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One Health in hospitals: how understanding the dynamics of people, animals, and the hospital built-environment can be used to better inform interventions for antimicrobial-resistant gram-positive infections. Antimicrob Resist Infect Control 2020; 9:78. [PMID: 32487220 PMCID: PMC7268532 DOI: 10.1186/s13756-020-00737-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/11/2020] [Indexed: 12/19/2022] Open
Abstract
Despite improvements in hospital infection prevention and control, healthcare associated infections (HAIs) remain a challenge with significant patient morbidity, mortality, and cost for the healthcare system. In this review, we use a One Health framework (human, animal, and environmental health) to explain the epidemiology, demonstrate key knowledge gaps in infection prevention policy, and explore improvements to control Gram-positive pathogens in the healthcare environment. We discuss patient and healthcare worker interactions with the hospital environment that can lead to transmission of the most common Gram-positive hospital pathogens – methicillin-resistant Staphylococcus aureus, Clostridioides (Clostridium) difficile, and vancomycin-resistant Enterococcus – and detail interventions that target these two One Health domains. We discuss the role of animals in the healthcare settings, knowledge gaps regarding their role in pathogen transmission, and the absence of infection risk mitigation strategies targeting animals. We advocate for novel infection prevention and control programs, founded on the pillars of One Health, to reduce Gram-positive hospital-associated pathogen transmission.
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George K, Abdulkader JK, Sugumar M, Rajagopal GK. Prevalence of MRSA Nasal Carriage in Patients Admitted to a Tertiary Care Hospital in Southern India. J Clin Diagn Res 2016; 10:DC11-3. [PMID: 27042461 PMCID: PMC4800526 DOI: 10.7860/jcdr/2016/18259.7262] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 01/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Infections with MRSA, both community and hospital acquired, are well established and the source of infection is often a carrier. There are very few studies showing the magnitude of MRSA nasal colonization among healthy persons from the community. This study was conducted to detect the prevalence of MRSA nasal carriage in patients who did not have any known risk factors associated with HA- MRSA colonization, admitted to a tertiary care centre in Kerala. MATERIALS AND METHODS Nasal swabs were collected from patients within 24 hours of admission. Specimen were inoculated on chromogenic agar (HiCrome MeReSa agar-HiMedia) for MRSA screening. Isolates were then subjected to antibiotic sensitivity tests, SCCmec typing and PVL gene detection. RESULTS Out of 683 patients, 16 carried MRSA in their nares (2.3%). Of the 16 strains 13 (81.25 %) strain were SCCmec type III and one belonged to SCCmec type IV (6.25 %). Two strains failed to amplify SCCmec genes. Three strains carried genes for PVL toxin (18.75%). CONCLUSION With a better understanding of the complex epidemiology of MRSA it is increasingly apparent that demarcations between the HA and CA phenotypes are not as clear cut as previously thought. In this study of nasal carriage of MRSA in the community we have demonstrated prevalence consistent with published data. Most isolates however were shown to belong to the type conventionally assigned to HA-MRSA.
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Affiliation(s)
- Kalpana George
- Assistant Professor, Department of Microbiology, Government Medical College, Kozhikode, Kerala, India
| | | | - Madhan Sugumar
- Research Fellow, Department of Microbiology, JIPMER, Puducherry, India
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Schinasi L, Wing S, Augustino KL, Ramsey KM, Nobles DL, Richardson DB, Price LB, Aziz M, MacDonald PDM, Stewart JR. A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region. Environ Health 2014; 13:54. [PMID: 24958086 PMCID: PMC4083368 DOI: 10.1186/1476-069x-13-54] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 06/10/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND Distinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina. METHODS MRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types. RESULTS From July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5. CONCLUSIONS Absence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry.
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Affiliation(s)
- Leah Schinasi
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steve Wing
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kerri L Augustino
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Keith M Ramsey
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - Delores L Nobles
- Department of Infection Control, Vidant Medical Center, Greenville, NC, USA
- Division of Infectious Diseases, The Brody School of Medicine at East Carolina University, Greenville, NC, USA
| | - David B Richardson
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lance B Price
- Division of Pathogen Genomics, The Translational Genomics Research Institute, Flagstaff, Arizona, USA
- Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA
| | - Maliha Aziz
- Division of Pathogen Genomics, The Translational Genomics Research Institute, Flagstaff, Arizona, USA
- Department of Occupational and Environmental Health, George Washington University, Washington, DC, USA
| | - Pia DM MacDonald
- Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Social & Scientific Systems, Inc., Durham, NC, USA
| | - Jill R Stewart
- Department of Environmental Sciences and Engineering, The University of NC at Chapel Hill, Chapel Hill, NC, USA
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