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Shahab SN, van Veen A, Büchler AC, Saharman YR, Karuniawati A, Vos MC, Voor In 't Holt AF, Severin JA. In search of the best method to detect carriage of carbapenem-resistant Pseudomonas aeruginosa in humans: a systematic review. Ann Clin Microbiol Antimicrob 2024; 23:50. [PMID: 38858708 PMCID: PMC11163693 DOI: 10.1186/s12941-024-00707-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 05/13/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Detection of carbapenem-resistant Pseudomonas aeruginosa (CR-PA) in humans is important to prevent transmission. However, the most optimal culture method to detect CR-PA is unknown. This systematic review aims to determine which culture method is most sensitive and which culture methods are used to detect CR-PA in humans. Second, to establish the most feasible culture method taking into account the turnaround time (TAT), and third, to provide an overview of the sampling sites used to detect carriage. METHODS We systematically searched the electronic databases Embase, Medline Ovid, Cochrane, Scopus, CINAHL, and Web of Science until January 27, 2023. All diagnostic accuracy studies comparing two or more culture methods to detect CR-PA and recent outbreak or surveillance reports on CR-PA carriage or infection in humans, which describe culture methods and their results, were eligible for inclusion. We used QUADAS-2 guideline for diagnostic accuracy studies and the STROBE or ORION guideline for outbreak-surveillance studies to assess the risk of bias. RESULTS Six diagnostic accuracy studies were included. An enrichment broth was found to increase the detection of CR-PA. Using an enrichment broth extended the TAT by 18-24 h, yet selective media could reduce the TAT by 24 h compared to routine media. In total, 124 outbreak-surveillance studies were included, of which 17 studies with surveillance samples and 116 studies with clinical samples. In outbreak-surveillance studies with surveillance samples, perianal, rectal swabs or stools were the most common sampling site/specimen (13/17, 76%). A large variety was observed in whether and which kind of enrichment broth and selective media were used. CONCLUSIONS We found a benefit of using an enrichment step prior to inoculation of the material onto selective media for the detection of CR-PA. More research is needed to determine the most sensitive sampling site and culture method. TRAIL REGISTRATION This study was registered in the PROSPERO International prospective register of systematic reviews (registration number: CRD42020207390, http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42020207390 ).
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Affiliation(s)
- Selvi N Shahab
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anneloes van Veen
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Andrea C Büchler
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Yulia R Saharman
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Anis Karuniawati
- Department of Clinical Microbiology, Faculty of Medicine, Universitas Indonesia/Dr. Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
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Popovich KJ, Aureden K, Ham DC, Harris AD, Hessels AJ, Huang SS, Maragakis LL, Milstone AM, Moody J, Yokoe D, Calfee DP. SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:1039-1067. [PMID: 37381690 PMCID: PMC10369222 DOI: 10.1017/ice.2023.102] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 05/03/2023] [Indexed: 06/29/2023]
Abstract
Previously published guidelines have provided comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute-care hospitals in implementing and prioritizing efforts to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission and infection. This document updates the "Strategies to Prevent Methicillin-Resistant Staphylococcus aureus Transmission and Infection in Acute Care Hospitals" published in 2014.1 This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Affiliation(s)
- Kyle J. Popovich
- Department of Internal Medicine, RUSH Medical College, Chicago, Illinois
| | - Kathy Aureden
- Infection Prevention, Advocate Aurora Health, Downers Grove, Illinois
| | - D. Cal Ham
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Anthony D. Harris
- Health Care Outcomes Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - Amanda J. Hessels
- Columbia School of Nursing, New York, New York
- Hackensack Meridian Health, Edison, New Jersey
| | - Susan S. Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California
| | - Lisa L. Maragakis
- Johns Hopkins University School of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Aaron M. Milstone
- Division of Pediatric Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia Moody
- Infection Prevention, HCA Healthcare, Nashville, Tennessee
| | - Deborah Yokoe
- Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California
- Transplant Infectious Diseases, UCSF Medical Center, San Francisco, California
| | - David P. Calfee
- Department of Medicine, Weill Cornell Medicine, New York, New York
- Department of Population Health Sciences, Weill Cornell Medicine, New York, New York
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3
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Bouiller K, Zeggay A, Gbaguidi-Haore H, Hocquet D, Chirouze C, Bertrand X. Epidemiology and risk factors of nasal carriage of Staphylococcus aureus CC398 in two distinct cohorts in France. Front Microbiol 2022; 13:1068420. [PMID: 36605518 PMCID: PMC9807596 DOI: 10.3389/fmicb.2022.1068420] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022] Open
Abstract
Background We aimed to determine the prevalence and factors associated with nasal carriage of Staphylococcus aureus CC398 in the community and among hospitalized patients. Methods We conducted a prospective cohort study in a French university hospital and a cross-sectional study in the surrounding region. Results From June 2019 to July 2020, 591 healthy blood donors (HBDs) and 647 hospitalized patients (HPs) were included. S. aureus CC398 was more prevalent in HBDs than in HPs (7.3% [5.3-9.7] vs. 3.8% [2.4-5.5], p = 0.006). Among S. aureus nasal carriers, the prevalence of CC398 isolates was 24.6% in HBDs and 18.3% in HPs (p = 0.19). No MRSA belonged to CC398. In multivariate analysis, prior antibiotic intake in the past year (OR 3.11 [1.37-7.06]) and active smoking (OR 3.01 [1.00-9.05]) were associated with S. aureus CC398 nasal carriage in the HBD cohort. A history of neurological disease was associated with nasal carriage (OR = 5.43 [1.21-24.2]), whereas an age between 82 and 90 years (OR 0.11 [0.02-0.54]) and diabetes (OR 0.18 [0.04-0.85]) were protective factors in the HP cohort. Contact with livestock was not a risk factor in either cohort. Conclusion The prevalence of MSSA CC398 was higher in the community than hospitalized patients. Factors associated with nasal carriage of MSSA CC398 were primarily related to general preconditions. No environmental sources of exposure were identified.
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Affiliation(s)
- Kevin Bouiller
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,*Correspondence: Kevin Bouiller,
| | - Abdeljalil Zeggay
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France
| | - Houssein Gbaguidi-Haore
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Didier Hocquet
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
| | - Catherine Chirouze
- Service de Maladies Infectieuses et Tropicales – CHU Besancon, Besancon, France,UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France
| | - Xavier Bertrand
- UMR-CNRS 6249 Chrono-environnement, Université Bourgogne Franche-Comté, Besançon, France,Service d’Hygiène Hospitalière – CHU Besancon, Besancon, France
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4
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Popovich KJ, Weinstein RA. Questioning Old Staphylococcus aureus Beliefs With New Technology. J Infect Dis 2022; 227:1028-1030. [PMID: 36322783 DOI: 10.1093/infdis/jiac439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center/Cook County Health, Section of Infectious Diseases, University Medical Center , Chicago, Illinois , USA
| | - Robert A Weinstein
- Rush University Medical Center/Cook County Health, Section of Infectious Diseases, University Medical Center , Chicago, Illinois , USA
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Beukes LS, Schmidt S. Manual emptying of ventilated improved pit latrines and hygiene challenges - a baseline survey in a peri-urban community in KwaZulu-Natal, South Africa. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2022; 32:1043-1054. [PMID: 32962416 DOI: 10.1080/09603123.2020.1823334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/09/2020] [Indexed: 06/11/2023]
Abstract
The presence of Escherichia coli and Staphylococcus spp. was determined on the skin, personal protective equipment, the municipal vehicle, and various surfaces at ten households in a peri-urban community (KwaZulu-Natal, South Africa) before and after manual emptying of ventilated improved pit latrines. Surface samples (n = 14) were collected using sterile wet wipes, and target bacteria were detected using standard procedures. Additionally, E. coli was enumerated in soil samples from an area of open defecation (log10 3.7 MPN/g) and areas where geophagia occurred (log10 2.7 - log10 3.3 MPN/g), using a most probable number (MPN) method. The detection frequency for the target bacteria on household surfaces (e.g., the walkway between the pit latrine and the municipal vehicle) and on municipal workers' hands (which were frequently contaminated before pit emptying), occasionally increased after the pits were emptied, indicating that manual pit emptying might pose a potential health risk to workers and community members.
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Affiliation(s)
- Lorika S Beukes
- Discipline of Microbiology, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Stefan Schmidt
- Discipline of Microbiology, School of Life Sciences, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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Popovich KJ, Thiede SN, Zawitz C, Payne D, Aroutcheva A, Schoeny M, Green SJ, Snitkin ES, Weinstein RA. Genomic Analysis of Community Transmission Networks for MRSA among Females Entering a Large Inner-City Jail. Open Forum Infect Dis 2022; 9:ofac049. [PMID: 35211635 PMCID: PMC8863081 DOI: 10.1093/ofid/ofac049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/25/2022] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
It is unclear if there are differences in MRSA risk between sexes in high-risk populations.
Methods
Females incarcerated at the Cook County Jail were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify colonization predictors. Univariate and multivariate analyses were performed to identify predictors of colonization at intake. Genomic sequencing was performed on MRSA colonization and archived clinical isolates.
Results
250 women were enrolled (70% AA, 15% Hispanic) with 70% previously in jail. The prevalence of MRSA colonization at intake was 20%, with 42% of those colonized solely in the throat or groin. Univariate predictors of MRSA colonization at entrance were illicit drug use, unstable housing, engaging in anal sex, recent exchange of sex for drugs/money, and a higher number of recent sexual partners. With multivariate adjustment for race/ethnicity, use of needles for illicit drugs was a significant predictor of MRSA. Use of illicit drugs was also associated with inclusion in a genomic cluster.
Nares colonization was significantly associated with not being in a genomic cluster (18.8% vs 78.6%, p<0.001), whereas exclusive extra-nasal colonization was associated (OR 15.89, p<0.001).
Conclusion
We found that a high proportion (20%) of females entered jail colonized with MRSA, suggesting that previously reported sex disparities of a lower risk in women may not apply to high-risk populations. Our findings suggest high-risk activities or venues in the community for MRSA, with potential for directing sex-specific interventions.
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Affiliation(s)
- Kyle J Popovich
- Rush University Medical Center/Cook County Health, Chicago, IL, USA
| | | | - Chad Zawitz
- Cermak Health Services, Cook County Health, Chicago, IL, USA
| | - Darjai Payne
- Rush University Medical Center, Chicago, IL, USA
| | - Alla Aroutcheva
- Rush University Medical Center/Cook County Health, Chicago, IL, USA
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7
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Price JR, Yokoyama M, Cole K, Sweetman J, Behar L, Stoneham S, Cantillon D, Waddell SJ, Hyde J, Alam R, Crook D, Paul J, Llewelyn MJ. Undetected carriage explains apparent Staphylococcus aureus acquisition in a non-outbreak healthcare setting. J Infect 2021; 83:332-338. [PMID: 34303737 DOI: 10.1016/j.jinf.2021.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 07/18/2021] [Accepted: 07/19/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Previous studies have been unable to identify patient or staff reservoirs for the majority of the nosocomial S. aureus acquisitions which occur in the presence of good infection control practice. We set out to establish the extent to which undetected pre-existing carriage explains apparent nosocomial S. aureus acquisition. METHODS Over two years elective cardiothoracic admissions were screened for S. aureus carriage before and during hospital admission. Routine screening (nose/groin/wound sampling), was supplemented by sampling additional body sites (axilla/throat/rectum) and culture-based methods optimised to detect fastidious phenotypes (small colony variants, cell wall deficient variants) and molecular identification by PCR. RESULTS 35% of participants (53/151) were S. aureus carriers according to routine pre-healthcare screening; increasing to 42% (63/151) when additional body sites and enhanced cultures were employed. 71% (5/7) of apparent acquisitions were explained by pre-existing carriage using augmented measures. Enhanced culture identified a minority of colonised individuals (3/151 including 1 MRSA carrier) who were undetected by routine and additional screening cultures. 4/14 (29%) participants who became culture-negative during admission had S. aureus genomic material detected at discharge. CONCLUSIONS Conventional sampling under-estimates carriage of S. aureus and this explains the majority of apparent S. aureus acquisitions among elective cardiothoracic patients.
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Affiliation(s)
- James R Price
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Maho Yokoyama
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Kevin Cole
- Public Health England, Royal Sussex County Hospital, Brighton, BN2 5BE, United Kingdom.
| | - Jonathan Sweetman
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Laura Behar
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Simon Stoneham
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Daire Cantillon
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Simon J Waddell
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
| | - Jonathan Hyde
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Ruhina Alam
- Clinical Investigation Research Unit, Brighton and Sussex University Hospital NHS Trust, Brighton, BN2 5BE, United Kingdom.
| | - Derrick Crook
- Department of Experimental Medicine, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom.
| | - John Paul
- Public Health England, Royal Sussex County Hospital, Brighton, BN2 5BE, United Kingdom.
| | - Martin J Llewelyn
- Department of Global Health and Infection, Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton, BN1 9PS, United Kingdom.
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Popovich KJ, Green SJ, Okamoto K, Rhee Y, Hayden MK, Schoeny M, Snitkin ES, Weinstein RA. MRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare Workers. Clin Infect Dis 2021; 72:1879-1887. [PMID: 32505135 PMCID: PMC8315036 DOI: 10.1093/cid/ciaa731] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 06/03/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA)-and now USA300 MRSA-is a significant intensive care unit (ICU) pathogen; healthcare worker (HCW) contamination may lead to patient cross-transmission. METHODS From September 2015 to February 2016, to study the spread of MRSA, we enrolled HCWs in 4 adult ICUs caring for patients on MRSA contact precautions. Samples were collected from patient body sites and high-touch surfaces in patient rooms. HCW hands, gloves, and personal protective equipment were sampled pre/post-patient encounter. Whole genome sequencing (WGS) was used to compare isolates from patients, HCWs, and environment. RESULTS There were 413 MRSA isolates sequenced (38% USA300, 52% USA100) from 66 patient encounters. Six of 66 HCWs were contaminated with MRSA prior to room entry. Isolates from a single patient encounter were typically either USA100 or USA300; in 8 (12%) encounters both USA300 and USA100 were isolated. WGS demonstrated that isolates from patients, HCWs, and environment often were genetically similar, although there was substantial between-encounter diversity. Strikingly, there were 5 USA100 and 1 USA300 clusters that contained similar strains (<22 single-nucleotide variants [SNVs], with most <10 SNVs) within the cluster despite coming from different encounters, suggesting intra- and inter-ICU spread of strains, that is, 4 of these genomic clusters were from encounters in the same ICU; 5 of 6 clusters occurred within 1 week. CONCLUSIONS We demonstrated frequent spread of MRSA USA300 and USA100 strains among patients, environment, and HCWs. WGS identified possible spread within and even between ICUs. Future analysis with detailed contact tracing in conjunction with genomic data may further elucidate pathways of MRSA spread and points for intervention.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Stefan J Green
- Genome Research Core, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Yoona Rhee
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Disease, Rush University Medical Center, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology and Division of Infectious Disease, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Robert A Weinstein
- Division of Infectious Disease, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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9
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Schweizer ML, Richardson K, Vaughan Sarrazin MS, Goto M, Livorsi DJ, Nair R, Alexander B, Beck BF, Jones MP, Puig-Asensio M, Suh D, Ohl M, Perencevich EN. Comparative Effectiveness of Switching to Daptomycin Versus Remaining on Vancomycin Among Patients With Methicillin-resistant Staphylococcus aureus (MRSA) Bloodstream Infections. Clin Infect Dis 2021; 72:S68-S73. [PMID: 33512521 DOI: 10.1093/cid/ciaa1572] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/13/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patients with methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSI) usually receive initial treatment with vancomycin but may be switched to daptomycin for definitive therapy, especially if treatment failure is suspected. Our objective was to evaluate the effectiveness of switching from vancomycin to daptomycin compared with remaining on vancomycin among patients with MRSA BSI. METHODS Patients admitted to 124 Veterans Affairs Hospitals who experienced MRSA BSI and were treated with vancomycin during 2007-2014 were included. The association between switching to daptomycin and 30-day mortality was assessed using Cox regression models. Separate models were created for switching to daptomycin any time during the first hospitalization and for switching within 3 days of receiving vancomycin. RESULTS In total, 7411 patients received vancomycin for MRSA BSI. Also, 606 (8.2%) patients switched from vancomycin to daptomycin during the first hospitalization, and 108 (1.5%) switched from vancomycin to daptomycin within 3 days of starting vancomycin. In the multivariable analysis, switching to daptomycin within 3 days was significantly associated with lower 30-day mortality (hazards ratio [HR] = 0.48; 95% confidence interval [CI]: .25, .92). However, switching to daptomycin at any time during the first hospitalization was not significantly associated with 30-day mortality (HR: 0.87; 95% CI: .69, 1.09). CONCLUSIONS Switching to daptomycin within 3 days of initial receipt of vancomycin is associated with lower 30-day mortality among patients with MRSA BSI. This benefit was not seen when the switch occurred later. Future studies should prospectively assess the benefit of early switching from vancomycin to other anti-MRSA antibiotics.
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Affiliation(s)
- Marin L Schweizer
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Kelly Richardson
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Mary S Vaughan Sarrazin
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Michihiko Goto
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Daniel J Livorsi
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Rajeshwari Nair
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Bruce Alexander
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Brice F Beck
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Michael P Jones
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Biostatistics, College of Public Health, University of Iowa, Iowa City, Iowa USA
| | - Mireia Puig-Asensio
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Daniel Suh
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA
| | - Madeline Ohl
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
| | - Eli N Perencevich
- Center for Access and Delivery Research and Evaluation, Iowa City VA Health Care System, Iowa City, Iowa USA.,Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa USA
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Popovich KJ, Snitkin ES, Zawitz C, Aroutcheva A, Payne D, Thiede SN, Schoeny M, Green SJ, Hayden MK, Hota B, Weinstein RA. Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks. Clin Infect Dis 2021; 71:323-331. [PMID: 31425575 DOI: 10.1093/cid/ciz818] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. METHODS Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks.We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. RESULTS There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001). CONCLUSIONS A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Chad Zawitz
- Clinical Coordinator of HIV and Infectious Disease Services, Cermak Health Services, Cook County Health, Chicago, Illinois, USA
| | - Alla Aroutcheva
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Darjai Payne
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Stephanie N Thiede
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Stefan J Green
- Sequencing Core and Associate Director, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Bala Hota
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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Detecting carbapenem-resistant Acinetobacter baumannii (CRAB) carriage: Which body site should be cultured? Infect Control Hosp Epidemiol 2020; 41:965-967. [PMID: 32618523 PMCID: PMC7511923 DOI: 10.1017/ice.2020.197] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We compared the yield of culturing various body sites to detect carriage of carbapenem-resistant Acinetobacter baumannii (CRAB). Culturing the skin using a premoistened sponge, with overnight enrichment and plating on CHROMagar MDR Acinetobacter, had the highest yield: 92%. Skin is satisfactory as a single site for active surveillance of CRAB.
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The Continuing Threat of Methicillin-Resistant Staphylococcus aureus. Antibiotics (Basel) 2019; 8:antibiotics8020052. [PMID: 31052511 PMCID: PMC6627156 DOI: 10.3390/antibiotics8020052] [Citation(s) in RCA: 165] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 02/06/2023] Open
Abstract
Staphylococcus aureus has been an exceptionally successful pathogen, which is still relevant in modern age-medicine due to its adaptability and tenacity. This bacterium may be a causative agent in a plethora of infections, owing to its abundance (in the environment and in the normal flora) and the variety of virulence factors that it possesses. Methicillin-resistant S. aureus (MRSA) strains—first described in 1961—are characterized by an altered penicillin-binding protein (PBP2a/c) and resistance to all penicillins, cephalosporins, and carbapenems, which makes the β-lactam armamentarium clinically ineffective. The acquisition of additional resistance determinants further complicates their eradication; therefore, MRSA can be considered as the first representative of multidrug-resistant bacteria. Based on 230 references, the aim of this review is to recap the history, the emergence, and clinical features of various MRSA infections (hospital-, community-, and livestock-associated), and to summarize the current advances regarding MRSA screening, typing, and therapeutic options (including lipoglycopeptides, oxazolidinones, anti-MRSA cephalosporins, novel pleuromutilin-, tetracycline- and quinolone-derivatives, daptomycin, fusidic acid, in addition to drug candidates in the development phase), both for an audience of clinical microbiologists and infectious disease specialists.
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Eggers S, Malecki KMC, Peppard P, Mares J, Shirley D, Shukla SK, Poulsen K, Gangnon R, Duster M, Kates A, Suen G, Sethi AK, Safdar N. Wisconsin microbiome study, a cross-sectional investigation of dietary fibre, microbiome composition and antibiotic-resistant organisms: rationale and methods. BMJ Open 2018; 8:e019450. [PMID: 29588324 PMCID: PMC5875638 DOI: 10.1136/bmjopen-2017-019450] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Prevention of multidrug-resistant organism (MDRO) infections, such as those caused by methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, fluoroquinolone-resistant Gram-negative bacteria and Clostridium difficile is crucial. Evidence suggests that dietary fibre increases gut microbial diversity, which may help prevent colonisation and subsequent infection by MDROs. The aim of the Winning the War on Antibiotic Resistance (WARRIOR) project is to examine associations of dietary fibre consumption with the composition of the gut microbiota and gut colonisation by MDROs. The secondary purpose of the study is to create a biorepository of multiple body site specimens for future microbiota research. METHODS AND ANALYSIS The WARRIOR project collects biological specimens, including nasal, oral and skin swabs and saliva and stool samples, along with extensive data on diet and MDRO risk factors, as an ancillary study of the Survey of the Health of Wisconsin (SHOW). The SHOW is a population-based health survey collecting data on several different health determinants and outcomes, as well as objective body measurements and biological specimens. WARRIOR participants include 600 randomly selected Wisconsin residents age 18 and over. Specimens are screened for MDRO colonisation and DNA is extracted for 16S ribosomal RNA-based microbiota sequencing. Data will be analysed to assess the relationship between dietary fibre, the gut microbiota composition and gut MDRO colonisation. ETHICS AND DISSEMINATION The WARRIOR project is approved by the University of Wisconsin Institutional Review Board. The main results of this study will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Shoshannah Eggers
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kristen MC Malecki
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Paul Peppard
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Julie Mares
- Department of Ophthalmology and Visual Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Daniel Shirley
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Sanjay K Shukla
- Center for Human Genetics, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA
| | - Keith Poulsen
- Department of Medical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald Gangnon
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Megan Duster
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ashley Kates
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Garret Suen
- Department of Bacteriology, College of Agricultural and Life Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ajay K Sethi
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nasia Safdar
- Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin, USA
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Eggers S, Barker AK, Valentine S, Hess T, Duster M, Safdar N. Effect of Lactobacillus rhamnosus HN001 on carriage of Staphylococcus aureus: results of the impact of probiotics for reducing infections in veterans (IMPROVE) study. BMC Infect Dis 2018; 18:129. [PMID: 29540160 PMCID: PMC5853063 DOI: 10.1186/s12879-018-3028-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 02/28/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Infection by Staphylococcus aureus (S. aureus) is a major cause of morbidity and mortality. Colonization by S. aureus increases the risk of infection. Little is known about decolonization strategies for S. aureus beyond antibiotics, however probiotics represent a promising alternative. A randomized controlled trial was conducted to determine the efficacy of Lactobacillus rhamnosus (L. rhamnosus) HN001 in reducing carriage of S. aureus at multiple body sites. METHODS One hundred thirteen subjects, positive for S. aureus carriage, were recruited from the William S. Middleton Memorial Medical Center, Madison, WI, USA, and randomized by initial site of colonization, either gastrointestinal (GI) or extra-GI, to 4-weeks of oral L. rhamnosus HN001 probiotic, or placebo. Nasal, oropharyngeal, and axillary/groin swabs were obtained, and serial blood and fecal samples were collected. Differences in prevalence of S. aureus carriage at the end of the 4-weeks of treatment were assessed. RESULTS The probiotic and placebo groups were similar in age, gender, and health history at baseline. S. aureus colonization within the stool samples of the extra-GI group was 15% lower in the probiotic than placebo group at the endpoint of the trial. Those in the probiotic group compared to the placebo group had 73% reduced odds (OR 0.27, 95% CI 0.07-0.98) of methicillin-susceptible S. aureus presence, and 83% reduced odds (OR 0.17, 95% CI 0.04-0.73) of any S. aureus presence in the stool sample at endpoint. CONCLUSION Use of daily oral L. rhamnosus HN001 reduced odds of carriage of S. aureus in the GI tract, however it did not eradicate S. aureus from other body sites. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01321606 . Registered March 21, 2011.
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Affiliation(s)
- Shoshannah Eggers
- William S. Middleton Veterans Affairs Medical Center, 2500 Overlook Terrace, Madison, WI 53705 USA ,0000 0001 2167 3675grid.14003.36Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin – Madison, Warf Office Bldg, 610 Walnut St #707, Madison, WI 53726 USA
| | - Anna K. Barker
- 0000 0001 2167 3675grid.14003.36Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin – Madison, Warf Office Bldg, 610 Walnut St #707, Madison, WI 53726 USA
| | - Susan Valentine
- William S. Middleton Veterans Affairs Medical Center, 2500 Overlook Terrace, Madison, WI 53705 USA
| | - Timothy Hess
- 0000 0001 2167 3675grid.14003.36Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, 1685 Highland Ave, Madison, WI 53705 USA
| | - Megan Duster
- 0000 0001 2167 3675grid.14003.36Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, 1685 Highland Ave, 5th Floor, Madison, WI 53705 USA
| | - Nasia Safdar
- William S. Middleton Veterans Affairs Medical Center, 2500 Overlook Terrace, Madison, WI 53705 USA ,0000 0001 2167 3675grid.14003.36Division of Infectious Disease, Department of Medicine, School of Medicine and Public Health, University of Wisconsin – Madison, 1685 Highland Ave, 5th Floor, Madison, WI 53705 USA
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Combination of MALDI-TOF MS and PBP2′ latex agglutination assay for rapid MRSA detection. J Microbiol Methods 2018; 144:122-124. [DOI: 10.1016/j.mimet.2017.11.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 11/23/2017] [Accepted: 11/24/2017] [Indexed: 01/09/2023]
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Schneider AC, Fritz D, Vasquez JK, Vollrath SBL, Blackwell HE, Brasë S. Microwave-Facilitated SPOT-Synthesis of Antibacterial Dipeptoids. ACS COMBINATORIAL SCIENCE 2017; 19:715-737. [PMID: 29035557 PMCID: PMC5931720 DOI: 10.1021/acscombsci.7b00096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
With microwave irradiation, the submonomer synthesis of dipeptoids on functionalized cellulose can be accelerated with good yields and purity. Optimization provided a library of 96 dipeptoids. From these, 29 compounds were found with an antibacterial activity against MRSA at a concentration of 25 μM. Large nonpolar residues, such as undecylamine and dehydroabiethylamine, are the key components engendering the observed antibacterial activity of these peptoids.
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Affiliation(s)
- Anne C. Schneider
- Institute of Organic Chemistry, Karlsruhe Institute of Technology, Fritz-Haber-Weg 6, 76131 Karlsruhe, Germany
| | - Daniel Fritz
- Institute of Organic Chemistry, Karlsruhe Institute of Technology, Fritz-Haber-Weg 6, 76131 Karlsruhe, Germany
| | - Joseph K. Vasquez
- Department of Chemistry, University of Wisconsin-Madison, 1101 University Avenue, Madison, Wisconsin 53706, United States
| | - Sidonie B. L. Vollrath
- Institute of Organic Chemistry, Karlsruhe Institute of Technology, Fritz-Haber-Weg 6, 76131 Karlsruhe, Germany
| | - Helen E. Blackwell
- Department of Chemistry, University of Wisconsin-Madison, 1101 University Avenue, Madison, Wisconsin 53706, United States
| | - Stefan Brasë
- Institute of Toxicology and Genetics, Karlsruhe Institute of Technology, Hermann-von-Helmholtz-Platz 1, 76344 Eggenstein-Leopoldshafen, Germany
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Affiliation(s)
- Siew S.C. Goh
- Department of Cardiothoracic Surgery; Liverpool Hospital; NSW Australia
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18
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Accurate Detection of Methicillin-Resistant Staphylococcus aureus in Mixtures by Use of Single-Bacterium Duplex Droplet Digital PCR. J Clin Microbiol 2017; 55:2946-2955. [PMID: 28724560 DOI: 10.1128/jcm.00716-17] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 07/14/2017] [Indexed: 12/16/2022] Open
Abstract
Accurate and rapid identification of methicillin-resistant Staphylococcus aureus (MRSA) is needed to screen MRSA carriers and improve treatment. The current widely used duplex PCR methods are not able to differentiate MRSA from coexisting methicillin-susceptible S. aureus (MSSA) or other methicillin-resistant staphylococci. In this study, we aimed to develop a direct method for accurate and rapid detection of MRSA in clinical samples from open environments, such as nasal swabs. The new molecular assay is based on detecting the cooccurrence of nuc and mecA markers in a single bacterial cell by utilizing droplet digital PCR (ddPCR) with the chimeric lysin ClyH for cell lysis. The method consists of (i) dispersion of an intact single bacterium into nanoliter droplets, (ii) temperature-controlled release of genomic DNA (gDNA) by ClyH at 37°C, and (iii) amplification and detection of the markers (nuc and mecA) using standard TaqMan chemistries with ddPCR. Results were analyzed based on MRSA index ratios used for indicating the presence of the duplex-positive markers in droplets. The method was able to achieve an absolute limit of detection (LOD) of 2,900 CFU/ml for MRSA in nasal swabs spiked with excess amounts of Escherichia coli, MSSA, and other mecA-positive bacteria within 4 h. Initial testing of 104 nasal swabs showed that the method had 100% agreement with the standard culture method, while the normal duplex qPCR method had only about 87.5% agreement. The single-bacterium duplex ddPCR assay is rapid and powerful for more accurate detection of MRSA directly from clinical specimens.
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Khader K, Thomas A, Huskins WC, Leecaster M, Zhang Y, Greene T, Redd A, Samore MH. A Dynamic Transmission Model to Evaluate the Effectiveness of Infection Control Strategies. Open Forum Infect Dis 2017; 4:ofw247. [PMID: 28702465 PMCID: PMC5499871 DOI: 10.1093/ofid/ofw247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 11/11/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The advancement of knowledge about control of antibiotic resistance depends on the rigorous evaluation of alternative intervention strategies. The STAR*ICU trial examined the effects of active surveillance and expanded barrier precautions on acquisition of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) in intensive care units. We report a reanalyses of the STAR*ICU trial using a Bayesian transmission modeling framework. METHODS The data included admission and discharge times and surveillance test times and results. Markov chain Monte Carlo stochastic integration was used to estimate the transmission rate, importation, false negativity, and clearance separately for MRSA and VRE. The primary outcome was the intervention effect, which when less than (or greater than) zero, indicated a decreased (or increased) transmission rate attributable to the intervention. RESULTS The transmission rate increased in both arms from pre- to postintervention (by 20% and 26% for MRSA and VRE). The estimated intervention effect was 0.00 (95% confidence interval [CI], -0.57 to 0.56) for MRSA and 0.05 (95% CI, -0.39 to 0.48) for VRE. Compared with MRSA, VRE had a higher transmission rate (preintervention, 0.0069 vs 0.0039; postintervention, 0.0087 vs 0.0046), higher importation probability (0.22 vs 0.17), and a lower clearance rate per colonized patient-day (0.016 vs 0.035). CONCLUSIONS Transmission rates in the 2 treatment arms were statistically indistinguishable from the pre- to postintervention phase, consistent with the original analysis of the STAR*ICU trial. Our statistical framework was able to disentangle transmission from importation and account for imperfect testing. Epidemiological differences between VRE and MRSA were revealed.
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Affiliation(s)
- Karim Khader
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
| | - Alun Thomas
- Genetic Epidemiology, University of Utah School of Medicine, Salt Lake City
| | - W Charles Huskins
- Division of Pediatric Infectious Diseases, Mayo Clinic, Rochester, Minnesota
| | - Molly Leecaster
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
| | - Yue Zhang
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
| | - Tom Greene
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
| | - Andrew Redd
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
| | - Matthew H Samore
- Informatics, Decision Enhancement, and Analytical Sciences 2.0 Center, VA Salt Lake City Health Care System, City, Utah.,Divisions of Epidemiology
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Lyles RD, Trick WE, Hayden MK, Lolans K, Fogg L, Logan LK, Shulman ST, Weinstein RA, Lin MY. Regional Epidemiology of Methicillin-Resistant Staphylococcus aureus Among Critically Ill Children in a State With Mandated Active Surveillance. J Pediatric Infect Dis Soc 2016; 5:409-416. [PMID: 26407280 PMCID: PMC8376206 DOI: 10.1093/jpids/piv050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 07/18/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND In theory, active surveillance of methicillin-resistant Staphylococcus aureus (MRSA) reduces MRSA spread by identifying all MRSA-colonized patients and placing them under contact precautions. In October 2007, Illinois mandated active MRSA surveillance in all intensive care units, including neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs). We evaluated MRSA trends in a large metropolitan region in the wake of this law. METHODS Chicago hospitals with a NICU or PICU were recruited for 8 single-day point prevalence surveys that occurred twice-yearly between June 2008 and July 2011 and then yearly in 2012 to 2013. Samples from all patients were cultured for MRSA (nose and umbilicus for neonates, nose and groin for pediatric patients). Hospital-reported admission MRSA-screening results also were obtained. Point prevalence cultures were screened for MRSA by using broth enrichment, chromogenic agar, and standard confirmatory methods. RESULTS All eligible hospitals (N = 10) participated (10 NICUs, 6 PICUs). Hospital-reported adherence to state-mandated MRSA screening at admission was high (95% for NICUs, 94% for PICUs). From serial point prevalence surveys, overall MRSA prevalences in the NICUs and PICUs were 4.2% (89 of 2101) and 5.7% (36 of 632), respectively. MRSA colonization prevalences were unchanged in the NICUs (year-over-year risk ratio [RR], 0.93 [95% confidence interval (CI), 0.78-1.12]; P = .45) and trended toward an increase in the PICUs (RR, 1.25 [95% CI, 0.72-2.12]; P = .053). We estimated that 81% and 40% of MRSA-positive patients in the NICUs and PICUs, respectively, had newly acquired MRSA. CONCLUSIONS In a region with mandated active MRSA surveillance, we found ongoing unchanged rates of MRSA colonization and acquisition among NICU and PICU patients.
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Affiliation(s)
- Rosie D. Lyles
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois
| | - William E. Trick
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Mary K. Hayden
- Department of Medicine, Rush University Medical Center, Chicago, Illinois;,Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Karen Lolans
- Department of Pathology, Rush University Medical Center, Chicago, Illinois
| | - Louis Fogg
- Department of Nursing, Rush University Medical Center, Chicago, Illinois
| | - Latania K. Logan
- Department of Pediatrics, Rush University Medical Center, Chicago, Illinois
| | - Stanford T. Shulman
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Illinois
| | - Robert A. Weinstein
- Department of Medicine, Cook County Health and Hospitals System, Chicago, Illinois;,Department of Medicine, Rush University Medical Center, Chicago, Illinois
| | - Michael Y. Lin
- Department of Medicine, Rush University Medical Center, Chicago, Illinois
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Karkaba A, Benschop J, Hill KE, Grinberg A. Characterisation of methicillin-resistant Staphylococcus aureus clinical isolates from animals in New Zealand, 2012-2013, and subclinical colonisation in dogs and cats in Auckland. N Z Vet J 2016; 65:78-83. [PMID: 27604152 DOI: 10.1080/00480169.2016.1222919] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIMS To characterise methicillin-resistant Staphylococcus aureus (MRSA) isolates from infection sites in animals in New Zealand and assess the prevalence of subclinical MRSA colonisation in dogs and cats attending veterinary clinics in Auckland. METHODS MRSA isolates from clinical specimens obtained by the main New Zealand veterinary diagnostic laboratories between June 2012 and June 2013, were genotypically characterised by DNA microarray hybridisation analysis and spa typing. In addition, nasal or perineal skin swabs collected from a cross-sectional sample of dogs (n=361) and cats (n=225) attending 29 veterinary clinics in Auckland during the same period were analysed for MRSA by culture. RESULTS Eight MRSA clinical isolates were submitted for characterisation by the participating laboratories. The isolates originated from five dogs, including two isolates from the same dog, one foal, and one isolate had no identification of the source. The strain-types identified were AK3 (ST-5 SCCmecIV t045; n=1), USA500 (ST8 SCCmecIV t064; n=1), WSPP (ST30 SCCmecIV t019; n=1), Rhine Hesse (ST5 SCCmecII t002; n=2), and EMRSA-15 (ST22 SCCmecIV t032; n=3). No MRSA were isolated from 586 cultured swabs. Methicillin-susceptible S. aureus were detected in 9/257 (3.5%) swabs and non-aureus staphylococci in 22/257 (8.5%) swabs. The estimated true MRSA subclinical colonisation prevalence was 0%, with an upper 95% CI boundary of 1.9% for cats and 1.4% for dogs. CONCLUSIONS The modest number of MRSA isolates submitted for this study by the participating laboratories suggests clinical MRSA infection in animals in New Zealand continues to be sporadic. The wide variety of strain-types found mirrored the evolving strain-type diversity observed in humans. We cannot rule out bias due to the non-random sampling of dogs and cats, but the apparent colonisation prevalence of 0% was consistent with the low prevalence of subclinical colonisation in humans in New Zealand. These similarities indicate the epidemiology of animal and human MRSA infections are linked. CLINICAL RELEVANCE In the last decade, the prevalence of human MRSA infections in New Zealand has steadily increased. This is the second published study of MRSA in animals in New Zealand. The results indicate clinical MRSA infection in animals remains sporadic, but the diversification of the strain-types may pose new therapeutic challenges to veterinarians, due to their diverse resistome.
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Affiliation(s)
- A Karkaba
- a Institute of Veterinary, Animal and Biomedical Sciences, Infectious Diseases Group , Massey University , Private Bag 11222, Palmerston North 4442 , New Zealand
| | - J Benschop
- b Institute of Veterinary, Animal and Biomedical Sciences, mEpiLab , Massey University , Private Bag 11222, Palmerston North 4442 , New Zealand
| | - K E Hill
- a Institute of Veterinary, Animal and Biomedical Sciences, Infectious Diseases Group , Massey University , Private Bag 11222, Palmerston North 4442 , New Zealand
| | - A Grinberg
- a Institute of Veterinary, Animal and Biomedical Sciences, Infectious Diseases Group , Massey University , Private Bag 11222, Palmerston North 4442 , New Zealand
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Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S108-32. [DOI: 10.1017/s0899823x00193882] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistantStaphylococcus aureus(MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Ultra-sensitive chemiluminescent detection of Staphylococcus aureus based on competitive binding of Staphylococcus protein A-modified magnetic beads to immunoglobulin G. Mikrochim Acta 2016. [DOI: 10.1007/s00604-016-1769-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ayeni FA, Gbarabon T, Andersen C, Norskov-Lauritsen N. Comparison of identification and antimicrobial resistance pattern of Staphylococcus aureus isolated from Amassoma, Bayelsa state, Nigeria. Afr Health Sci 2015; 15:1282-8. [PMID: 26958032 PMCID: PMC4765414 DOI: 10.4314/ahs.v15i4.30] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Staphylococcus aureus is often responsible for fatal infections and recent upsurge of resistant strains has resulted in therapeutic failure. The identification of this microorganism is a major challenge to medical microbiologists in developing countries. METHODS One hundred and eighty five isolates which had been previously isolated from the nares of 185 healthy college students' volunteers in Amassoma, Bayelsa State, South Nigeria were identified by MALDI TOF mass spectrometry, and PCR amplification of the spa gene. The identified isolates were compared with presumptive identities obtained by growth on MSA, tube coagulation and slide agglutination tests. Antimicrobial susceptibility testing of S. aureus isolates was performed by Kirby Bauer technique while MRSA was screened for by growth on chromlDTM MRSA plate and confirmed by PCR-amplification of mecA/mecC genes. RESULTS From the 185 staphylococci that grew with yellow colonies on MSA, 24 were positive in the slide coagulase test, while 17 were positive in the tube coagulase test; MALDI TOF mass spectrometry and PCR amplification of the spa gene showed excellent concordance with the tube test, as all tube coagulase-positive strains were identified as S. aureus, while tube coagulase-test negative isolates in all cases were designated as other staphylococcal species by MALDI-TOF mass spectrometry and were spa PCR test negative. All S. aureus isolates were susceptible to clindamycin, vancomycin, fusidic acid, rifampicin and linezolid, while observed resistance to penicillin and trimethoprim were high. Only one MRSA strain was detected. CONCLUSION The study confirms that the tube coagulase test is an accurate diagnostic method for identification of S. aureus, while growths on MSA and slide agglutination tests are inaccurate. We found a low prevalence of MRSA and a high rate of trimethroprim-resistance in the studied population.
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Affiliation(s)
- Funmilola Abidemi Ayeni
- University of Ibadan, Faculty of Pharmacy, Department of Pharmaceutical Microbiology. Ibadan, Nigeria
| | - Tombari Gbarabon
- Niger Delta University, Faculty of Pharmacy, Department of Pharmaceutical Microbiology, Amassoma, Nigeria
| | - Camilla Andersen
- Aarhus University Hospital, Department of Clinical Microbiology, Aarhus, Denmark
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Mehta MS, McClure J, Mangold K, Peterson LR. Performance of 3 real-time PCR assays for direct detection of Staphylococcus aureus and MRSA from clinical samples. Diagn Microbiol Infect Dis 2015; 83:211-5. [DOI: 10.1016/j.diagmicrobio.2014.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 05/18/2014] [Accepted: 06/10/2014] [Indexed: 11/16/2022]
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Zagólski O, Stręk P, Kasprowicz A, Białecka A. Effectiveness of Polyvalent Bacterial Lysate and Autovaccines Against Upper Respiratory Tract Bacterial Colonization by Potential Pathogens: A Randomized Study. Med Sci Monit 2015; 21:2997-3002. [PMID: 26434686 PMCID: PMC4599189 DOI: 10.12659/msm.893779] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Polyvalent bacterial lysate (PBL) is an oral immunostimulating vaccine consisting of bacterial standardized lysates obtained by lysis of different strains of bacteria. Autovaccines are individually prepared based on the results of smears obtained from the patient. Both types of vaccine can be used to treat an ongoing chronic infection. This study sought to determine which method is more effective against nasal colonization by potential respiratory tract pathogens. MATERIAL AND METHODS We enrolled 150 patients with aerobic Gram stain culture and count results indicating bacterial colonization of the nose and/or throat by potential pathogens. The participants were randomly assigned to each of the following groups: 1. administration of PBL, 2. administration of autovaccine, and 3. no intervention (controls). RESULTS Reduction of the bacterial count in Streptococcus pneumoniae-colonized participants was significant after the autovaccine (p<0.001) and PBL (p<0.01). Reduction of the bacterial count of other β-hemolytic streptococcal strains after treatment with the autovaccine was significant (p<0.01) and was non-significant after PBL. In Haemophilus influenzae colonization, significant reduction in the bacterial count was noted in the PBL group (p<0.01). Methicillin-resistant Staphylococcus aureus colonization did not respond to either treatment. CONCLUSIONS The autovaccine is more effective than PBL for reducing bacterial count of Streptococcus pneumoniae and β-hemolytic streptococci, while PBL was more effective against Haemophilus influenzae colonization.
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Affiliation(s)
- Olaf Zagólski
- Department of Otorhinolaryngology, St. John Grande's Hospital, Cracow, Poland
| | - Paweł Stręk
- Department of Otolaryngology, Jagiellonian University, Cracow, Poland
| | | | - Anna Białecka
- Centre of Microbiological Research and Autovaccines, Cracow, Poland
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Warrack S, Panjikar P, Duster M, Safdar N. Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation. Benef Microbes 2015; 5:389-95. [PMID: 25213147 DOI: 10.3920/bm2013.0062] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.
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Affiliation(s)
- S Warrack
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA
| | - P Panjikar
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA
| | - M Duster
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA
| | - N Safdar
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Section of Infectious Diseases, 1685 Highland Avenue, Madison, WI 53792, USA William S. Middleton Memorial Veterans Affairs Hospital, 2500 Overlook Terrace, Madison, WI 53705, USA
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van Vugt JLA, Coelen RJS, van Dam DW, Winkens B, Derikx JPM, Heddema ER, Stoot JHMB. Nasal carriage of Staphylococcus aureus among surgeons and surgical residents: a nationwide prevalence study. Surg Infect (Larchmt) 2015; 16:178-82. [PMID: 25826230 DOI: 10.1089/sur.2014.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Staphylococcus aureus nasal carriage is an independent risk factor for developing nosocomial infections and for developing surgical site infection (SSI) in particular. The number of post-operative nosocomial S. aureus infections can be reduced by screening patients and decolonizing nasal carriers. In addition to patients, health care workers may also be S. aureus nasal carriers. The aim of this study was to explore S. aureus nasal carriage rates among surgeons. METHODS Nasal swabs were collected from surgeons and surgical residents during a national surgical congress. The control group consisted of non-hospitalized patients. Staphylococcus aureus carriage was detected using selective chromogenic agars by use of a fully automated inoculator. Suspected colonies were identified further by positive catalase and slide coagulation reactions. RESULTS Samples were collected from 366 surgeons and surgical residents and 950 control patients. The S. aureus nasal carriage rate among surgeons and residents was significantly greater compared with the control group (45.4% versus 30.8%, odds ratio [OR] 1.86 [1.45-2.38], p<0.001). No significant difference in carriage rate was found between surgeons and residents (46.8% versus 43.3%, p=0.769) and years of experience as a surgeon was not associated with a greater carriage rate. Male gender was an independent risk factor for carriage among physicians odds ratio ([OR] 1.90 [95% confidence interval 1.19-3.01], p=0.007). CONCLUSIONS The nationwide rate of S. aureus nasal carriage among surgeons and surgical residents proved to be significantly greater compared with a non-hospitalized patient control group. Male gender is an independent risk factor for carriage among physicians. Future studies are needed to investigate the possible relation with nosocomial post-operative S. aureus infections.
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Affiliation(s)
- Jeroen L A van Vugt
- 1 Department of Surgery, Orbis Medical Center , Sittard-Geleen, The Netherlands
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Calfee DP, Salgado CD, Milstone AM, Harris AD, Kuhar DT, Moody J, Aureden K, Huang SS, Maragakis LL, Yokoe DS. Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35:772-96. [PMID: 24915205 DOI: 10.1086/676534] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Calfee DP, Salgado CD, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin H, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Marschall J, Mermel LA, Nicolle L, Pegues DA, Perl TM, Saint S, Weinstein RA, Wise R, Yokoe DS. Strategies to Prevent Transmission of Methicillin-ResistantStaphylococcus aureusin Acute Care Hospitals. Infect Control Hosp Epidemiol 2015; 29 Suppl 1:S62-80. [DOI: 10.1086/591061] [Citation(s) in RCA: 152] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). Our intent in this document is to highlight practical recommendations in a concise format to assist acute care hospitals in their efforts to prevent transmission of methicillin-resistantStaphylococcus aureus(MRSA). Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary, Introduction, and accompanying editorial for additional discussion.1. Burden of HAIs caused by MRSA in acute care facilitiesa. In the United States, the proportion of hospital-associatedS. aureusinfections that are caused by strains resistant to methicillin has steadily increased. In 2004, MRSA accounted for 63% ofS. aureusinfections in hospitals.b. Although the proportion ofS. aureus–associated HAIs among intensive care unit (ICU) patients that are due to methicillin-resistant strains has increased (a relative measure of the MRSA problem), recent data suggest that the incidence of central line–associated bloodstream infection caused by MRSA (an absolute measure of the problem) has decreased in several types of ICUs since 2001. Although these findings suggest that there has been some success in preventing nosocomial MRSA transmission and infection, many patient groups continue to be at risk for such transmission.c. MRSA has also been documented in other areas of the hospital and in other types of healthcare facilities, including those that provide long-term care.
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Wendt C, Schinke S, Württemberger M, Oberdorfer K, Bock-Hensley O, von Baum H. Value of Whole-Body Washing With Chlorhexidine for the Eradication of Methicillin-ResistantStaphylococcus aureus:A Randomized, Placebo-Controlled, Double-Blind Clinical Trial. Infect Control Hosp Epidemiol 2015; 28:1036-43. [DOI: 10.1086/519929] [Citation(s) in RCA: 97] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2006] [Accepted: 03/28/2007] [Indexed: 11/03/2022]
Abstract
Background.Whole-body washing with antiseptic solution has been widely used as part of eradication treatment for colonization with methicillin-resistantStaphylococcus aureus(MRSA), but evidence for the effectiveness of this measure is limited.Objective.To study the efficacy of whole-body washing with chlorhexidine for the control of MRSA.Design.Randomized, placebo-controlled, double-blinded clinical trial.Setting.University Hospital of Heidelberg and surrounding nursing homes.Patients.MRSA carriers who were not treated concurrently with antibiotics effective against MRSA were eligible for the study.Intervention.Five days of whole-body washing with either 4% chlorhexidine solution (treatment group) or with a placebo solution. All patients received mupirocin nasal ointment and chlorhexidine mouth rinse. The outcome was evaluated 3, 4, 5, 9, and 30 days after treatment with swab samples taken from several body sites.Results.Of 114 patients enrolled in the study (56 in the treatment group and 58 in the placebo group), 11 did not finish treatment (8 from the treatment group and 3 from the placebo group [P= .02]). At baseline, the groups did not differ with regard to age, sex, underlying condition, site of MRSA colonization, or history of MRSA eradication treatment. Eleven patients were MRSA-free 30 days after treatment (4 from the treatment group and 7 from the placebo group [P= .47]). Only groin-area colonization was significantly better eradicated by the use of chlorhexidine. The best predictor for total eradication was a low number of body sites positive for MRSA. Adverse effects were significantly more frequent in the treatment group than in the placebo group (any symptom, 71% vs 33%) but were reversible in most cases.Conclusion.Whole-body washing can reduce skin colonization, but it appears necessary to extend eradication measures to the gastrointestinal tract, wounds, and/or other colonized body sites if complete eradication is the goal.Trial Registration.ClinicalTrials.gov identifier: NCT00266448.
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O'Malley SM, Emele FE, Nwaokorie FO, Idika N, Umeizudike AK, Emeka-Nwabunnia I, Hanson BM, Nair R, Wardyn SE, Smith TC. Molecular typing of antibiotic-resistant Staphylococcus aureus in Nigeria. J Infect Public Health 2014; 8:187-93. [PMID: 25441090 DOI: 10.1016/j.jiph.2014.08.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Revised: 07/29/2014] [Accepted: 08/24/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Antibiotic-resistant Staphylococcus aureus including methicillin-resistant strains (MRSA) are a major concern in densely populated urban areas. Initial studies of S. aureus in Nigeria indicated existence of antibiotic-resistant S. aureus strains in clinical and community settings. METHODS 73 biological samples (40 throat, 23 nasal, 10 wound) were collected from patients and healthcare workers in three populations in Nigeria: Lagos University Teaching Hospital, Nigerian Institute of Medical Research, and Owerri General Hospital. RESULTS S. aureus was isolated from 38 of 73 samples (52%). Of the 38 S. aureus samples, 9 (24%) carried the Panton-Valentine leukocidin gene (PVL) while 16 (42%) possessed methicillin resistance genes (mecA). Antibiotic susceptibility profiles indicated resistance to several broad-spectrum antibiotics. CONCLUSION Antibiotic-resistant S. aureus isolates were recovered from clinical and community settings in Nigeria. Insight about S. aureus in Nigeria may be used to improve antibiotic prescription methods and minimize the spread of antibiotic-resistant organisms in highly populated urban communities similar to Lagos, Nigeria.
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Affiliation(s)
- S M O'Malley
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, United States
| | - F E Emele
- Department of Medical Microbiology, Nnamdi Azikiwe University, Nigeria
| | | | - N Idika
- Nigerian Institute of Medical Research, Nigeria
| | | | - I Emeka-Nwabunnia
- Department of Biotechnology, Federal University of Technology, Owerri, Nigeria
| | - B M Hanson
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, United States
| | - R Nair
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, United States
| | - S E Wardyn
- Center for Emerging Infectious Diseases, College of Public Health, University of Iowa, United States
| | - T C Smith
- Department of Biostatistics, Environmental Health Sciences, & Epidemiology, College of Public Health, Kent State University, United States.
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Salehzadeh A, Asadpour L, Naeemi AS, Houshmand E. Antimicrobial activity of methanolic extracts of Sambucus ebulus and Urtica dioica against clinical isolates of methicillin resistant Staphylococcus aureus. AFRICAN JOURNAL OF TRADITIONAL, COMPLEMENTARY, AND ALTERNATIVE MEDICINES : AJTCAM 2014; 11:38-40. [PMID: 25395702 PMCID: PMC4202515 DOI: 10.4314/ajtcam.v11i5.6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Increase in the emergence of drug -resistant pathogens led to the development of natural antimicrobials. In this study the antimicrobial effect of methanolic extracts of Sambucus ebulus and Urtica dioica on 16 skin and wound infections isolates of methicillin resistant S. aureus have been studied. MATERIAL AND METHODS Solvent extraction procedure was done using soxhlet apparatus for extracting antimicrobial agents from freeze dried plants. Antibacterial activity was measured using agar well diffusion method. RESULTS The MIC of Sambucus ebulus and Urtica dioica extracts against the standard strain of S. aureus ATCC 6538 were determined using the micro dilution method at 15 mg and 20 mg respectively. All the test bacteria were found sensitive to the Sambucus ebulus extract and only one isolate was resistant to Urtica dioica extract. CONCLUSION Extracts of Sambucus ebulus and Urtica dioica possess antibacterial potency against MRSA isolates and may be used as a natural antiseptics and antimicrobial agents in medicine.
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Affiliation(s)
- Ali Salehzadeh
- Department of Biology, Rasht Branch, Islamic Azad University, Rasht, Iran
| | - Leila Asadpour
- Department of Veterinary science, Rasht Branch, Islamic Azad University, Rasht, Iran
| | | | - Elham Houshmand
- Department of Veterinary science, Rasht Branch, Islamic Azad University, Rasht, Iran
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Champion AE, Goodwin TA, Brolinson PG, Werre SR, Prater MR, Inzana TJ. Prevalence and characterization of methicillin-resistant Staphylococcus aureus isolates from healthy university student athletes. Ann Clin Microbiol Antimicrob 2014; 13:33. [PMID: 25085442 PMCID: PMC4362218 DOI: 10.1186/s12941-014-0033-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 07/13/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) has been increasing in the general population, and there is concern that close or physical contact, such as in professional and collegiate sports, may increase spread of MRSA. We sought to determine the prevalence of MRSA colonization of male and female athletes from 9 different sports at a major, Division I University during a 12-week period, and determine the USA and SCCmec type from select isolates. METHODS Swabs for culture of MRSA were obtained from nasal, axillary, and inguinal sites from healthy, asymptomatic student athletes and support staff each week for 12 weeks. Select MRSA isolates were typed by pulsed field gel electrophoresis (PFGE), and the genes encoding for MecA, cassette chromosome recombinase (Ccr), and several toxins were determined by multiplex polymerase chain reaction (PCR). Discrepant results were clarified by multi-locus sequence typing (MLST) and spa typing. RESULTS Thirty-five percent (78/223) of test subjects were positive for MRSA during the study period, resulting in isolation of 139 MRSA isolates. However, 47% (37/78) of MRSA-positive participants carried MRSA in axillary or inguinal sites, but not in the anterior nares. There was significant correlation between MRSA carriage and participation in wrestling (76%, 19/25; adjusted odds ratio 29.7, 95% CI 5.8-151.5) and baseball (44%, 17/39; adjusted odds ratio 4.4, 95% CI 1.1- 17.4), compared with a staff prevalence of 18.1% (4/22), but other factors were not examined. Multiplex PCR analysis indicated that of the 32 isolates examined 26 could be typed, and all of these carried the SCCmec type IV cassette. PFGE typing identified USA types 300, 400, 500, 700, and 800. However, one isolate was not a known USA type, but was identified as a novel ST951 by MLST, and as spa type t216. Of the strains typed from the same individual, there was consistency, but also variation and alternation of the SCCmec and spa types isolated from individual subjects. Various staphylococcal toxin genes were identified in 31 of the 32 isolates analyzed. CONCLUSIONS Colonization by MRSA was greater in some student athletes than the average carriage rate for the general population, and only 53% of MRSA carriers were identified by nasal cultures. Carriage of MRSA clones on the same individual and transmission to contacts could vary over time, indicating colonization can be a dynamic process that may be difficult to control.
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Affiliation(s)
- Anna E Champion
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - Thomas A Goodwin
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - P Gunnar Brolinson
- Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Stephen R Werre
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA.
| | - M Renee Prater
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Edward Via Virginia College of Osteopathic Medicine, Blacksburg, VA, 24061, USA.
| | - Thomas J Inzana
- Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, VA, USA. .,Virginia Tech Carilion School of Medicine, Virginia Polytechnic Institute and State University, Life Sciences 1, 970 Washington St. SW, Blacksburg, VA, 24061, USA.
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Bryson DJ, Gulihar A, Aujla RS, Taylor GJS. The hip fracture best practice tariff: early surgery and the implications for MRSA screening and antibiotic prophylaxis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2014; 25:123-7. [DOI: 10.1007/s00590-014-1448-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/23/2014] [Indexed: 11/27/2022]
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Comparison of pulsed-gel electrophoresis and a commercial repetitive-element PCR method for assessment of methicillin-resistant Staphylococcus aureus clustering in different health care facilities. J Clin Microbiol 2014; 52:2027-32. [PMID: 24671801 DOI: 10.1128/jcm.03466-13] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Pulsed-field gel electrophoresis (PFGE) is a common method used to type methicillin-resistant Staphylococcus aureus (MRSA) in nosocomial investigations and epidemiological studies but is time-consuming and methodologically challenging. We compared typing results obtained using a commercial repetitive-element PCR (rep-PCR) system with PFGE in a sample of 86 unique MRSA isolates recovered from subjects in an academic referral hospital and two nursing homes in the same geographic region. Both methods reliably assigned isolates to the same Centers for Disease Control and Prevention (CDC) pulsotype. PFGE was significantly more discriminatory (Simpson's index of diversity, 0.92 at the 95% strain similarity threshold) than the commercial rep-PCR system (Simpson's index of diversity, 0.58). The global (adjusted Rand coefficient, 0.10) and directional congruence (adjusted Wallace coefficient(repPCR→PFGE) = 0.06; adjusted Wallace coefficient(PFGE → repPCR) = 0.52) between the two methods was low. MRSA strains recovered from study nursing homes that were clonal when typed by the commercial rep-PCR method were frequently noted to be genetically distinct when typed using PFGE. These data suggest that the commercial rep-PCR has less utility than PFGE in small-scale epidemiological assessments of MRSA in health care settings.
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Warrack S, Panjikar P, Duster M, Safdar N. Tolerability of a probiotic in subjects with a history of methicillin-resistant <i>Staphylococcus aureus</i> colonisation. Benef Microbes 2014. [DOI: 10.3920/bm2013-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Nadimpalli M, Heaney C, Stewart JR. Identification of Staphylococcus aureus from enriched nasal swabs within 24 h is improved with use of multiple culture media. J Med Microbiol 2013; 62:1365-1367. [PMID: 23764742 DOI: 10.1099/jmm.0.058248-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Nasal carriage of Staphylococcus aureus is commonly evaluated via culture-based methods. We found that parallel use of two media, Baird-Parker and CHROMagar™ Staph aureus, increased detection of S. aureus from a healthy population by 29 %. We suggest use of both media for optimal identification of S. aureus from healthy cohorts.
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Affiliation(s)
- Maya Nadimpalli
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1301 Michael Hooker Research Center, 135 Dauer Drive, CB 7431, Chapel Hill, NC 27599, USA
| | - Christopher Heaney
- Departments of Environmental Health Sciences and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Room W7033B, 615 N. Wolfe St, Baltimore, MD 21205, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 1301 Michael Hooker Research Center, 135 Dauer Drive, CB 7431, Chapel Hill, NC 27599, USA
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Lepelletier D, Lucet JC. Controlling meticillin-susceptible Staphylococcus aureus: not simply meticillin-resistant S. aureus revisited. J Hosp Infect 2013; 84:13-21. [DOI: 10.1016/j.jhin.2013.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 01/07/2013] [Indexed: 10/27/2022]
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Huh HJ, Kim ES, Chae SL. Methicillin-resistant Staphylococcus aureus in nasal surveillance swabs at an intensive care unit: an evaluation of the LightCycler MRSA advanced test. Ann Lab Med 2012; 32:407-12. [PMID: 23130339 PMCID: PMC3486934 DOI: 10.3343/alm.2012.32.6.407] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/23/2012] [Accepted: 09/19/2012] [Indexed: 12/04/2022] Open
Abstract
Background We compared the LightCycler MRSA advanced test (Roche Diagnostics, Germany) with enrichment culture methods to evaluate the relative diagnostic performance of the LightCycler MRSA advanced test for active surveillance in a high-prevalence setting. Methods A total of 342 nasal swab specimens were obtained from patients in the intensive care unit at admission and on the seventh day for follow-up. The results of LightCycler MRSA advanced test were compared to those of the enrichment culture. For discrepant results, mecA gene PCR was performed. Results For the detection of methicillin-resistant Staphylococcus aureus (MRSA), the LightCycler MRSA advanced test showed 98.5% sensitivity and 78.6% specificity and had positive and negative predictive values of 75.0% and 98.8%, respectively. A total of 46 samples had discrepant results between the LightCycler MRSA advanced test and enrichment culture. Of the 44 specimens that were positive in the LightCycler MRSA advanced test but negative by enrichment culture, mecA genes were detected in 37 specimens. In addition, of the original 44 cases, 21 patients had a history of MRSA colonization or infection within the last month; of those 21 specimens, 20 were positive for mecA gene as shown by PCR. Seven mecA-negative discrepant specimens comprised 3 methicillin-sensitive S. aureus-culture positive and only 2 patients had MRSA infections. Conclusions Despite its low specificity and positive predictive value, the LightCycler MRSA advanced test could serve as a rapid test for patients colonized with MRSA.
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Affiliation(s)
- Hee Jin Huh
- Department of Laboratory Medicine, Dongguk University Ilsan Hospital, Goyang, Korea
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Arcenas RC, Spadoni S, Mohammad A, Kiechle FL, Walker K, Fader RC, Perdreau-Remington F, Osiecki J, Liesenfeld O, Hendrickson S, Rao A. Multicenter evaluation of the LightCycler MRSA advanced test, the Xpert MRSA Assay, and MRSASelect directly plated culture with simulated workflow comparison for the detection of methicillin-resistant Staphylococcus aureus in nasal swabs. J Mol Diagn 2012; 14:367-75. [PMID: 22584139 DOI: 10.1016/j.jmoldx.2012.01.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 01/26/2012] [Accepted: 01/30/2012] [Indexed: 10/28/2022] Open
Abstract
Rapid detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) followed by appropriate infection control procedures reduces MRSA infection and transmission. We compared the performance and workflow of two Food and Drug Administration-approved nucleic acid amplification assays, the LightCycler MRSA Advanced Test and the Xpert MRSA test, with those of directly plated culture (MRSASelect) using 1202 nasal swabs collected at three U.S. sites. The sensitivity of the LightCycler test (95.2%; 95% CI, 89.1% to 98.4%) and Xpert assay (99%; 95% CI, 94.8% to 100%) did not differ compared with that of culture; the specificity of the two assays was identical (95.5%; 95% CI, 94.1% to 96.7%) compared with culture. However, sequencing performed on 71 samples with discordant results among the three methods confirmed the presence of MRSA in 40% of samples that were positive by both molecular methods but negative by culture. Workflow analysis from all sites including batch runs revealed average hands-on sample preparation times of 1.40, 2.35, and 1.44 minutes per sample for the LightCycler, Xpert, and MRSASelect methods, respectively. Discrete event simulation analysis of workflow efficiencies revealed that the LightCycler test used less hands-on time for the assay when greater than eight batched samples were run. The high sensitivity and specificity, low hands-on time, and efficiency gains using batching capabilities make the LightCycler test suitable for rapid batch screening of MRSA colonization.
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Affiliation(s)
- Rodney C Arcenas
- Department of Pathology, Memorial Regional Hospital South, Hollywood, Florida, USA
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Tübbicke A, Hübner C, Kramer A, Hübner NO, Fleßa S. Transmission rates, screening methods and costs of MRSA--a systematic literature review related to the prevalence in Germany. Eur J Clin Microbiol Infect Dis 2012; 31:2497-511. [PMID: 22573360 DOI: 10.1007/s10096-012-1632-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2012] [Accepted: 04/12/2012] [Indexed: 11/30/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infections represent a serious challenge for health care institutions, which is inherent in the combination of prevalence, transmission rates and costs. Furthermore, performing an MRSA screening requires information on the complex system of effectiveness, accuracy and costs of different screening methods. The purpose of this study was to give an overview of parameters with decisive significance for the burden of MRSA and the selection of a specific MRSA screening strategy. A systematic literature search for peer-reviewed health economic studies associated with MRSA was performed (from 1995 to the present). Eighty-seven different studies met all inclusion and exclusion criteria. Primary outcomes included the prevalence of MRSA, MRSA transmission rates, performance characteristics of MRSA screening methods, costs for pre-emptive isolation precautions and costs per MRSA case. The prevalence rates reported for all inpatients (1.2-5.3 %) as well as for inpatients with risk factors or patients in risk areas (3.85-20.6 %) vary greatly. The range of cross-transmission rates per day reported for patients with MRSA in isolation is 0.00081-0.009 and for carriers not in isolation is 0.00137-0.140, respectively. For polymerase chain reaction (PCR) methods, the mean sensitivity and specificity were 91.09 and 95.79 %, respectively. Culture methods show an average sensitivity of 89.01 % and an average specificity of 93.21 %. The turn-around time for PCR methods averages 15 h, while for the culture method, it can only be estimated as 48-72 h. This review filtered important parameters and cost drivers, and covered them with literature-based averages. These findings serve as an ideal evidence base for further health economic considerations of the cost-effectiveness of different MRSA screening methods.
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Affiliation(s)
- A Tübbicke
- Institute of Health Care Management, Department of Law and Economics, University of Greifswald, Friedrich-Loeffler-Str. 70, 17489 Greifswald, Germany
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Colombo C, Senn G, Bürgel A, Ruef C. Clearance of an epidemic clone of methicillin-resistant Staphylococcus aureus in a drug-use network: a follow-up study in Switzerland. ACTA ACUST UNITED AC 2012; 44:650-5. [PMID: 22497490 DOI: 10.3109/00365548.2012.672766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND A single clone of methicillin-resistant Staphylococcus aureus (MRSA) was observed in a drug-use network starting in 1994, and was found to persist throughout 2001, with up to 19% MRSA colonization of intravenous drug users (IDUs). Recent clinical observations have shown low prevalences of this endemic drug clone among MRSA isolates. The goal of this study was to assess the evolution of MRSA carriage among IDUs. METHODS The survey took place from November 2008 to September 2009. Ten drug dispensary facilities took part. Demographic and clinical data including sex, history of MRSA, past hospitalization, use of antibiotics, and presence of wounds were collected. Screening of the nares, throat, and wounds was done. RESULTS Five hundred and fourteen swab specimens were obtained; 497 of them were nose/throat samples and 17 were wound swabs. MRSA was identified in 5 samples (1%). Four MRSA were found in nose/throat samples and 1 in a wound swab. Pulsed-field gel electrophoresis typing of the MRSA isolates revealed 2 different common endemic types: 4 were identified as the Zurich IDU clone and 1 as the Grison clone. CONCLUSIONS The study shows a significant decline of MRSA colonization among IDUs. The underlying causes for this decline could not be determined fully, but we hypothesize a bundle of interventions as contributing: enhanced medical care, better wound management, isolation management, teaching IDUs basic hygiene techniques, and the national 'Four Pillars' policy. Hospital epidemiological policies such as pre-emptive isolation, length of isolation time, and screening procedures were adapted accordingly.
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Affiliation(s)
- Carlo Colombo
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland.
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Wahl K, Adams SB, Moore GE. Contamination of joints with tissue debris and hair after arthrocentesis: the effect of needle insertion angle, spinal needle gauge, and insertion of spinal needles with and without a stylet. Vet Surg 2012; 41:391-8. [PMID: 22380793 DOI: 10.1111/j.1532-950x.2011.00969.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess fetlock joint contamination with tissue debris and hair after arthrocentesis. STUDY DESIGN Experimental. ANIMALS Fetlock joint tissues (n = 10 horses). METHODS Soft tissue flaps including the joint capsule were dissected from the dorsal fetlock joints of 7 anesthetized horses leaving an intact proximal base. Needles inserted through the tissue flaps were flushed into tissue cell culture plates and examined for debris. Studies were repeated on excised fetlock tissue preparations after being stored for 5 days. Variables included gauge and type of needle, insertion of spinal needles with and without a stylet, angle of insertion, length of hair, and ante- and postmortem needle insertion. Tissue fragments collected from 3 horses were cultured for bacteria. RESULTS Compared to 20 g disposable needles inserted perpendicularly through unclipped skin, the odds ratios (ORs) for hair contamination were significantly greater for 20 g spinal needles without a stylet, and significantly less for 22 g spinal needles inserted with a stylet and for angled insertion of disposable needles. Tissue contamination OR was significantly less for 20 g spinal needles inserted without a stylet, angled insertion, and clipped hair. Bacteria were isolated from 2.6% of tissue fragments. CONCLUSIONS Angled needle insertion reduces joint contamination with tissue and hair. Spinal needles should be inserted with a stylet in place and 22 g spinal needles are preferable to 20 g spinal needles. Joints may be contaminated with bacteria after routine surgical preparation of skin.
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Affiliation(s)
- Kevin Wahl
- Veterinary Clinical Sciences, School of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA
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Ghebremedhin B, König B, König W. BD GeneOhm-MRSA assay for detection of methicillin-resistant Staphylococcus aureus directly in nasal and non-nasal swab specimens from haematologic patients. Eur J Microbiol Immunol (Bp) 2011; 1:297-301. [PMID: 24516736 DOI: 10.1556/eujmi.1.2011.4.5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Accepted: 09/27/2011] [Indexed: 11/19/2022] Open
Abstract
Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are responsible for rising health care costs and have a high attribution to mortality. Reliable and rapid detection of MRSA carriage is essential. Real-time PCR allows an early detection of MRSA colonization within 2 h. By using the BD GeneOhm-MRSA assay we analysed directly swabs of different sampling sites and compared the assay with culture method. One thousand one hundred and sixty samples from 129 patients in Magdeburg were examined. Of the samples, 8 (0.69%) or 1117 (96.3%) were tested equally positive or negative by both methods whereas 16 (1.38%) specimens were MRSA positive only by the GeneOhm-MRSA assay and 6 (0.52%) were MRSA positive only by culture method. Thirteen samples (1.12%), which are culture negative, were unresolved by the GeneOhm-MRSA. With regard to the patients, seven were detected as MRSA carriers only by the GeneOhm-MRSA while one patient was tested positive for MRSA only by culture. Assuming 100% correct results by the culture method, sensitivity and specificity of GeneOhm-MRSA assay could be calculated as 84.4% and 96.1% for nasal swabs, 78.7% and 96.9% for all swabs under study, and 94.8% and 99.5% when focussed on patients. PPV and NPV were 70.3% and 98% for all specimens together, respectively. BD GeneOhm-MRSA assay is a sensitive test for the detection of MRSA colonization from swab specimens without the need for an initial culture, but should always be performed in parallel to the culture method for comparison reasons. Furthermore, our results indicate that in addition swabs taken from different body sites were successfully analysed by the BD GeneOhm-MRSA assay. However, we conclude that the PCR assay might not be a preferred tool for screening in haematologic patients with low MRSA rate; for screening haematologic patients, the culture method is sufficient enough.
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Affiliation(s)
- B Ghebremedhin
- Otto-von-Guericke-University Clinic, Clinical Microbiology Magdeburg Germany
| | - B König
- Otto-von-Guericke-University Clinic, Clinical Microbiology Magdeburg Germany
| | - W König
- Otto-von-Guericke-University Clinic, Clinical Microbiology Magdeburg Germany
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Evaluation of the BD GeneOhm MRSA and VanR Assays as a Rapid Screening Tool for Detection of Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococci in a Tertiary Hospital in Saudi Arabia. Int J Microbiol 2011; 2011:861514. [PMID: 22187558 PMCID: PMC3236454 DOI: 10.1155/2011/861514] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2011] [Accepted: 10/17/2011] [Indexed: 12/01/2022] Open
Abstract
Objectives. The aim of this study was to evaluate the diagnostic performance of BD GeneOhm VanR Assay, a rapid PCR test that detects the presence of vanA and/or vanB genes and the performance of BDGeneOhm MRSA Assay which detects the staphylococcal cassette chromosomemec (SCCmec cassette) carrying the mecA gene and Staphylococcus aureus specific sequence located within the orfX gene. Methods. 300 duplicate rectal swabs collected consecutively were analyzed for the presence of VRE by culture and BD PCR. 2267 duplicate swabs were collected (728 nasal and 1539 groin swabs) and analyzed for the presence of MRSA by culture method and BD PCR. Results. Compared to culture, the BD GeneOhm VanR Assay showed a sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 100%, 91.1%, 23.5%, and 100%, respectively. The BD GeneOhm MRSA Assay revealed sensitivity, specificity, PPV, and NPV of 97.2%, 99.4%, 89.7%, and 99.9%, respectively, for nasal swabs. For groin swabs, it was 100%, 98.7%, 61.5% and 100%, respectively. Conclusion. The BD GeneOhm vanR Assay is a good screening test for rapid exclusion of VRE carriers in hospitals. The BD GeneOhm MRSA Assay represents a reliable screening test. The true strength of the BD GeneOhm Assay for MRSA and VRE is its exceptionally high NPV making the test an ideal tool for rapid exclusion of MRSA and VRE carriers in hospitals. As a consequence, this would dramatically shorten the patient isolation time.
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Risk factors for household transmission of community-associated methicillin-resistant Staphylococcus aureus. Pediatr Infect Dis J 2011; 30:927-32. [PMID: 21617572 DOI: 10.1097/inf.0b013e31822256c3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a community pathogen. Community-associated (CA) MRSA infections have occurred among multiple members of a household. We describe the incidence of and risk factors for MRSA colonization among household contacts of children with CA-MRSA infections. METHODS MRSA-infected children <18 years of age who lacked established healthcare-associated MRSA risk factors were identified through surveillance at 12 Minnesota hospital laboratories. Nasal swab specimens and information on medical history and hygiene behaviors were collected from case-patients and enrolled household contacts during home visits. S. aureus isolates obtained from nasal cultures were screened for oxacillin resistance. RESULTS In all, 236 households consisting of 236 case-patients and 712 household contacts were enrolled. Home visits were conducted on an average of 69 days after the onset of symptom in case-patients (range: 16-178 days). Twenty-nine (13%) case-patients and 82 (12%) household contacts had MRSA nasal colonization. Nasal MRSA colonization in ≥ 1 household contact occurred in 58 (25%) households. Household contacts who assisted the case-patient to bathe or who shared balms/ointments/lotion with the case-patient were more likely to be colonized (P < 0.01, P < 0.05), whereas those who reported using antibacterial versus nonantibacterial soap for hand washing were less likely to be colonized (P < 0.05) with MRSA clonally related to the case-patient infection isolate. CONCLUSIONS Only 13% of case-patients had MRSA nasal colonization on an average of 69 days after their initial MRSA infection. CA-MRSA colonization may be short-lived or may occur at non-nasal sites. One quarter of households had at least one household contact colonized with MRSA. Modifiable behaviors, such as sharing personal items, may contribute to transmission.
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Evaluation of the impact of direct plating, broth enrichment, and specimen source on recovery and diversity of methicillin-resistant Staphylococcus aureus isolates among HIV-infected outpatients. J Clin Microbiol 2011; 49:4126-30. [PMID: 21998435 DOI: 10.1128/jcm.05323-11] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swab specimens of 600 HIV-infected outpatients by selective and nonselective direct plating and broth enrichment. Swabs were collected at baseline, 6-month, and 12-month visits and cultured by direct plating to mannitol salt agar (MSA) and CHROMagar MRSA (CM) and overnight broth enrichment with subculture to MSA (broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the Panton-Valentine leukocidin. At each visit, 13 to 15% of patients were colonized with MRSA and 30 to 33% were colonized with methicillin-susceptible S. aureus (MSSA). Broth, CM, and MSA detected 95%, 82%, and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from broth than CM (P ≤ 0.001) or MSA (P ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly when using broth than when using MSA (P ≤ 0.001). Among specimens collected from the groin, broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (P ≤ 0.001) and MSA (P ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal swab specimen culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (P = 0.05).
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Robotham JV, Graves N, Cookson BD, Barnett AG, Wilson JA, Edgeworth JD, Batra R, Cuthbertson BH, Cooper BS. Screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus in intensive care units: cost effectiveness evaluation. BMJ 2011; 343:d5694. [PMID: 21980062 PMCID: PMC3188660 DOI: 10.1136/bmj.d5694] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess the cost effectiveness of screening, isolation, and decolonisation strategies in the control of meticillin resistant Staphylococcus aureus (MRSA) in intensive care units. DESIGN Economic evaluation based on a dynamic transmission model. SETTING England and Wales. Population Theoretical population of patients on an intensive care unit. MAIN OUTCOME MEASURES Infections, deaths, costs, quality adjusted life years (QALYs), incremental cost effectiveness ratios for alternative strategies, and net monetary benefits. RESULTS All decolonisation strategies improved health outcomes and reduced costs. Although universal decolonisation (regardless of MRSA status) was the most cost effective in the short term, strategies using screening to target MRSA carriers may be preferred owing to the reduced risk of selecting for resistance. Among such targeted strategies, universal admission and weekly screening with polymerase chain reaction coupled with decolonisation using nasal mupirocin was the most cost effective. This finding was robust to the size of intensive care units, prevalence of MRSA on admission, proportion of patients classified as high risk, and precise value of willingness to pay for health benefits. All strategies using isolation but not decolonisation improved health outcomes but costs were increased. When the prevalence of MRSA on admission to the intensive care unit was 5% and the willingness to pay per QALY gained was between £20,000 (€23,000; $32,000) and £30,000, the best such strategy was to isolate only those patients at high risk of carrying MRSA (either pre-emptively or after identification by admission and weekly screening for MRSA using chromogenic agar). Universal admission and weekly screening using polymerase chain reaction based detection of MRSA coupled with isolation was unlikely to be cost effective unless prevalence was high (10% of patients colonised with MRSA on admission). CONCLUSIONS MRSA control strategies that use decolonisation are likely to be cost saving in an intensive care unit setting provided resistance is lacking, and combining universal screening using polymerase chain reaction with decolonisation is likely to represent good value for money if untargeted decolonisation is considered unacceptable. In intensive care units where decolonisation is not implemented, evidence is insufficient to support universal screening for MRSA outside high prevalence settings.
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Affiliation(s)
- Julie V Robotham
- Modelling and Economics, Health Protection Agency, London NW9 5EQ, UK.
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Gingrich EN, Kurt T, Hyatt DR, Lappin MR, Ruch-Gallie R. Prevalence of methicillin-resistant staphylococci in northern Colorado shelter animals. J Vet Diagn Invest 2011; 23:947-50. [PMID: 21908352 DOI: 10.1177/1040638711407301] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus pseudintermedius (MRSP) have been recognized as significant pathogens in veterinary medicine. There have been documented cases of MRSA infection and colonization in veterinary critical care units, in veterinary personnel, and in equine and feline patients. To date, there have been no studies examining the prevalence of MRSA or MRSP colonization of cats and dogs in animal shelters in the United States. The purpose of the current study was to determine the prevalence of MRSA and MRSP in cats and dogs in a northern Colorado animal shelter. Samples were collected from 200 cats and 200 dogs in an open admission shelter. Each species was divided into 2 smaller groups: 100 dogs or cats housed in the stray ward and 100 dogs or cats housed in the adoption area. Samples were evaluated for the prevalence of MRSA or MRSP, which was verified through aerobic culture and Kirby-Bauer agar disc diffusion to confirm antimicrobial sensitivity. Results revealed MRSA in 0.5% of cat samples, MRSA in 0.5% of dog samples, and MRSP in 3% of dog samples. These results are consistent with previously published prevalence rates for these 2 organisms in non-shelter populations of dogs and cats, indicating that cats and dogs from this Colorado shelter do not appear to pose any greater risk to the public than do cats and dogs in the general pet population.
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Affiliation(s)
- Elise N Gingrich
- Colorado State University, College of Veterinary Medicine and Biomedical Sciences, Fort Collins, CO, USA
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