthcare-associated infections. There are currently limited national screening policies for the detection of S. aureus despite the World Health Organization's recommendations. This study aimed to evaluate the diagnostic performance of molecular and culture techniques in S. aureus screening, determine the cause of any discrepancy between the diagnostic techniques, and model the potential effect of different diagnostic techniques on S. aureus detection in orthopaedic patients. METHODS Paired nasal swabs for polymerase chain reaction (PCR) assay and culture of S. aureus were collected from a study population of 273 orthopaedic outpatients due to undergo joint arthroplasty surgery. RESULTS The prevalence of MSSA nasal colonization was found to be between 22.4% to 35.6%. The current standard direct culturing methods for detecting S. aureus significantly underestimated the prevalence (p = 0.005), failing to identify its presence in approximately one-third of patients undergoing joint arthroplasty surgery. CONCLUSION Modelling these results to national surveillance data, it was estimated that approximately 5000 to 8000 S. aureus surgical site infections could be prevented, and approximately $140 million to $950 million (approximately £110 million to £760 million) saved in treatment costs annually in the United States and United Kingdom combined, by using alternative diagnostic methods to direct culture in preoperative S. aureus screening and eradication programmes.Cite this article: S. T. J. Tsang, M. P. McHugh, D. Guerendiain, P. J. Gwynne, J. Boyd, A. H. R. W. Simpson, T. S. Walsh, I. F. Laurenson, K. E. Templeton. Underestimation of Staphylococcus aureus (MRSA and MSSA) carriage associated with standard culturing techniques: One third of carriers missed. Bone Joint Res 2018;7:79-84. DOI: 10.1302/2046-3758.71.BJR-2017-0175.R1.
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Affiliation(s)
- S T J Tsang
- Department of Orthopaedic Surgery, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK and School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
| | - M P McHugh
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - D Guerendiain
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - P J Gwynne
- School of Biological Sciences, University of Edinburgh, King's Buildings, Mayfield Road, Edinburgh EH9 3JR, UK
| | - J Boyd
- Edinburgh Clinical Trials Unit, University of Edinburgh (Usher Institute), Nine Bioquarter, 9 Little France Road, Edinburgh, EH16 4UX
| | - A H R W Simpson
- Department of Orthopaedic Surgery, Critical care and Pain Medicine, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - T S Walsh
- Critical care and Pain Medicine, Department of Anaesthesia, Critical care and Pain Medicine, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SB, UK
| | - I F Laurenson
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
| | - K E Templeton
- Department of Medical Microbiology, Royal Infirmary of Edinburgh, 51 Little France Crescent, Old Dalkeith Road, Edinburgh EH16 4SA, UK
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Heckel M, Geißdörfer W, Herbst FA, Stiel S, Ostgathe C, Bogdan C. Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at a palliative care unit: A prospective single service analysis. PLoS One 2017; 12:e0188940. [PMID: 29228010 PMCID: PMC5724845 DOI: 10.1371/journal.pone.0188940] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 11/15/2017] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The emergence of multidrug-resistant bacterial microorganisms is a particular challenge for the health care systems. Little is known about the occurrence of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Gram-negative bacteria (MDRGNB) in patients of palliative care units (PCU). AIM The primary aim of this study was to determine the carriage of MRSA among patients of a PCU at a German University Hospital and to assess whether the positive cases would have been detected by a risk-factor-based screening-approach. DESIGN Between February 2014 and January 2015 patients from our PCU were tested for MRSA carriage within 48 hours following admission irrespective of pre-existing risk factors. In addition, risk factors for MRSA colonization were assessed. Samples from the nostrils and, if applicable, from pre-existing wounds were analysed by standardized culture-based laboratory techniques for the presence of MRSA and of other bacteria and fungi. Results from swabs taken prior to admission were also recorded if available. RESULTS 297 out of 317 patients (93.7%) fulfilled one or more MRSA screening criteria. Swabs from 299 patients were tested. The detection rate was 2.1% for MRSA. All MRSA cases would have been detected by a risk-factor-based screening-approach. Considering the detected cases and the results from swabs taken prior to admission, 4.1% of the patients (n = 13) were diagnosed with MRSA and 4.1% with MDRGNB (n = 13), including two patients with MRSA and MDRGNB (0.6%). The rate of MRSA carriage in PCU patients (4.1%) was elevated compared to the rate seen in the general cohort of patients admitted to our University Hospital (2.7%). CONCLUSIONS PCU patients have an increased risk to carry MRSA compared to other hospitalized patients. Although a risk factor-based screening is likely to detect all MRSA carriers amongst PCU patients, we rather recommend a universal screening to avoid the extra effort to identify the few risk factor-negative patients (<7%). As we did not perform a systematic MDRGNB screening, further studies are needed to determine the true prevalence of MDRGNB amongst PCU patients.
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Affiliation(s)
- Maria Heckel
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Walter Geißdörfer
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | | | - Stephanie Stiel
- Institute for General Practice, Hannover Medical School, Germany
| | - Christoph Ostgathe
- Department of Palliative Medicine, Comprehensive Cancer Center CCC Erlangen-EMN, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
| | - Christian Bogdan
- Mikrobiologisches Institut - Klinische Mikrobiologie, Immunologie und Hygiene, Universitätsklinikum Erlangen and Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Germany
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8
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Reid MJA, Fischer RSB, Mannathoko N, Muthoga C, McHugh E, Essigmann H, Brown EL, Steenhoff AP. Prevalence of Staphylococcus aureus Nasal Carriage in Human Immunodeficiency Virus-Infected and Uninfected Children in Botswana: Prevalence and Risk Factors. Am J Trop Med Hyg 2017; 96:795-801. [PMID: 28167588 DOI: 10.4269/ajtmh.16-0650] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AbstractStaphylococcus aureus is an important cause of morbidity and mortality in children in sub-Saharan Africa (SSA). A major risk factor for staphylococcal infection is S. aureus colonization of the anterior nares. We sought to define risk factors for S. aureus carriage and characterize antimicrobial resistance patterns in children in Botswana. A cross-sectional study was conducted at two clinical sites in southern Botswana. Patients under 18 years of age underwent two nasal swabs and brief interviews, 4 weeks apart. Standard microbiological techniques were used. For persistent carriers, S. aureus was isolated from swabs at both time points, and for intermittent carriers, S. aureus was isolated from only one swab. Poisson regression with robust variance estimator was used to compare prevalence of carriage and the resistance phenotypes. Among 56 enrollees, prevalence of S. aureus colonization was 55% (N = 31), of whom 42% (N = 13) were persistent carriers. Of human immunodeficiency virus-infected children, 64% (N = 9) were carriers. Risk factors for nasal carriage included a history of tuberculosis (prevalence ratio [PR] = 1.60; 95% confidence interval [CI] = 1.02, 2.51; P = 0.040) and closer proximity to health care (PR = 0.89; 95% CI = 0.80, 0.99; P = 0.048). Prior pneumonia was more common among persistent rather than intermittent carriers (PR = 2.64; 95% CI = 1.64, 4.23; P < 0.001). Methicillin-resistant S. aureus (MRSA) prevalence was 13%. Of isolates tested, 16% were resistant to three or more drugs (N = 7/44). In summary, children in southern Botswana are frequently colonized with S. aureus. Antibiotic resistance, especially MRSA, is also widespread. Antibiotic recommendations for treatment of staphylococcal infections in SSA should take cognizance of these resistance patterns.
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Affiliation(s)
- Michael J A Reid
- University of California San Francisco, San Francisco, California
| | - Rebecca S B Fischer
- The University of Texas Health Science Center School of Public Health, Houston, Texas.,National School of Tropical Medicine, Baylor College of Medicine, Houston, Texas
| | | | | | - Erin McHugh
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Heather Essigmann
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Eric L Brown
- The University of Texas Health Science Center School of Public Health, Houston, Texas
| | - Andrew P Steenhoff
- Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania.,Botswana-UPenn Partnership, Gaborone, Botswana.,University of Botswana, Gaborone, Botswana
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9
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Muenks CE, Hogan PG, Wang JW, Eisenstein KA, Burnham CAD, Fritz SA. Diversity of Staphylococcus aureus strains colonizing various niches of the human body. J Infect 2016; 72:698-705. [PMID: 27045982 DOI: 10.1016/j.jinf.2016.03.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 03/22/2016] [Accepted: 03/27/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVES As individuals may be colonized with multiple strains of Staphylococcus aureus at different body sites, the objectives of this study were to determine whether S. aureus polyclonal colonization exists within one body niche and the optimal sampling sites and culture methodology to capture the diversity of S. aureus strains in community-dwelling individuals. METHODS Swabs were collected from the nares, axillae, and inguinal folds of 3 children with community-associated S. aureus infections and 11 household contacts, all with known S. aureus colonization. S. aureus isolates were recovered from each body niche using 4 culture methods and evaluated for polyclonality using phenotypic and genotypic strain characterization methodologies. RESULTS Within individuals, the mean (range) number of phenotypes and genotypes was 2.4 (1-4) and 3.1 (1-6), respectively. Six (43%) and 10 (71%) participants exhibited phenotypic and genotypic polyclonality within one body niche, respectively. Broth enrichment yielded the highest analytical sensitivity for S. aureus recovery, while direct plating to blood agar yielded the highest genotypic strain diversity. CONCLUSIONS This study revealed S. aureus polyclonality within a single body niche. Culture methodology and sampling sites influenced the analytical sensitivity of S. aureus colonization detection and the robustness of phenotypic and genotypic strain recovery.
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Affiliation(s)
- Carol E Muenks
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Patrick G Hogan
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Jeffrey W Wang
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kimberly A Eisenstein
- Department of Pediatrics, 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
| | - Stephanie A Fritz
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA.
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10
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Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments. J Clin Microbiol 2015; 53:3478-84. [PMID: 26292314 DOI: 10.1128/jcm.01371-15] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 08/15/2015] [Indexed: 11/20/2022] Open
Abstract
Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a prevalent cause of skin and soft tissue infections (SSTI), but the association between CA-MRSA colonization and infection remains uncertain. We studied the carriage frequency at several body sites and the diversity of S. aureus strains from patients with and without SSTI. Specimens from the nares, throat, rectum, and groin of case subjects with a closed skin abscess (i.e., without drainage) and matched control subjects without a skin infection (n = 147 each) presenting to 10 U.S. emergency departments were cultured using broth enrichment; wound specimens were cultured from abscess cases. Methicillin resistance testing and spa typing were performed for all S. aureus isolates. S. aureus was found in 85/147 (57.8%) of abscesses; 49 isolates were MRSA, and 36 were methicillin-susceptible S. aureus (MSSA). MRSA colonization was more common among cases (59/147; 40.1%) than among controls (27/147; 18.4%) overall (P < 0.001) and at each body site; no differences were observed for MSSA. S. aureus-infected subjects were usually (75/85) colonized with the infecting strain; among MRSA-infected subjects, this was most common in the groin. The CC8 lineage accounted for most of both infecting and colonizing isolates, although more than 16 distinct strains were identified. Nearly all MRSA infections were inferred to be USA300. There was more diversity among colonizing than infecting isolates and among those isolated from controls versus cases. CC8 S. aureus is a common colonizer of persons with and without skin infections. Detection of S. aureus colonization, and especially MRSA, may be enhanced by extranasal site culture.
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11
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Rectal Carriage of Extended-Spectrum-Beta-Lactamase-Producing Enterobacteriaceae in Hospitalized Patients: Selective Preenrichment Increases Yield of Screening. J Clin Microbiol 2015; 53:2709-12. [PMID: 25994164 DOI: 10.1128/jcm.01251-15] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/15/2015] [Indexed: 11/20/2022] Open
Abstract
This study evaluated the added value of selective preenrichment for the detection of rectal carriage of extended-spectrum-beta-lactamase-producing Enterobacteriaceae (ESBL-E). ESBL-E rectal carriage was identified in 4.8% of hospitalized patients, and 25.9% of ESBL-E rectal carriers were identified with selective preenrichment only.
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12
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Report of the 13th vancomycin-resistant Staphylococcus aureus isolate from the United States. J Clin Microbiol 2013; 52:998-1002. [PMID: 24371243 DOI: 10.1128/jcm.02187-13] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Vancomycin-resistant Staphylococcus aureus (VRSA), an important multidrug-resistant organism of public health concern, has been infrequently identified in the United States since 2002. All previous VRSA isolates belonged to clonal complex 5, a lineage associated primarily with health care. This report describes the most recent (13th) U.S. VRSA isolate, the first to be community associated.
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Peters PJ, Brooks JT, McAllister SK, Limbago B, Lowery HK, Fosheim G, Guest JL, Gorwitz RJ, Bethea M, Hageman J, Mindley R, McDougal LK, Rimland D. Methicillin-resistant Staphylococcus aureus colonization of the groin and risk for clinical infection among HIV-infected adults. Emerg Infect Dis 2013; 19:623-9. [PMID: 23631854 PMCID: PMC3647417 DOI: 10.3201/eid1904.121353] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007–2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%–15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population.
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Affiliation(s)
- Philip J Peters
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Kluytmans-van den Bergh MFQ, Vos MC, Diederen BMW, Vandenbroucke-Grauls CMJE, Voss A, Kluytmans JAJW. Dutch guideline on the laboratory detection of methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2013; 33:89-101. [PMID: 23893016 DOI: 10.1007/s10096-013-1933-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 07/11/2013] [Indexed: 01/25/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) has rapidly emerged worldwide, affecting both healthcare and community settings, and intensive livestock industry. The efficient control of MRSA strongly depends on its adequate laboratory detection. This guideline provides recommendations on the appropriate use of currently available diagnostic laboratory methods for the timely and accurate detection of MRSA in patients and healthcare workers. Herewith, it aims to standardise and improve the diagnostic laboratory procedures that are used for the detection of MRSA in Dutch medical microbiology laboratories.
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Hawken P, Weese JS, Friendship R, Warriner K. Longitudinal study of Clostridium difficile and Methicillin-resistant Staphylococcus aureus associated with pigs from weaning through to the end of processing. J Food Prot 2013; 76:624-30. [PMID: 23575124 DOI: 10.4315/0362-028x.jfp-12-330] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There has been a recent increase in community-associated infections linked to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile. It is established that both pathogens can be recovered from retail pork, although it is unclear to what degree contamination is acquired at the farm in comparison to that acquired during processing. To address this gap, the following study reports on the carriage of MRSA and C. difficile on pigs from birth through to the end of processing. C. difficile was isolated from 28 (93%) of 30 pigs at 1 day of age, but prevalence declined sharply to 1 of 26 by market age (188 days). MRSA prevalence peaked at 74 days of age, with 19 (68%) of 28 pigs testing positive, but declined to 3 of 26 at 150 days of age, with no pig being detected as positive at market age. At the processing facility, C. difficile was isolated from the holding area, with a single carcass testing positive for the pathogen at preevisceration. MRSA was primarily isolated from nasal swabs with 8 (31%) carcasses testing positive at postbleed, which increased to 14 (54%) positive at postscald tanks. Only one carcass (sampled at postbleed) tested positive for MRSA, with no recovery of the pathogen from environmental samples taken. C. difficile ribotype 078 predominated in the longitudinal portion of the study, accounting for all of the 68 isolates recovered from pigs. Only three C. difficile isolates, which were identified as ribotype 078, were recovered at the slaughterhouse. MRSA spa type 539 (t034) predominated in pigs on the farm and samples taken at the slaughterhouse, accounting for 80% of all isolates recovered. The study demonstrated that both C. difficile and MRSA acquired on the farm can be transferred through to processing, although no evidence for significant cross-contamination between carcasses or the slaughterhouse environment was evident.
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Affiliation(s)
- Philip Hawken
- Department of Food Science, University of Guelph, Guelph, Ontario, Canada
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Evaluation of brilliance MRSA 2 agar for detection of methicillin-resistant Staphylococcus aureus in clinical samples. J Clin Microbiol 2013; 51:1026-7. [PMID: 23284023 DOI: 10.1128/jcm.02995-12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared 2 chromogenic media (Oxoid Brilliance MRSA 2 agar [Thermo Fisher Scientific] and MRSA-ID [bioMérieux]) for the detection of methicillin-resistant Staphylococcus aureus (MRSA) in 1,368 hospital samples. For both media, broth enrichment was essential to obtain satisfactory diagnostic performance. Although with direct cultures only, the diagnostic performance (particularly sensitivity) of Brilliance MRSA 2 agar appears better than that of MRSA-ID, no difference in sensitivity or specificity between the media was detected after inclusion of an enrichment step.
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Detection of methicillin-resistant Staphylococcus aureus in clinical specimens from cystic fibrosis patients by use of chromogenic selective agar. J Clin Microbiol 2012; 50:2506-8. [PMID: 22518859 DOI: 10.1128/jcm.00549-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We evaluated the use of a chromogenic selective medium (MRSA ID) as a useful tool for the detection of methicillin-resistant Staphylococcus aureus (MRSA) in cystic fibrosis (CF) patient samples. Fifty-four MRSA isolates were detected by MRSA ID, while only 24/54 (44%) (odds ratio [OR], 2.79; 95% confidence interval [CI], 1.63 to 4.76) were detected by conventional methods. A chromogenic selective medium for MRSA detection may improve its surveillance in CF patients.
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