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Kobayashi T, Ai C, Jung M, Salinas JL, Yu KC. Trends and outcomes in community-onset and hospital-onset Staphylococcus bacteremia among hospitals in the United States from 2015 to 2020. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e136. [PMID: 39290620 PMCID: PMC11406565 DOI: 10.1017/ash.2024.402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 09/19/2024]
Abstract
Background We investigated trends in Staphylococcus aureus (staph) bacteremia incidence stratified by methicillin susceptibility (methicillin-susceptible S. aureus [MSSA] vs. methicillin-resistant S. aureus [MRSA]) and onset designation (community-onset [CO] vs. hospital-onset [HO]). Methods We evaluated the microbiological data among adult patients who were admitted to 267 acute-care hospitals during October 1, 2015, to February 28, 2020. Using a subset of data from 41 acute-care hospitals, we conducted a retrospective cohort study to assess patient demographics, characteristics, mortality, length of stay, and costs. We also conducted a case-control study between those with and without staph bacteremia. Results The incidence of MSSA bacteremia significantly increased from 2.43 per 1,000 admissions to 2.87 per 1,000 admissions (estimate=0.0047, P-value=.0006). The incidence of MRSA significantly increased from 2.11 per 1,000 admissions to 2.42 per 1,000 admissions (estimate=0.0126, P-value <.0001). While the incidence of CO MSSA and CO MRSA demonstrated a significant increase (p=0.0023, and p < 0.0001), the incidence of HO MSSA and HO MRSA did not significantly change (p=0.2795 and p < 0.4464). Compared to those without staph bacteremia, mortality, length of stay, and total cost were significantly higher in those with staph bacteremia, regardless of methicillin susceptibility or onset designation. Conclusion The increasing incidence of CO MSSA and MRSA bacteremia might suggest the necessity for dedicated infection control measures and interventions for community members colonized with or at risk of acquiring Staphylococcus aureus.
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Affiliation(s)
| | - ChinEn Ai
- Medical & Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Molly Jung
- Medical & Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, NJ, USA
| | - Jorge L Salinas
- Division of Infectious Diseases, Department of Internal Medicine, Stanford University, Stanford, CA, USA
| | - Kalvin C Yu
- Medical & Scientific Affairs, Becton, Dickinson and Company, Franklin Lakes, NJ, USA
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2
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Walker MK, Kadri SS. Antibiotic resistance incidence or proportions: where does the greatest burden lie? THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00485-7. [PMID: 39151439 DOI: 10.1016/s1473-3099(24)00485-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2024] [Accepted: 07/16/2024] [Indexed: 08/19/2024]
Affiliation(s)
- Morgan K Walker
- Critical care Medicine Department, NIH Clinical Center, Bethesda, MD 20892, USA
| | - Sameer S Kadri
- Critical care Medicine Department, NIH Clinical Center, Bethesda, MD 20892, USA.
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Pham TM, Zhang Y, Nevers M, Li H, Khader K, Grad YH, Lipsitch M, Samore M. Trends in infection incidence and antimicrobial resistance in the US Veterans Affairs Healthcare System: a nationwide retrospective cohort study (2007-22). THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(24)00416-X. [PMID: 39151443 DOI: 10.1016/s1473-3099(24)00416-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 06/12/2024] [Accepted: 06/18/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Antimicrobial resistance poses a major threat to public health. There are few comprehensive nationwide studies that quantify long-term trends in infection incidence and antimicrobial resistance for multiple pathogens. We aimed to analyse trends in inpatient infection incidence and antimicrobial resistance for nine pathogens over the past 15 years across the USA. METHODS In this US nationwide retrospective cohort study, we analysed clinical microbiology data from electronic health records from all patients admitted to all 138 Veterans Affairs (VA) Medical Centers with acute care wards across the USA from Feb 1, 2007, to March 31, 2022. We quantified inpatient antibiotic use as days of therapy (DOT) per 1000 patient-days and antimicrobial resistance by resistance proportion (proportion of incident isolates identified as resistant) and phenotypic incidence (incidence of infections per 1000 admissions classified as resistant, susceptible, or missing). To analyse trends before the COVID-19 pandemic and during the COVID-19 pandemic, we used generalised estimating equation models and reported average annual percentage changes (AAPC). FINDINGS We collected 991 527 30-day incident isolates from 507 760 patients in 138 VA Medical Centers and 50 states in the USA. Between Feb 1, 2007, and Dec 31, 2019, infection incidence and antimicrobial resistance declined for many pathogens and pathogen-drug combinations. The proportion of methicillin resistance in Staphylococcus aureus decreased from 57·7% (11 876 of 20 584 incident isolates) to 44·6% (5916 of 13 257) over these 13 years (AAPC -1·8%; 95% CI -2·4 to -1·2; p<0·0001), and vancomycin-resistant Enterococcus faecium infections decreased from 77·8% (2555 of 3285) to 65·1% (893 of 1371; AAPC -1·2%; 95% CI -2·5 to 0·0; p=0·052). Fluoroquinolone resistance declined in both proportion and incidence for most pathogens. These trends correlated with substantial reductions in fluoroquinolone use, from 125 DOT per 1000 patient-days to 20 DOT per 1000 patient-days. Third generation cephalosporin resistance increased steeply in Escherichia coli infections from 6·7% (942 of 14 042) in 2007 to 15·3% (2153 of 14 053) in 2019 (AAPC 8·5%; 95% CI 6·2 to 10·7; p<0·0001). Carbapenem resistance proportion increased in Enterobacter cloacae infections from 1·1% (30 of 2852) in 2007 to 7·3% (212 of 2919) in 2019 (AAPC 19·8%; 95% CI 13·7 to 26·2; p<0·0001), but remained low for Klebsiella pneumoniae and E coli. During the COVID-19 pandemic between Jan 1, 2020, and March 31, 2022, several pathogen-drug combinations increased in both incidence and resistance for hospital-associated infections. For some pathogen-drug combinations, trends in incidence of resistant and susceptible infections were divergent, whereas for other combinations, these trends were in the same direction. INTERPRETATION Significant reductions in methicillin resistance in S aureus, vancomycin-resistant E faecium, and fluoroquinolone resistance across multiple pathogens suggest that control efforts have had an effect on resistance. The rise in extended-spectrum β-lactamases-producing Enterobacterales and recent surge in hospital-associated infections emphasise the need for ongoing surveillance and interventions. Our study highlights how coupling the analysis of phenotypic incidence with resistance proportion can enhance interpretation of antimicrobial resistance data. FUNDING US Centers for Disease Control and Prevention.
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Affiliation(s)
- Thi Mui Pham
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA; Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA.
| | - Yue Zhang
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - McKenna Nevers
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA; IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
| | - Haojia Li
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Karim Khader
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA; IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
| | - Yonatan H Grad
- Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, Boston, MA, USA; Department of Immunology and Infectious Diseases, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Marc Lipsitch
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, MA, USA; Center for Communicable Disease Dynamics, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Matthew Samore
- Department of Internal Medicine, Division of Epidemiology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA; IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, UT
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Kavanagh KT, Maiwald M, Cormier LE. Viewpoint: The impending pandemic of resistant organisms - a paradigm shift towards source control is needed. Medicine (Baltimore) 2024; 103:e39200. [PMID: 39093771 PMCID: PMC11296458 DOI: 10.1097/md.0000000000039200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024] Open
Abstract
The United States needs a paradigm shift in its approach to control infectious diseases. Current recommendations are often made in a siloed feedback loop. This may be the driver for such actions as the abandonment of contact precautions in some settings, the allowance of nursing home residents who are carriers of known pathogens to mingle with others in their facility, and the determination of an intervention's feasibility based upon budgetary rather than health considerations for patients and staff. Data from both the U.S. Veterans Health Administration and the U.K.'s National Health Service support the importance of carrier identification and source control. Both organizations observed marked decreases in methicillin-resistant Staphylococcus aureus (MRSA), but not methicillin-susceptible Staphylococcus aureus infections with the implementation of MRSA admission screening measures. Facilities are becoming over-reliant on horizontal prevention strategies, such as hand hygiene and chlorhexidine bathing. Hand hygiene is an essential practice, but the goal should be to minimize the risk of workers' hands becoming contaminated with defined pathogens, and there are conflicting data on the efficacy of chlorhexidine bathing in non-ICU settings. Preemptive identification of dedicated pathogens and effective source control are needed. We propose that the Centers for Disease Control and Prevention should gather and publicly report the community incidence of dedicated pathogens. This will enable proactive rather than reactive strategies. In the future, determination of a patient's microbiome may become standard, but until then we propose that we should have knowledge of the main pathogens that they are carrying.
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Affiliation(s)
| | - Matthias Maiwald
- Department of Pathology and Laboratory Medicine, KK Women’s and Children’s Hospital, Singapore
- Department of Microbiology and Immunology, National University of Singapore; and Duke-National University of Singapore Graduate Medical School, Singapore
| | - Lindsay E. Cormier
- Health Watch USA, Department of Pharmacology and Nutritional Sciences, University of Kentucky, Lexington, KY
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Ahmed OB, Bahwerth FS, Alsafi R, Elsebaei EA, Ebid GT, Theyab A, Assaggaf H. The Prevalence and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Before and After the COVID-19 Pandemic in a Tertiary Saudi Hospital. Cureus 2024; 16:e54809. [PMID: 38529437 PMCID: PMC10962010 DOI: 10.7759/cureus.54809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/24/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) has become a major public health problem all over the world. After the 2019 coronavirus illness (COVID-19), the pandemic may have influenced research priorities and resource allocation, potentially affecting the ability to monitor MRSA trends. AIMS The study aimed to evaluate the prevalence of S. aureus, including MRSA infections, and their antimicrobial susceptibilities over the years 2019 and 2020 in a tertiary hospital in Makkah City, KSA. METHODOLOGY A total of 2128 and 1515 laboratory (lab) samples were collected during the years 2019 and 2020, respectively. From these samples, the prevalence of S. aureus, including MRSA, and their antibiotic susceptibility were identified using standard, automated, and molecular microbiological methods. RESULTS The present study shows that the lab prevalence of all S. aureus during 2019 was found to be 35.5%, of which MRSA was 44.8%. During 2020, the frequency of S. aureus strains was 16%, of which MRSA was 41.2%. The most common MRSA isolated during both years were colonizing pus swabs and urine samples. The results showed that MRSA susceptibility against antimicrobial agents in 2019 was as follows: vancomycin (100%), linezolid (100%), trimethoprim-sulfamethoxazole (88%), and doxycycline (34.2%). The MRSA strains isolated during 2020 were as follows: vancomycin (100%), linezolid (96%), trimethoprim-sulfamethoxazole (100%), and doxycycline (24.3%). There was no significant difference in the incidence and antimicrobial resistance rates of MRSA over the two years. CONCLUSION It was concluded that the prevalence rates of MRSA have not increased in 2020 when compared to 2019. Vancomycin, linezolid, trimethoprim-sulfamethoxazole, and doxycycline remain susceptible to the positive collected MRSA strains. There was no significant difference between the prevalence and antimicrobial resistance rates of MRSA between 2019 and 2020. Continued research efforts are needed to address this persistent public health threat. Strategies to control the spread of MRSA should include early detection of MRSA and surveillance, even during pandemics.
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Affiliation(s)
- Omar B Ahmed
- Environmental and Health Research, Umm Al-Qura University, Makkah, SAU
| | | | - Radi Alsafi
- Laboratory Medicine, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, SAU
| | - Eman A Elsebaei
- Medical Microbiology, Egypt Healthcare Authority, Cairo, EGY
| | - Gamal T Ebid
- Laboratory Medicine, Security Forces Hospital, Makkah, Makkah, SAU
- National Cancer Institute, Cairo University, Cairo, EGY
| | - Abdulrhaman Theyab
- Department of Laboratory and Blood Bank, Security Forces Hospital, Mecca, Makkah, SAU
- Collage of Medicine, Al-Faisal University, Riyadh, SAU
| | - Hamza Assaggaf
- Laboratory Medicine/Public Health, Umm Al-Qura University, Makkah, SAU
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Cranmer KD, Pant MD, Quesnel S, Sharp JA. Clonal Diversity, Antibiotic Resistance, and Virulence Factor Prevalence of Community Associated Staphylococcus aureus in Southeastern Virginia. Pathogens 2023; 13:25. [PMID: 38251333 PMCID: PMC10821353 DOI: 10.3390/pathogens13010025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
Staphylococcus aureus is a significant human pathogen with a formidable propensity for antibiotic resistance. Worldwide, it is the leading cause of skin and soft tissue infections (SSTI), septic arthritis, osteomyelitis, and infective endocarditis originating from both community- and healthcare-associated settings. Although often grouped by methicillin resistance, both methicillin-resistant (MRSA) and methicillin-sensitive (MSSA) strains are known to cause significant pathologies and injuries. Virulence factors and growing resistance to antibiotics play major roles in the pathogenicity of community-associated strains. In our study, we examined the genetic variability and acquired antibiograms of 122 S. aureus clinical isolates from SSTI, blood, and urinary tract infections originating from pediatric patients within the southeast region of Virginia, USA. We identified a suite of clinically relevant virulence factors and evaluated their prevalence within these isolates. Five genes (clfA, spA, sbi, scpA, and vwb) with immune-evasive functions were identified in all isolates. MRSA isolates had a greater propensity to be resistant to more antibiotics as well as significantly more likely to carry several virulence factors compared to MSSA strains. Further, the carriage of various genes was found to vary significantly based on the infection type (SSTI, blood, urine).
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Affiliation(s)
- Katelyn D. Cranmer
- Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Mohan D. Pant
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA 23507, USA
| | - Suzanne Quesnel
- Children’s Hospital of the King’s Daughters, Norfolk, VA 23507, USA
| | - Julia A. Sharp
- Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, VA 23507, USA
- School of Health Professions, Eastern Virginia Medical School, Norfolk, VA 23507, USA
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7
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Evans ME, Simbartl LA, McCauley BP, Flarida LK, Jones MM, Harris AD, Perencevich EN, Rubin MA, Hicks NR, Kralovic SM, Roselle GA. Active Surveillance and Contact Precautions for Preventing Methicillin-Resistant Staphylococcus aureus Healthcare-Associated Infections During the COVID-19 Pandemic. Clin Infect Dis 2023; 77:1381-1386. [PMID: 37390613 DOI: 10.1093/cid/ciad388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 06/06/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Statistically significant decreases in methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) occurred in Veterans Affairs (VA) hospitals from 2007 to 2019 using a national policy of active surveillance (AS) for facility admissions and contact precautions for MRSA colonized (CPC) or infected (CPI) patients, but the impact of suspending these measures to free up laboratory resources for testing and conserve personal protective equipment for coronavirus disease 2019 (COVID-19) on MRSA HAI rates is not known. METHODS From July 2020 to June 2022 all 123 acute care VA hospitals nationwide were given the rolling option to suspend (or re-initiate) any combination of AS, CPC, or CPI each month, and MRSA HAIs in intensive care units (ICUs) and non-ICUs were tracked. RESULTS There were 917 591 admissions, 5 225 174 patient-days, and 568 MRSA HAIs. The MRSA HAI rate/1000 patient-days in ICUs was 0.20 (95% confidence interval [CI], .15-.26) for facilities practicing "AS + CPC + CPI" compared to 0.65 (95% CI, .41-.98; P < .001) for those not practicing any of these strategies, and in non-ICUs was 0.07 (95% CI, .05-.08) and 0.12 (95% CI, .08-.19; P = .01) for the respective policies. Accounting for monthly COVID-19 facility admissions using a negative binomial regression model did not change the relationships between facility policy and MRSA HAI rates. There was no significant difference in monthly facility urinary catheter-associated infection rates, a non-equivalent dependent variable, in the policy categories in either ICUs or non-ICUs. CONCLUSIONS Facility removal of MRSA prevention practices was associated with higher rates of MRSA HAIs in ICUs and non-ICUs.
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Affiliation(s)
- Martin E Evans
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Lexington Veterans Affairs Healthcare System, Lexington, Kentucky, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Kentucky School of Medicine, Lexington, Kentucky, USA
| | - Loretta A Simbartl
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Brian P McCauley
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Linda K Flarida
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Makoto M Jones
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Anthony D Harris
- University of Maryland School of Medicine, Baltimore, Maryland, USA
| | | | - Michael A Rubin
- VA Salt Lake City Health Care System, Salt Lake City, Utah, USA
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Natalie R Hicks
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
| | - Stephen M Kralovic
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Cincinnati Veterans Affairs Healthcare System, Cincinnati, Ohio, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
| | - Gary A Roselle
- National Infectious Diseases Service, Specialty Care Services, Veterans Health Administration, US Department of Veterans Affairs, Washington, DC, USA
- Cincinnati Veterans Affairs Healthcare System, Cincinnati, Ohio, USA
- Division of Infectious Diseases, Department of Internal Medicine, University of Cincinnati School of Medicine, Cincinnati, Ohio, USA
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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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Pennone V, Prieto M, Álvarez-Ordóñez A, Cobo-Diaz JF. Antimicrobial Resistance Genes Analysis of Publicly Available Staphylococcus aureus Genomes. Antibiotics (Basel) 2022; 11:1632. [PMID: 36421276 PMCID: PMC9686812 DOI: 10.3390/antibiotics11111632] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 07/30/2023] Open
Abstract
Staphylococcus aureus is a pathogen that can cause severe illness and express resistance to multiple antimicrobial agents. It is part of the ESKAPE organisms and it has been included by the Centers for Disease Control and Prevention (CDC) of USA in the list of serious threats to humans. Many antimicrobial mechanisms have been identified, and, in particular, antimicrobial resistance genes (ARGs) can be determined by whole genome sequencing. Mobile genetic elements (MGEs) can determine the spread of these ARGs between strains and species and can be identified with bioinformatic analyses. The scope of this work was to analyse publicly available genomes of S. aureus to characterise the occurrence of ARGs present in chromosomes and plasmids in relation to their geographical distribution, isolation sources, clonal complexes, and changes over time. The results showed that from a total of 29,679 S. aureus genomes, 24,765 chromosomes containing 73 different ARGs, and 21,006 plasmidic contigs containing 47 different ARGs were identified. The most abundant ARG in chromosomes was mecA (84%), while blaZ was the most abundant in plasmidic contigs (30%), although it was also abundant in chromosomes (42%). A total of 13 clonal complexes were assigned and differences in ARGs and CC distribution were highlighted among continents. Temporal changes during the past 20 years (from 2001 to 2020) showed that, in plasmids, MRSA and macrolide resistance occurrence decreased, while the occurrence of ARGs associated with aminoglycosides resistance increased. Despite the lack of metadata information in around half of the genomes analysed, the results obtained enable an in-depth analysis of the distribution of ARGs and MGEs throughout different categories to be undertaken through the design and implementation of a relatively simple pipeline, which can be also applied in future works with other pathogens, for surveillance and screening purposes.
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Affiliation(s)
- Vincenzo Pennone
- Department of Food and Drug, Università degli Studi di Parma, 43121 Parma, Italy
- Department of Food Hygiene and Technology, Universidad de León, 24071 León, Spain
| | - Miguel Prieto
- Department of Food Hygiene and Technology, Universidad de León, 24071 León, Spain
- Institute of Food Science and Technology, Universidad de León, 24071 León, Spain
| | - Avelino Álvarez-Ordóñez
- Department of Food Hygiene and Technology, Universidad de León, 24071 León, Spain
- Institute of Food Science and Technology, Universidad de León, 24071 León, Spain
| | - José F. Cobo-Diaz
- Department of Food Hygiene and Technology, Universidad de León, 24071 León, Spain
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Saber DA, Norris AE, Reinking J, Trompeter G, Sanford D. Analyzing the Cost of Hospital Contact Isolation Practices: Implications for Nursing Administrator Practice, Research, and Policy. J Nurs Adm 2022; 52:352-358. [PMID: 35608977 DOI: 10.1097/nna.0000000000001160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to determine the weekly costs of contact precaution (CP) use with medically stable patients infected/colonized with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate the annual financial and environmental costs of CP. BACKGROUND The increasing use of disposables for infection control contributes to increasing hospital costs and amounts of solid waste at rates that are becoming unsustainable. METHODS A cost analysis was conducted using data from time/motion observations and previous waste audit study, along with hospital finance department values and US Department of Labor salary rates. RESULTS Weekly and annual costs were $521.67 and $557 463 (5% hospital multidrug-resistant organism [MDRO] rate assumed). Personal protective equipment accounted for 43% of the waste produced (approximately 1600 pounds annually). CONCLUSIONS Implications for nurse administrators include reevaluating activities that require personal protective equipment (PPE) and partnering with materials and human factor engineers to develop more financially and environmentally sustainable infection control practices.
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Affiliation(s)
- Deborah A Saber
- Author Affiliations: Associate Professor (Dr Saber), School of Nursing, University of Maine, Faculty Associate (Dr Saber), Senator George J. Mitchell Center for Sustainability Solutions, University of Maine, Orono, Maine; Director for Nursing Research and Evidence-Based Practice (Dr Saber), Northern Light Eastern Maine Medical Center, Bangor, Maine; Professor Emeritus (Dr Norris), School of Nursing and Health Studies, University of Miami, Coral Gables, Florida; Assistant School Director and Senior Lecturer (Dr Reinking), Professor and C.G. Avery Chair (Dr Trompeter), Dixon School of Accounting, University of Central Florida, Orlando, Florida; and Vice President of Nursing and Patient Care Services (Ms Sanford), Northern Light Eastern Maine Medical Center, Bangor, Maine
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Chiotos K, Fitzgerald JC, Hayes M, Dashefsky H, Metjian TA, Woods-Hill C, Biedron L, Stinson H, Ku BC, Robbins Tighe S, Weiss SL, Balamuth F, Schriver E, Gerber JS. Improving Vancomycin Stewardship in Critically Ill Children. Pediatrics 2022; 149:185402. [PMID: 35362066 PMCID: PMC9647566 DOI: 10.1542/peds.2021-052165] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/04/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Inappropriate vancomycin use is common in children's hospitals. We report a quality improvement (QI) intervention to reduce vancomycin use in our tertiary care PICU. METHODS We retrospectively quantified the prevalence of infections caused by organisms requiring vancomycin therapy, including methicillin-resistant Staphylococcus aureus (MRSA), among patients with suspected bacterial infections. Guided by these data, we performed 3 QI interventions over a 3-year period, including (1) stakeholder education, (2) generation of a consensus-based guideline for empiric vancomycin use, and (3) implementation of this guideline through clinical decision support. Vancomycin use in days of therapy (DOT) per 1000 patient days was measured by using statistical process control charts. Balancing measures included frequency of bacteremia due to an organism requiring vancomycin not covered with empiric therapy, 30-day mortality, and cardiovascular, respiratory, and renal organ dysfunction. RESULTS Among 1276 episodes of suspected bacterial infection, a total of 19 cases of bacteremia (1.5%) due to organisms requiring vancomycin therapy were identified, including 6 MRSA bacteremias (0.5%). During the 3-year QI project, overall vancomycin DOT per 1000 patient days in the PICU decreased from a baseline mean of 182 DOT per 1000 patient days to 109 DOT per 1000 patient days (a 40% reduction). All balancing measures were unchanged, and all cases of MRSA bacteremia were treated empirically with vancomycin. CONCLUSION Our interventions reduced overall vancomycin use in the PICU without evidence of harm. Provider education and consensus building surrounding indications for empiric vancomycin use were key strategies.
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Affiliation(s)
- Kathleen Chiotos
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care,Division of Infectious Diseases, Department of Pediatrics,Antimicrobial Stewardship Program,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania,Address correspondence to Kathleen Chiotos, MD, MSCE, 3401 Civic Center Blvd, Wood Building, 6 Floor Room 6029, Philadelphia, PA 19104. E-mail:
| | - Julie C. Fitzgerald
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | | | - Hannah Dashefsky
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Charlotte Woods-Hill
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lauren Biedron
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hannah Stinson
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Brandon C. Ku
- Division of Emergency Medicine,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sheila Robbins Tighe
- Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Scott L. Weiss
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Care,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Fran Balamuth
- Division of Emergency Medicine,Pediatric Sepsis Program, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Jeffrey S. Gerber
- Antimicrobial Stewardship Program,Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Wong SC, Chen JHK, Yuen LLH, Chan VWM, AuYeung CHY, Leung SSM, So SYC, Chan BWK, Li X, Leung JOY, Chung PK, Chau PH, Lung DC, Lo JYC, Ma ESK, Chen H, Yuen KY, Cheng VCC. Air dispersal of meticillin-resistant Staphylococcus aureus in residential care homes for the elderly: implication in transmission during COVID-19 pandemic. J Hosp Infect 2022; 123:52-60. [DOI: 10.1016/j.jhin.2022.02.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/15/2022] [Accepted: 02/15/2022] [Indexed: 12/14/2022]
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13
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Klein EY, Zhu X, Petersen M, Patel EU, Cosgrove SE, Tobian AAR. Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus Hospitalizations: National Inpatient Sample, 2016-2019. Open Forum Infect Dis 2022; 9:ofab585. [PMID: 34988254 PMCID: PMC8715851 DOI: 10.1093/ofid/ofab585] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 11/16/2022] Open
Abstract
Data from the National Inpatient Sample demonstrate that methicillin-resistant Staphylococcus aureus (MRSA)–related septicemia hospitalizations increased from 1.67 (95% CI, 1.63–1.72) to 1.94 (95% CI, 1.88–2.00; Ptrend < .001) discharges per 1000 hospitalizations between 2016 and 2019. Regionally, the trends were similar. Rates of MSSA-related septicemia and pneumonia hospitalizations also increased significantly over this time period.
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Affiliation(s)
- Eili Y Klein
- Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Center for Disease Dynamics, Economics & Policy, Washington DC, USA
| | - Xianming Zhu
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Molly Petersen
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Eshan U Patel
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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14
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Chen Y, Liu L, Wang X, Liao Z, Wang R, Xiong YS, Chen J, jiang G, Wang J, Liao X. Synthesis and antibacterial activity study of ruthenium-based metallodrugs with membrane-disruptive mechanism against Staphylococcus aureus. Dalton Trans 2022; 51:14980-14992. [DOI: 10.1039/d2dt01531e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The wide spread of drug-resistant bacteria, especially methicillin-resistant Staphylococcus aureus (MRSA), have posed a tremendous threat to global health. Of particular concern, resistance to vancomycin, linezolid and daptomycin have already...
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15
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Lee AS, Huttner BD, Catho G, Harbarth S. Methicillin-Resistant Staphylococcus aureus: An Update on Prevention and Control in Acute Care Settings. Infect Dis Clin North Am 2021; 35:931-952. [PMID: 34752226 DOI: 10.1016/j.idc.2021.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a leading cause of health-care-associated infections. Controversies regarding the effectiveness of various control strategies have contributed to varying approaches to MRSA control. However, new evidence from large-scale studies has emerged, particularly concerning screening and decolonization. Importantly, implementation and outcomes of control measures in practice are not only influenced by scientific evidence, but also economic, administrative, and political factors, as demonstrated by decreasing MRSA rates in a number of countries after concerted and coordinated efforts at a national level. Flexibility to adapt measures based on local epidemiology and resources is essential for successful MRSA control.
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Affiliation(s)
- Andie S Lee
- Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, University of Sydney, Missenden Road, Camperdown, Sydney, NSW 2050, Australia.
| | - Benedikt D Huttner
- Division of Infectious Diseases, University of Geneva Hospitals, University of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Gaud Catho
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals, Rue Gabrielle-Perret-Gentil 4, Geneva CH-1205, Switzerland
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16
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Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Crit Care Med 2021; 49:e1063-e1143. [PMID: 34605781 DOI: 10.1097/ccm.0000000000005337] [Citation(s) in RCA: 968] [Impact Index Per Article: 322.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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17
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Evans L, Rhodes A, Alhazzani W, Antonelli M, Coopersmith CM, French C, Machado FR, Mcintyre L, Ostermann M, Prescott HC, Schorr C, Simpson S, Wiersinga WJ, Alshamsi F, Angus DC, Arabi Y, Azevedo L, Beale R, Beilman G, Belley-Cote E, Burry L, Cecconi M, Centofanti J, Coz Yataco A, De Waele J, Dellinger RP, Doi K, Du B, Estenssoro E, Ferrer R, Gomersall C, Hodgson C, Møller MH, Iwashyna T, Jacob S, Kleinpell R, Klompas M, Koh Y, Kumar A, Kwizera A, Lobo S, Masur H, McGloughlin S, Mehta S, Mehta Y, Mer M, Nunnally M, Oczkowski S, Osborn T, Papathanassoglou E, Perner A, Puskarich M, Roberts J, Schweickert W, Seckel M, Sevransky J, Sprung CL, Welte T, Zimmerman J, Levy M. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med 2021; 47:1181-1247. [PMID: 34599691 PMCID: PMC8486643 DOI: 10.1007/s00134-021-06506-y] [Citation(s) in RCA: 1577] [Impact Index Per Article: 525.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/05/2021] [Indexed: 02/07/2023]
Affiliation(s)
- Laura Evans
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Washington, Seattle, WA, USA.
| | - Andrew Rhodes
- Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK
| | - Waleed Alhazzani
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Massimo Antonelli
- Dipartimento di Scienze dell'Emergenza, Anestesiologiche e della Rianimazione, Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | | | | | - Flávia R Machado
- Anesthesiology, Pain and Intensive Care Department, Federal University of São Paulo, Hospital of São Paulo, São Paulo, Brazil
| | | | | | - Hallie C Prescott
- University of Michigan and VA Center for Clinical Management Research, Ann Arbor, MI, USA
| | | | - Steven Simpson
- University of Kansas Medical Center, Kansas City, KS, USA
| | - W Joost Wiersinga
- ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis, Division of Infectious Diseases, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Fayez Alshamsi
- Department of Internal Medicine, College of Medicine and Health Sciences, Emirates University, Al Ain, United Arab Emirates
| | - Derek C Angus
- University of Pittsburgh Critical Care Medicine CRISMA Laboratory, Pittsburgh, PA, USA
| | - Yaseen Arabi
- Intensive Care Department, Ministry of National Guard Health Affairs, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Kingdom of Saudi Arabia
| | - Luciano Azevedo
- School of Medicine, University of Sao Paulo, São Paulo, Brazil
| | | | | | | | - Lisa Burry
- Mount Sinai Hospital & University of Toronto (Leslie Dan Faculty of Pharmacy), Toronto, ON, Canada
| | - Maurizio Cecconi
- Department of Biomedical Sciences, Humanitas University Pieve Emanuele, Milan, Italy.,Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - John Centofanti
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
| | - Angel Coz Yataco
- Lexington Veterans Affairs Medical Center/University of Kentucky College of Medicine, Lexington, KY, USA
| | | | | | - Kent Doi
- The University of Tokyo, Tokyo, Japan
| | - Bin Du
- Medical ICU, Peking Union Medical College Hospital, Beijing, China
| | - Elisa Estenssoro
- Hospital Interzonal de Agudos San Martin de La Plata, Buenos Aires, Argentina
| | - Ricard Ferrer
- Intensive Care Department, Vall d'Hebron University Hospital, Vall d'Hebron Institut de Recerca, Barcelona, Spain
| | | | - Carol Hodgson
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC, Australia
| | - Morten Hylander Møller
- Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Shevin Jacob
- Liverpool School of Tropical Medicine, Liverpool, UK
| | | | - Michael Klompas
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Younsuck Koh
- ASAN Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Anand Kumar
- University of Manitoba, Winnipeg, MB, Canada
| | - Arthur Kwizera
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Suzana Lobo
- Intensive Care Division, Faculdade de Medicina de São José do Rio Preto, São Paulo, Brazil
| | - Henry Masur
- Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | | | | | - Yatin Mehta
- Medanta the Medicity, Gurugram, Haryana, India
| | - Mervyn Mer
- Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Mark Nunnally
- New York University School of Medicine, New York, NY, USA
| | - Simon Oczkowski
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Tiffany Osborn
- Washington University School of Medicine, St. Louis, MO, USA
| | | | | | - Michael Puskarich
- University of Minnesota/Hennepin County Medical Center, Minneapolis, MN, USA
| | - Jason Roberts
- Faculty of Medicine, University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Australia.,Department of Pharmacy, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital, Brisbane, Australia.,Division of Anaesthesiology Critical Care Emergency and Pain Medicine, Nîmes University Hospital, University of Montpellier, Nîmes, France
| | | | | | | | - Charles L Sprung
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center, Jerusalem, Israel
| | - Tobias Welte
- Medizinische Hochschule Hannover and German Center of Lung Research (DZL), Hannover, Germany
| | - Janice Zimmerman
- World Federation of Intensive and Critical Care, Brussels, Belgium
| | - Mitchell Levy
- Warren Alpert School of Medicine at Brown University, Providence, Rhode Island & Rhode Island Hospital, Providence, RI, USA
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18
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Key Takeaways From the U.S. CDC's 2019 Antibiotic Resistance Threats Report for Frontline Providers. Crit Care Med 2021; 48:939-945. [PMID: 32282351 PMCID: PMC7176261 DOI: 10.1097/ccm.0000000000004371] [Citation(s) in RCA: 74] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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19
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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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20
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Khader K, Thomas A, Stevens V, Visnovsky L, Nevers M, Toth D, Keegan LT, Jones M, Rubin M, Samore MH. Association Between Contact Precautions and Transmission of Methicillin-Resistant Staphylococcus aureus in Veterans Affairs Hospitals. JAMA Netw Open 2021; 4:e210971. [PMID: 33720369 PMCID: PMC7961311 DOI: 10.1001/jamanetworkopen.2021.0971] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/16/2021] [Indexed: 12/19/2022] Open
Abstract
Importance The effectiveness and importance of contact precautions for endemic pathogens has long been debated, and their use has broad implications for infection control of other pathogens. Objective To estimate the association between contact precautions and transmission of methicillin-resistant Staphylococcus aureus (MRSA) across US Department of Veterans Affairs (VA) hospitals. Design, Setting, and Participants This retrospective cohort study used mathematical models applied to data from a population-based sample of adults hospitalized in 108 VA acute care hospitals for at least 24 hours from January 1, 2008, to December 31, 2017. Data were analyzed from May 2, 2019, to December 11, 2020. Exposures A positive MRSA test result, presumed to indicate contact precautions use according to the VA MRSA Prevention Initiative. Main Outcomes and Measures The main outcome was the association between contact precautions and MRSA transmission, defined as the relative transmissibility attributed to contact precautions. A contact precaution effect estimate (<1 indicates a reduction in transmission associated with contact precautions) was estimated for each hospital and then pooled over time and across hospitals using meta-regression. Results In this cohort study of 108 VA hospitals, more than 2 million unique individuals had over 5.6 million admissions, of which 14.1% were presumed to have contact precautions with more than 8.4 million MRSA surveillance tests. Pooled estimates found associations between contact precautions and transmission to be stable from 2008 to 2017, with estimated transmission reductions ranging from 43% (95% credible interval [CrI], 38%-48%) to 51% (95% CrI, 46%-55%). Over the entire 10-year study period, contact precautions reduced transmission 47% (95% CrI, 45%-49%), and the intrafacility autocorrelation coefficient estimate was 0.99, suggesting consistent estimates over time within facilities. Larger facilities and those with higher admission screening compliance observed additional reductions in transmission associated with contact precautions (relative rate, 0.84; 95% CI, 0.74-0.96 and 0.74; 95% CI, 0.58-0.96, respectively) compared with smaller facilities and those with lower admission screening compliance. Facilities in the southern US had a smaller transmission reduction attributable to contact precautions (relative rate, 1.14; 95% CI, 1.01-1.28) compared with facilities in other regions in the US. Conclusions and Relevance In this cohort study of adults in VA hospitals, transmissibility of MRSA was found to be reduced by approximately 50% among patients with contact precautions. These results provide an explanation for decreasing acquisition rates in VA hospitals since the MRSA Prevention Initiative.
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Affiliation(s)
- Karim Khader
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Alun Thomas
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Vanessa Stevens
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lindsay Visnovsky
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - McKenna Nevers
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Damon Toth
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Lindsay T. Keegan
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Makoto Jones
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Michael Rubin
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Matthew H. Samore
- IDEAS Center of Innovation, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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21
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Prevalence of antibiotic-resistant organisms among hospitalized patients at a tertiary care center in Lebanon, 2010-2018. J Infect Public Health 2020; 14:12-16. [PMID: 33341479 DOI: 10.1016/j.jiph.2020.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/28/2020] [Accepted: 11/27/2020] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Infections due to antibiotic resistant organisms (ARO) among hospitalized patients are associated with increased morbidity, mortality, and healthcare costs. Longitudinal data about antimicrobial resistance are scarce in Lebanon and the region. The objective of this study is to describe the temporal trends of resistance of selected pathogens among hospitalized patients at a tertiary care center in Lebanon. METHODS We conducted a retrospective review of surveillance data from 2010 until 2018. Six target organisms isolated from hospitalized patients were included: carbapenem-resistant Escherichia coli (CREC), carbapenem-resistant Klebsiella spp. (CRKP), multi-drug resistant Pseudomonas aeruginosa (MDRPA), carbapenem-resistant Acinetobacter baumannii (CRAB), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus spp. (VRE). Correlation analysis was performed to evaluate for temporal trends. RESULTS A total of 15,901 isolates were examined, most of which were obtained from urinary specimens. Among Gram-negative organisms, the highest resistance was found among CRAB (81.7%), followed by CRKP (6.5%) and CREC (3.3%). MDRPA overall prevalence was 0.8%. Among Gram-positive organisms, the prevalence of MRSA and VRE was 26.2% and 2.6%, respectively. CREC, MRSA, and VRE showed statistically significant increasing temporal trends, while CRAB decreased significantly from 2013 to 2018. CONCLUSION These data are helpful in characterizing the epidemiology of antimicrobial resistance in Lebanon and show that controlling emerging resistance is achievable with concerted infection control and antimicrobial stewardship efforts. Caution should be exercised to contain early on the spread of CREC and of resistant Gram-positive pathogens.
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22
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Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in respiratory cultures and diagnostic performance of the MRSA nasal polymerase chain reaction (PCR) in patients hospitalized with coronavirus disease 2019 (COVID-19) pneumonia. Infect Control Hosp Epidemiol 2020; 42:1156-1158. [PMID: 32843125 PMCID: PMC7588710 DOI: 10.1017/ice.2020.440] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ruan Z, Cui J, He Z, Guo Y, Jia X, Huang X. Synergistic Effects from Combination of Cryptotanshinone and Fosfomycin Against Fosfomycin-Susceptible and Fosfomycin-Resistant Staphylococcus aureus. Infect Drug Resist 2020; 13:2837-2844. [PMID: 32884307 PMCID: PMC7431450 DOI: 10.2147/idr.s255296] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/09/2020] [Indexed: 02/06/2023] Open
Abstract
Purpose Fosfomycin is now widely used to treat methicillin-resistant S. aureus due to its unique antibacterial activity. However, fosfomycin-resistant S. aureus has rapidly emerged, it is urgent to find new treatments to eliminate fosfomycin-resistant S. aureus infection. The purpose of this study was to analyze the activity of cryptanshinone, a traditional Chinese medicine monomer, in combination with fosfomycin against fosfomycin-sensitive S. aureus (FSSA) and fosfomycin-resistant S. aureus (FRSA). Methods The MICs of fosfomycin and/or cryptanshinone were determined by agar dilution assay and checkerboard microdilution assay. Furthermore, synergistic effects from fosfomycin and/or cryptanshinone were analyzed by the time-kill assay in vitro. Results The combination of fosfomycin and cryptotanshinone had a synergistic effect on most (71.43%) of the FRSA and had a partial (28.57%) synergistic effect on a small part. In addition, time sterilization curve verified synergistic activity between cryptanshinone and fosfomycin against FSSA and FRSA, especially when fosfomycin was added for a second time. Conclusion These data suggest that cryptanshinone combined with fosfomycin could be a novel treatment for FRSA and provide a new direction for the treatment of bacterial infections in the future.
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Affiliation(s)
- Zijing Ruan
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, People's Republic of China
| | - Jiaqi Cui
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China.,Department of Pathology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, People's Republic of China
| | - Zhenqing He
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Yuting Guo
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Xu Jia
- Non-Coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, People's Republic of China
| | - Xinhe Huang
- School of Life Science and Engineering, Southwest Jiaotong University, Chengdu, Sichuan, People's Republic of China
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24
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Ham DC, See I, Novosad S, Crist M, Mahon G, Fike L, Spicer K, Talley P, Flinchum A, Kainer M, Kallen AJ, Walters MS. Investigation of Hospital-Onset Methicillin-Resistant Staphylococcus aureus Bloodstream Infections at Eight High Burden Acute Care Facilities in the United States, 2016. J Hosp Infect 2020; 105:S0195-6701(20)30182-1. [PMID: 32283173 PMCID: PMC7857529 DOI: 10.1016/j.jhin.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 04/06/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite large reductions from 2005-2012, hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections (HO MRSA BSIs) continue be a major source of morbidity and mortality. AIM To describe risk factors for and underlying sources of HO MRSA BSIs. METHODS We investigated HO MRSA BSIs at eight high-burden short-stay acute care hospitals. A case was defined as first isolation of MRSA from a blood specimen collected in 2016 on hospital day ≥4 from a patient without an MRSA-positive blood culture in the 14 days prior. We reviewed case-patient demographics and risk factors by medical record abstraction. The potential clinical source(s) of infection were determined by consensus by a clinician panel. FINDINGS Of the 195 eligible cases, 186 were investigated. Case-patients were predominantly male (63%); median age was 57 years (range 0-92). In the two weeks prior to the BSI, 88% of case-patients had indwelling devices, 31% underwent a surgical procedure, and 18% underwent dialysis. The most common locations of attribution were intensive care units (ICUs) (46%) and step-down units (19%). The most commonly identified non-mutually exclusive clinical sources were CVCs (46%), non-surgical wounds (17%), surgical site infections (16%), non-ventilator healthcare-associated pneumonia (13%), and ventilator-associated pneumonia (11%). CONCLUSIONS Device-and procedure-related infections were common sources of HO MRSA BSIs. Prevention strategies focused on improving adherence to existing prevention bundles for device-and procedure-associated infections and on source control for ICU patients, patients with certain indwelling devices, and patients undergoing certain high-risk surgeries are being pursued to decrease HO MRSA BSI burden at these facilities.
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Affiliation(s)
- D Cal Ham
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
| | - Isaac See
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Shannon Novosad
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Matthew Crist
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Garrett Mahon
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Lucy Fike
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kevin Spicer
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | | | | | | | - Alexander J Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA
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25
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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26
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Jones BE, Ying J, Stevens V, Haroldsen C, He T, Nevers M, Christensen MA, Nelson RE, Stoddard GJ, Sauer BC, Yarbrough PM, Jones MM, Goetz MB, Greene T, Samore MH. Empirical Anti-MRSA vs Standard Antibiotic Therapy and Risk of 30-Day Mortality in Patients Hospitalized for Pneumonia. JAMA Intern Med 2020; 180:552-560. [PMID: 32065604 PMCID: PMC7042818 DOI: 10.1001/jamainternmed.2019.7495] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022]
Abstract
Importance Use of empirical broad-spectrum antibiotics for pneumonia has increased owing to concern for resistant organisms, including methicillin-resistant Staphylococcus aureus (MRSA). The association of empirical anti-MRSA therapy with outcomes among patients with pneumonia is unknown, even for high-risk patients. Objective To compare 30-day mortality among patients hospitalized for pneumonia receiving empirical anti-MRSA therapy vs standard empirical antibiotic regimens. Design, Setting, and Participants Retrospective multicenter cohort study was conducted of all hospitalizations in which patients received either anti-MRSA or standard therapy for community-onset pneumonia in the Veterans Health Administration health care system from January 1, 2008, to December 31, 2013. Subgroups of patients analyzed were those with initial intensive care unit admission, MRSA risk factors, positive results of a MRSA surveillance test, and positive results of a MRSA admission culture. Primary analysis was an inverse probability of treatment-weighted propensity score analysis using generalized estimating equation regression; secondary analyses included an instrumental variable analysis. Statistical analysis was conducted from June 14 to November 20, 2019. Exposures Empirical anti-MRSA therapy plus standard pneumonia therapy vs standard therapy alone within the first day of hospitalization. Main Outcomes and Measures Risk of 30-day all-cause mortality after adjustment for patient comorbidities, vital signs, and laboratory results. Secondary outcomes included the development of kidney injury and secondary infections with Clostridioides difficile, vancomycin-resistant Enterococcus species, or gram-negative bacilli. Results Among 88 605 hospitalized patients (86 851 men; median age, 70 years [interquartile range, 62-81 years]), empirical anti-MRSA therapy was administered to 33 632 (38%); 8929 patients (10%) died within 30 days. Compared with standard therapy alone, in weighted propensity score analysis, empirical anti-MRSA therapy plus standard therapy was significantly associated with an increased adjusted risk of death (adjusted risk ratio [aRR], 1.4 [95% CI, 1.3-1.5]), kidney injury (aRR, 1.4 [95% CI, 1.3-1.5]), and secondary C difficile infections (aRR, 1.6 [95% CI, 1.3-1.9]), vancomycin-resistant Enterococcus spp infections (aRR, 1.6 [95% CI, 1.0-2.3]), and secondary gram-negative rod infections (aRR, 1.5 [95% CI, 1.2-1.8]). Similar associations between anti-MRSA therapy use and 30-day mortality were found by instrumental variable analysis (aRR, 1.6 [95% CI, 1.4-1.9]) and among patients admitted to the intensive care unit (aRR, 1.3 [95% CI, 1.2-1.5]), those with a high risk for MRSA (aRR, 1.2 [95% CI, 1.1-1.4]), and those with MRSA detected on surveillance testing (aRR, 1.6 [95% CI, 1.3-1.9]). No significant favorable association was found between empirical anti-MRSA therapy and death among patients with MRSA detected on culture (aRR, 1.1 [95% CI, 0.8-1.4]). Conclusions and Relevance This study suggests that empirical anti-MRSA therapy was not associated with reduced mortality for any group of patients hospitalized for pneumonia. These results contribute to a growing body of evidence that questions the value of empirical use of anti-MRSA therapy using existing risk approaches.
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Affiliation(s)
- Barbara Ellen Jones
- Division of Pulmonary and Critical Care, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
- University of Utah, Salt Lake City
| | - Jian Ying
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Vanessa Stevens
- University of Utah, Salt Lake City
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | | | - Tao He
- Division of Epidemiology, University of Utah, Salt Lake City
| | - McKenna Nevers
- Division of Epidemiology, University of Utah, Salt Lake City
| | | | - Richard E. Nelson
- University of Utah, Salt Lake City
- Department of Health Economics and Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | | | - Brian C. Sauer
- University of Utah, Salt Lake City
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Peter M. Yarbrough
- University of Utah, Salt Lake City
- Department of Internal Medicine, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Makoto M. Jones
- University of Utah, Salt Lake City
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
| | - Matthew Bidwell Goetz
- Division of Infectious Disease, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
| | - Tom Greene
- Division of Epidemiology, University of Utah, Salt Lake City
| | - Matthew H. Samore
- University of Utah, Salt Lake City
- Division of Epidemiology, Veterans Affairs Salt Lake City Health Care System, Salt Lake City, Utah
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27
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Chow HY, Po KHL, Gao P, Blasco P, Wang X, Li C, Ye L, Jin K, Chen K, Chan EWC, You X, Yi Tsun Kao R, Chen S, Li X. Methylation of Daptomycin Leading to the Discovery of Kynomycin, a Cyclic Lipodepsipeptide Active against Resistant Pathogens. J Med Chem 2020; 63:3161-3171. [PMID: 32097000 DOI: 10.1021/acs.jmedchem.9b01957] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Increased usage of daptomycin to treat infections caused by Gram-positive bacterial pathogens has resulted in emergence of resistant mutants. In a search for more effective daptomycin analogues through medicinal chemistry studies, we found that methylation at the nonproteinogenic amino acid kynurenine in daptomycin could result in significant enhancement of antibacterial activity. Termed "kynomycin," this new antibiotic exhibits higher antibacterial activity than daptomycin and is able to eradicate methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) strains, including daptomycin-resistant strains. The improved antimicrobial activity of kynomycin was demonstrated in in vitro time-killing assay, in vivo wax worm model, and different mouse infection models. The increased antibacterial activity, improved pharmacokinetics, and lower cytotoxicity of kynomycin, compared to daptomycin, showed the promise of the future design and development of next-generation daptomycin-based antibiotics.
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Affiliation(s)
- Hoi Yee Chow
- Department of Chemistry, State Key Lab of Synthetic Chemistry, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Kathy Hiu Laam Po
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong.,State Key Laboratory of Chemical Biology and Drug Discovery, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Peng Gao
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Pilar Blasco
- Department of Chemistry, State Key Lab of Synthetic Chemistry, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Xiukun Wang
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Congran Li
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Lianwei Ye
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Kang Jin
- Department of Chemistry, State Key Lab of Synthetic Chemistry, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Kaichao Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Edward Wai Chi Chan
- State Key Laboratory of Chemical Biology and Drug Discovery, Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - Xuefu You
- Beijing Key Laboratory of Antimicrobial Agents, Institute of Medicinal Biotechnology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Richard Yi Tsun Kao
- Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
| | - Sheng Chen
- Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, Kowloon, Hong Kong
| | - Xuechen Li
- Department of Chemistry, State Key Lab of Synthetic Chemistry, The University of Hong Kong, Pokfulam Road, Pok Fu Lam, Hong Kong
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28
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Marked Reduction of Vancomycin Utilization in a Veterans Hospital. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2020. [DOI: 10.1097/ipc.0000000000000826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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Garza-González E, Franco-Cendejas R, Morfín-Otero R, Echaniz-Aviles G, Rojas-Larios F, Bocanegra-Ibarias P, Flores-Treviño S, Ponce-de-León A, Rodríguez-Noriega E, Alavez-Ramírez N, Mena-Ramirez JP, Rincón-Zuno J, Fong-Camargo MG, Morales-De-la-Peña CT, Huerta-Baltazar CR, López-Jacome LE, Carnalla-Barajas MN, Soto-Noguerón A, Sanchez-Francia D, Moncada-Barrón D, Ortíz-Brizuela E, García-Mendoza L, Newton-Sánchez OA, Choy-Chang EV, Aviles-Benitez LK, Martínez-Miranda R, Feliciano-Guzmán JM, Peña-Lopez CD, Couoh-May CA, López-Gutiérrez E, Gil-Veloz M, Armenta-Rodríguez LC, Manriquez-Reyes M, Gutierrez-Brito M, López-Ovilla I, Adame-Álvarez C, Barajas-Magallón JM, Aguirre-Burciaga E, Coronado-Ramírez AM, Rosales-García AA, Sida-Rodríguez S, Urbina-Rodríguez RE, López-Moreno LI, Juárez-Velázquez GE, Martínez-Villarreal RT, Canizales-Oviedo JL, Cetina-Umaña CM, Perez-Juárez MM, González-Moreno A, Romero-Romero D, Bello-Pazos FD, Aguilar-Orozco G, Barlandas-Rendón NRE, Maldonado-Anicacio JY, Valadez-Quiroz A, Camacho-Ortiz A. The Evolution of Antimicrobial Resistance in Mexico During the Last Decade: Results from the INVIFAR Group. Microb Drug Resist 2020; 26:1372-1382. [PMID: 32027229 DOI: 10.1089/mdr.2019.0354] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Surveillance of antimicrobial resistance (AMR) requires an international approach with national and local strategies. Our aim was to summarize a retrospective 10-year report of antibiotic resistance of gram-positive and gram-negative bacteria in Mexico. Methods: A total of 46 centers from 22 states of Mexico participated. Databases of AMR from January 2009 to December 2018 were included for most species. The 10-year period was divided into five 2-year periods. Results: For Staphylococcus aureus, a decrease in resistance in all specimens was observed for erythromycin and oxacillin (p < 0.0001 for each). For Enterobacter spp., resistance to meropenem increased for urine specimens (p = 0.0042). For Klebsiella spp., increased drug resistance in specimens collected from blood was observed for trimethoprim/sulfamethoxazole, gentamicin, tobramycin (p < 0.0001 for each), meropenem (p = 0.0014), and aztreonam (p = 0.0030). For Acinetobacter baumannii complex, high drug resistance was detected for almost all antibiotics, including carbapenems, except for tobramycin, which showed decreased resistance for urine, respiratory, and blood isolates (p < 0.0001 for each), and for amikacin, which showed a decrease in resistance in urine specimens (p = 0.0002). An increase in resistance to cefepime was found for urine, respiratory, and blood specimens (p < 0.0001 for each). For Pseudomonas aeruginosa, aztreonam resistance increased for isolates recovered from blood (p = 0.0001). Conclusion: This laboratory-based surveillance of antibiotic resistance shows that resistance is increasing for some antibiotics in different bacterial species in Mexico and highlights the need for continuous monitoring of antibiotic resistance.
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Affiliation(s)
- Elvira Garza-González
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Rafael Franco-Cendejas
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | - Rayo Morfín-Otero
- Hospital Civil de Guadalajara e Instituto de Patología Infecciosa, Universidad de Guadalajara, Guadalajara, Mexico
| | | | | | - Paola Bocanegra-Ibarias
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Samantha Flores-Treviño
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Alfredo Ponce-de-León
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Eduardo Rodríguez-Noriega
- Hospital Civil de Guadalajara e Instituto de Patología Infecciosa, Universidad de Guadalajara, Guadalajara, Mexico
| | - Norma Alavez-Ramírez
- Hospital Regional Tipo B, de Alta Especialidad Bicentenario de La Independencia, Tultitlán de Mariano Escobedo, Mexico
| | - Juan Pablo Mena-Ramirez
- Hospital General de Zona No. 21 IMSS, Centro Universitario de los Altos (CUALTOS), Universidad de Guadalajara, Tepatitlán de Morelos, Mexico
| | - Joaquín Rincón-Zuno
- Hospital Para el Niño de Toluca, Instituto Materno Infantil del Estado De México, Toluca, Mexico
| | | | | | | | - Luis Esau López-Jacome
- Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Ciudad de México, Mexico
| | | | | | | | | | - Edgar Ortíz-Brizuela
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jorge Luis Canizales-Oviedo
- Centro Universitario De Salud, Universidad Autónoma de Nuevo León, Laboratorio Pueblo Nuevo, Monterrey, Mexico
| | | | | | | | | | | | | | | | | | | | - Adrián Camacho-Ortiz
- Hospital Universitario Dr. José E. González, Universidad Autónoma de Nuevo León, Monterrey, Mexico
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30
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Kern WV, Rieg S. Burden of bacterial bloodstream infection-a brief update on epidemiology and significance of multidrug-resistant pathogens. Clin Microbiol Infect 2019; 26:151-157. [PMID: 31712069 DOI: 10.1016/j.cmi.2019.10.031] [Citation(s) in RCA: 164] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/28/2019] [Accepted: 10/29/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Bloodstream infections comprise a wide variety of pathogens and clinical syndromes with considerable overlap with similar syndromes of non-bacteraemic infections and diverse risk factors, therapeutic implications and outcomes. Yet, this heterogeneous 'entity' has the advantage to be pathogen-defined compared with the broad and even more heterogeneous entity 'sepsis', and so has become helpful for clinicians and epidemiologists for research and surveillance purposes. The increasing availability of population-based and large multicentre well-defined cohort studies should allow us to assess with much confidence and in detail its burden, the significance of antimicrobial resistance, and areas of uncertainty regarding further epidemiological evolution and optimized treatment regimens. AIM To review key aspects of bloodstream infection epidemiology and burden, and summarize recent news and questions concerning critical developments. SOURCES Peer-reviewed articles based on the search terms 'bloodstream infection' and 'bacteremia' combined with the terms 'epidemiology' and 'burden'. The emphasis was on new information from studies in adult patients and on the added burden due to pathogen resistance to first- and second-line antimicrobial agents. CONTENT Topics covered include recent developments in the epidemiology of bloodstream infection due to key pathogens and published information about the relevance of resistance for patient outcomes. IMPLICATIONS Despite the availability of population-based studies and an increasing number of large well-defined multicentre cohort studies, more surveillance and systematic data on bloodstream infection epidemiology at regional level and in resource-limited settings may be needed to better design new methods for prevention and define the need for and further develop optimized therapeutic strategies.
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Affiliation(s)
- W V Kern
- Division of Infectious Diseases, Department of Medicine II, Albert-Ludwigs-University Faculty of Medicine and Medical Centre, Freiburg, Germany; ESCMID Study Group on Bloodstream Infection, Endocarditis and Sepsis, Basel, Switzerland.
| | - S Rieg
- Division of Infectious Diseases, Department of Medicine II, Albert-Ludwigs-University Faculty of Medicine and Medical Centre, Freiburg, Germany
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31
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Pearson T, Barger SD, Lininger M, Wayment H, Hepp C, Villa F, Tucker-Morgan K, Kyman S, Cabrera M, Hurtado K, Menard A, Fulbright K, Wood C, Mbegbu M, Zambrano Y, Fletcher A, Medina-Rodriguez S, Manone M, Aguirre A, Milner T, Trotter Ii RT. Health Disparities in Staphylococcus aureus Transmission and Carriage in a Border Region of the United States Based on Cultural Differences in Social Relationships: Protocol for a Survey Study. JMIR Res Protoc 2019; 8:e14853. [PMID: 31573953 PMCID: PMC6789426 DOI: 10.2196/14853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/19/2019] [Accepted: 07/23/2019] [Indexed: 01/19/2023] Open
Abstract
Background Health care–associated Staphylococcus aureus infections are declining but remain common. Conversely, rates of community-associated infections have not decreased because of the inadequacy of public health mechanisms to control transmission in a community setting. Our long-term goal is to use risk-based information from empirical socio-cultural-biological evidence of carriage and transmission to inform intervention strategies that reduce S aureus transmission in the community. Broad differences in social interactions because of cultural affiliation, travel, and residency patterns may impact S aureus carriage and transmission, either as risk or as protective factors. Objective This study aims to (1) characterize S aureus carriage rates and compare circulating pathogen genotypes with those associated with disease isolated from local clinical specimens across resident groups and across Hispanic and non-Hispanic white ethnic groups and (2) evaluate social network relationships and social determinants of health-based risk factors for their impact on carriage and transmission of S aureus. Methods We combine sociocultural survey approaches to population health sampling with S aureus carriage and pathogen genomic analysis to infer transmission patterns. Whole genome sequences of S aureus from community and clinical sampling will be phylogenetically compared to determine if strains that cause disease (clinical samples) are representative of community genotypes. Phylogenetic comparisons of strains collected from participants within social groups can indicate possible transmission within the group. We can therefore combine transmission data with social determinants of health variables (socioeconomic status, health history, etc) and social network variables (both egocentric and relational) to determine the extent to which social relationships are associated with S aureus transmission. Results We conducted a first year pilot test and feasibility test of survey and biological data collection and analytic procedures based on the original funded design for this project (#NIH U54MD012388). That design resulted in survey data collection from 336 groups and 1337 individuals. The protocol, described below, is a revision based on data assessment, new findings for statistical power analyses, and refined data monitoring procedures. Conclusions This study is designed to evaluate ethnic-specific prevalence of S aureus carriage in a US border community. The study will also examine the extent to which kin and nonkin social relationships are concordant with carriage prevalence in social groups. Genetic analysis of S aureus strains will further distinguish putative transmission pathways across social relationship contexts and inform our understanding of the correspondence of S aureus reservoirs across clinical and community settings. Basic community-engaged nonprobabilistic sampling procedures provide a rigorous framework for completion of this 5-year study of the social and cultural parameters of S aureus carriage and transmission.
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Affiliation(s)
- Talima Pearson
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
| | - Steven D Barger
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psycological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Monica Lininger
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Physical Therapy and Athletic Training, Northern Arizona University, Flagstaff, AZ, United States
| | - Heidi Wayment
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Psycological Sciences, Northern Arizona University, Flagstaff, AZ, United States
| | - Crystal Hepp
- School of Informatics, Computing, and Cyber Systems, Northern Arizona University, Flagstaff, AZ, United States
| | - Francisco Villa
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | | | - Shari Kyman
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Melissa Cabrera
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Kevin Hurtado
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Ashley Menard
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States.,Northern Arizona University-Yuma, Yuma, AZ, United States
| | - Kelly Fulbright
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Colin Wood
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | - Mimi Mbegbu
- Pathogen & Microbiome Institute, Northern Arizona University, Flagstaff, AZ, United States
| | | | | | | | - Mark Manone
- Department of Geography, Planning and Recreation, Northern Arizona University, Flagstaff, AZ, United States
| | - Amanda Aguirre
- Regional Center for Border Health, Somerton, AZ, United States
| | - Trudie Milner
- Yuma Regional Medical Center, Yuma, AZ, United States
| | - Robert T Trotter Ii
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States.,Department of Anthropology, Northern Arizona University, Flagstaff, AZ, United States
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Reddy SC, Valderrama AL, Kuhar DT. Improving the Use of Personal Protective Equipment: Applying Lessons Learned. Clin Infect Dis 2019; 69:S165-S170. [DOI: 10.1093/cid/ciz619] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Abstract
Unrecognized transmission of pathogens in healthcare settings can lead to colonization and infection of both patients and healthcare personnel. The use of personal protective equipment (PPE) is an important strategy to protect healthcare personnel from contamination and to prevent the spread of pathogens to subsequent patients. However, optimal PPE use is difficult, and healthcare personnel may alter delivery of care because of the PPE. Here, we summarize recent research from the Prevention Epicenters Program on healthcare personnel contamination and improvement of the routine use of PPE as well as Ebola-specific PPE. Future efforts to optimize the use of PPE should include increasing adherence to protocols for PPE use, improving PPE design, and further research into the risks, benefits, and best practices of PPE use.
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Affiliation(s)
- Sujan C Reddy
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy L Valderrama
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - David T Kuhar
- Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kavanagh KT. Control of MSSA and MRSA in the United States: protocols, policies, risk adjustment and excuses. Antimicrob Resist Infect Control 2019; 8:103. [PMID: 31244994 PMCID: PMC6582558 DOI: 10.1186/s13756-019-0550-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 05/28/2019] [Indexed: 12/17/2022] Open
Abstract
Data released by the U.S. Centers for Disease Control and Prevention (CDC) on March 5, 2019 showed that Staph aureus infections are a major problem in the United States, with 119,000 infections and almost 20,000 deaths in 2017. Rates of decline for hospital-onset MRSA have slowed since 2012 and the United States is not on track for meeting the 2015 U.S. Dept. of Health and Human Services’ goal of a 50% reduction by 2020. There is a need for improved standards for control of dangerous pathogens. Currently, the World Health Organization’s recommendation of preoperatively screening patients for Staph aureus has not become a standard of care in the United States. The U.S. Veterans Health Administration also released data which found a much larger decrease in hospital-onset MRSA infections as opposed to hospital-onset MSSA using various infectious disease bundles that all included universal MRSA surveillance and isolation for MRSA carriers. These results mirror the results obtained by the United Kingdom’s National Health Service. These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA. A case is made that concerns with the integrity of healthcare policy research, along with industrial conflicts-of-interest have inhibited effective formulation of infectious disease policy in the United States. Because MRSA has become endemic in the general U.S. population (approximately 2%), the author advocates that universal facility-wide screening of MRSA on admission be included in infection prevention bundles used at U.S. hospital.
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Kourtis AP, Hatfield K, Baggs J, Mu Y, See I, Epson E, Nadle J, Kainer MA, Dumyati G, Petit S, Ray SM, Ham D, Capers C, Ewing H, Coffin N, McDonald LC, Jernigan J, Cardo D. Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections - United States. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2019; 68:214-219. [PMID: 30845118 PMCID: PMC6421967 DOI: 10.15585/mmwr.mm6809e1] [Citation(s) in RCA: 434] [Impact Index Per Article: 86.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Introduction Staphylococcus aureus is one of the most common pathogens in health care facilities and in the community, and can cause invasive infections, sepsis, and death. Despite progress in preventing methicillin-resistant S. aureus (MRSA) infections in health care settings, assessment of the problem in both health care and community settings is needed. Further, the epidemiology of methicillin-susceptible S. aureus (MSSA) infections is not well described at the national level. Methods Data from the Emerging Infections Program (EIP) MRSA population surveillance (2005–2016) and from the Premier and Cerner Electronic Health Record databases (2012–2017) were analyzed to describe trends in incidence of hospital-onset and community-onset MRSA and MSSA bloodstream infections and to estimate the overall incidence of S. aureus bloodstream infections in the United States and associated in-hospital mortality. Results In 2017, an estimated 119,247 S. aureus bloodstream infections with 19,832 associated deaths occurred. During 2005–2012 rates of hospital-onset MRSA bloodstream infection decreased by 17.1% annually, but the decline slowed during 2013–2016. Community-onset MRSA declined less markedly (6.9% annually during 2005–2016), mostly related to declines in health care–associated infections. Hospital-onset MSSA has not significantly changed (p = 0.11), and community-onset MSSA infections have slightly increased (3.9% per year, p<0.0001) from 2012 to 2017. Conclusions and Implications for Public Health Practice Despite reductions in incidence of MRSA bloodstream infections since 2005, S. aureus infections account for significant morbidity and mortality in the United States. To reduce the incidence of these infections further, health care facilities should take steps to fully implement CDC recommendations for prevention of device- and procedure-associated infections and for interruption of transmission. New and novel prevention strategies are also needed.
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