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Mekuriya E, Manilal A, Aklilu A, Woldemariam M, Hailu T, Wasihun B. Methicillin-resistant Staphylococcus aureus colonization among medicine and health science students, Arba Minch University, Ethiopia. Sci Rep 2022; 12:10161. [PMID: 35715485 PMCID: PMC9205900 DOI: 10.1038/s41598-022-14212-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 06/02/2022] [Indexed: 11/29/2022] Open
Abstract
Individuals with Methicillin-Resistant Staphylococcus aureus (MRSA) colonized nasal cavities were at greater risk of developing the infection and can serve as potential reservoirs of transmission. Aim of this study is to determine the extent of nasal carriage and associated factors linked to MRSA in medical and health science students of Arba Minch University (AMU), Ethiopia, who are much prone. An institution based cross-sectional study was conducted at AMU from 01st August through 30th November, 2020 by means of a systematic sampling technique using a structured questionnaire. Nasal swabs samples were collected and S. aureus were identified following standard microbiological methods. Methicillin resistance was tested using cefoxitin disk and antimicrobial susceptibility tests were performed by Kirby-Bauer disk diffusion. Biofilm forming ability was phenotypically detected by micro-titer plate assay. Descriptive statistics and multivariable logistic regression analysis were done by Statistical Package for Social Service (SPSS) version 25. The overall prevalence of Staphylococcus aureus and MRSA were 27.1% (70/258) and 7.4% (19/258) respectively. Methicillin-Resistant S. aureus carriage were higher among medical interns, 16.9% (11/65). Isolates in general were co-resistant to antibiotics, such as trimethoprim-sulfamethoxazole (63.2%) and tetracycline (48.4%). Multidrug resistance (MDR) were observed among 52.6% (10/19) of the isolates. Besides, 31.4% (6/19) of MRSA were biofilm producers and all of them were MDR. Multivariable analysis showed that mean exposure for > 2 years to hospital settings [p = 0.048, AOR: 4.99, 95% CI 1.01–24.66] and the habit of sharing clothing and sports equipment [p = 0.017, AOR: 5.43, 95% CI 1.35–21.83] were statistically significant. The overall prevalence of nasal colonized MRSA among students were comparatively lower than that observed in other studies done in Ethiopia itself. An alarming factor is that, 60% of MDR-MRSA were biofilm producers.
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Affiliation(s)
- Ermiyas Mekuriya
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Addis Aklilu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia.
| | - Melat Woldemariam
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Tadiwos Hailu
- School of Medicine, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Biresaw Wasihun
- Department of Midwifery, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
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Leibler JH, Liebschutz JM, Keosaian J, Stewart C, Monteiro J, Woodruff A, Stein MD. Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs. J Urban Health 2019; 96:734-740. [PMID: 31493182 PMCID: PMC6814663 DOI: 10.1007/s11524-019-00379-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a leading cause of hospitalization and medical visits among individuals experiencing homelessness and also among persons who inject drugs (PWID), populations with significant overlap in urban centers in the USA. While injection drug use is a risk factor for MRSA skin infections, MRSA is also known to transmit easily in crowded, public locations in which individuals have reduced personal hygiene. Individuals in urban centers who experience homelessness or drug addiction may spend significant amounts of time in environments where MRSA can be easily transmitted, and may also experience reduced access to facilities to maintain personal hygiene. We assessed the relationship between homelessness, personal hygiene, and MRSA nasal colonization, a proxy for MRSA infection risk, in a study of PWID in Boston, MA (n = 78). Sleeping in a homeless shelter for at least one night in the last 3 months was significantly associated with MRSA nasal colonization (OR 3.0; p = 0.02; 95% CI 1.2, 7.6). Sleeping at more than one place during the last week (considered a metric of elevated housing instability) was also associated with a threefold increase in odds of MRSA nasal colonization (OR 3.1; p = 0.01; 95% CI 1.3, 7.6). MRSA nasal colonization was strongly associated with use of public showers (OR 13.7; p = 0.02; 95% CI 1.4, 132.8), although few people in this study (4 of 78) reported using these public facilities. Sharing bedding with other people was also associated with increased risk of MRSA colonization (OR 2.2; p = 0.05; 95% CI 1.0-4.7). No associations between hand hygiene, frequency of bathing or clothes laundering, or street sleeping were observed. Use of public facilities supporting persons experiencing homelessness and housing instability, including shelters and public showers, is associated with an increased risk of MRSA nasal colonization in this study. Personal hygiene behaviors appear less associated with MRSA nasal colonization. Environmental assessments of MRSA contamination in homeless shelters and public sanitation facilities are warranted so as to inform appropriate intervention activities.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Jane M Liebschutz
- Department of Medicine, Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia Keosaian
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Catherine Stewart
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jordanna Monteiro
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Alexander Woodruff
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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May LS, Zocchi M, Zatorski C, Jordan JA, Rothman RE, Ware CE, Eells S, Miller L. Treatment Failure Outcomes for Emergency Department Patients with Skin and Soft Tissue Infections. West J Emerg Med 2015; 16:642-52. [PMID: 26587085 PMCID: PMC4644029 DOI: 10.5811/westjem.2015.7.26213] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 07/07/2015] [Accepted: 07/23/2015] [Indexed: 11/14/2022] Open
Abstract
Introduction Skin and soft tissue infections (SSTIs) are commonly evaluated in the emergency department (ED). Our objectives were to identify predictors of SSTI treatment failure within one week post-discharge in patients with cutaneous abscesses, as well as to identify predictors of recurrence within three months in that proportion of participants. Methods This was a sub-analysis of a parent study, conducted at two EDs, evaluating a new, nucleic acid amplification test (NAAT) for Staphylococcus aureus in ED patients. Patients ≥18 years receiving incision and drainage (I&D) were eligible. Patient-reported outcome data on improvement of fever, swelling, erythema, drainage, and pain were collected using a structured abstraction form at one week, one month, and three months post ED visit. Results We enrolled 272 participants (20 from a feasibility study and 252 in this trial), of which 198 (72.8%) completed one-week follow up. Twenty-seven additional one-week outcomes were obtained through medical record review rather than by the one-week follow-up phone call. One hundred ninety-three (73%) patients completed either the one- or three-month follow up. Most patients recovered from their initial infection within one week, with 10.2% of patients reporting one-week treatment failure. The odds of treatment failure were 66% lower for patients who received antibiotics following I&D at their initial visit. Overall SSTI recurrence rate was 28.0% (95% CI [21.6%–34.4%]) and associated with contact with someone infected with methicillin resistant S. aureus (MRSA), previous SSTI history, or clinician use of wound packing. Conclusion Treatment failure was reduced by antibiotic use, whereas SSTI recurrence was associated with prior contact, SSTI, or use of packing.
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Affiliation(s)
- Larissa S May
- University of California, Davis, Department of Emergency Medicine, Davis, California
| | - Mark Zocchi
- The George Washington University, Office for Clinical Practice Innovation, Washington, District of Columbia
| | - Catherine Zatorski
- The George Washington University, Department of Emergency Medicine, Washington, District of Columbia
| | - Jeanne A Jordan
- The George Washington University, Department of Epidemiology and Biostatistics, Washington, District of Columbia
| | - Richard E Rothman
- Johns Hopkins University, Department of Emergency Medicine, Baltimore, Maryland
| | - Chelsea E Ware
- The George Washington University, Department of Emergency Medicine, Washington, District of Columbia
| | - Samantha Eells
- Los Angeles BioMedical Research Center at Harbor - UCLA Medical Center, Torrance, California
| | - Loren Miller
- Los Angeles BioMedical Research Center at Harbor - UCLA Medical Center, Torrance, California
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David MZ, Siegel JD, Henderson J, Leos G, Lo K, Iwuora J, Porsa E, Schumm LP, Boyle-Vavra S, Daum RS. A randomized, controlled trial of chlorhexidine-soaked cloths to reduce methicillin-resistant and methicillin-susceptible Staphylococcus aureus carriage prevalence in an urban jail. Infect Control Hosp Epidemiol 2015; 35:1466-73. [PMID: 25419768 DOI: 10.1086/678606] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess an intervention to limit community-associated methicillin-resistant Staphylococcus aureus (MRSA) dissemination. DESIGN Randomized, controlled trial. SETTING County Jail, Dallas, Texas. PARTICIPANTS A total of 4,196 detainees in 68 detention tanks. METHODS Tanks were randomly assigned to 1 of 3 groups: in group 1, detainees received cloths that contained chlorhexidine gluconate (CHG) to clean their entire skin surface 3 times per week for 6 months; group 2 received identical cloths containing only water; and group 3 received no skin treatment. During the study, all newly arrived detainees were invited to enroll. Nares and hand cultures were obtained at baseline and from all current enrollees at 2 and 6 months. RESULTS At baseline, S. aureus was isolated from 41.2% and MRSA from 8.0% (nares and/or hand) of 947 enrollees. The average participation rate was 47%. At 6 months, MRSA carriage was 10.0% in group 3 and 8.7% in group 1 tanks (estimated absolute risk reduction [95% confidence interval (CI)], 1.4% [-4.8% to 7.1%]; P = .655). At 6 months, carriage of any S. aureus was 51.1% in group 3, 40.7% in group 1 (absolute risk reduction [95% CI], 10.4% [0.01%-20.1%]; P = .047), and 42.8% (absolute risk reduction [95% CI], 8.3% [-1.4% to 18.0%]; P = .099) in group 2. CONCLUSIONS Skin cleaning with CHG for 6 months in detainees, compared with no intervention, significantly decreased carriage of S. aureus, and use of water cloths produced a nonsignificant but similar decrease. A nonsignificant decrease in MRSA carriage was found with CHG cloth use. TRIAL REGISTRATION ClinicalTrials.gov identifier NCT00785200.
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Affiliation(s)
- Michael Z David
- Department of Medicine, University of Chicago, Chicago, Illinois
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Miko BA, Befus M, Herzig CTA, Mukherjee DV, Apa ZL, Bai RY, Tanner JP, Gage D, Genovese M, Koenigsmann CJ, Larson EL, Lowy FD. Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons. Clin Infect Dis 2015; 61:203-10. [PMID: 25810281 DOI: 10.1093/cid/civ242] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 03/12/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Large outbreaks of Staphylococcus aureus (SA) infections have occurred in correctional facilities across the country. We aimed to define the epidemiological and microbiological determinants of SA infection in prisons to facilitate development of prevention strategies for this underserved population. METHODS We conducted a case-control study of SA infection at 2 New York State maximum security prisons. SA-infected inmates were matched with 3 uninfected controls. Subjects had cultures taken from sites of infection and colonization (nose and throat) and were interviewed via structured questionnaire. SA isolates were characterized by spa typing. Bivariate and multivariable analyses were conducted using conditional logistic regression. RESULTS Between March 2011 and January 2013, 82 cases were enrolled and matched with 246 controls. On bivariate analysis, the use of oral and topical antibiotics over the preceding 6 months was strongly associated with clinical infection (OR, 2.52; P < .001 and 4.38, P < .001, respectively). Inmates with clinical infection had 3.16 times the odds of being diabetic compared with inmates who did not have clinical infection (P < .001). Concurrent nasal and/or oropharyngeal colonization was also associated with an increased odds of infection (OR, 1.46; P = .002). Among colonized inmates, cases were significantly more likely to carry the SA clone spa t008 (usually representing the epidemic strain USA300) compared to controls (OR, 2.52; P = .01). CONCLUSIONS Several inmate characteristics were strongly associated with SA infection in the prison setting. Although many of these factors were likely present prior to incarceration, they may help medical staff identify prisoners for targeted prevention strategies.
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Affiliation(s)
- Benjamin A Miko
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
| | - Montina Befus
- Department of Epidemiology, Mailman School of Public Health, Columbia University
| | - Carolyn T A Herzig
- Department of Epidemiology, Mailman School of Public Health, Columbia University Columbia University School of Nursing, New York
| | - Dhritiman V Mukherjee
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
| | - Zoltan L Apa
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
| | - Ruo Yu Bai
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
| | - Joshua P Tanner
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
| | - Dana Gage
- New York State Department of Corrections and Community Supervision, Albany, New York
| | - Maryann Genovese
- New York State Department of Corrections and Community Supervision, Albany, New York
| | - Carl J Koenigsmann
- New York State Department of Corrections and Community Supervision, Albany, New York
| | - Elaine L Larson
- Department of Epidemiology, Mailman School of Public Health, Columbia University Columbia University School of Nursing, New York
| | - Franklin D Lowy
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons
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Bloomfield S, Exner M, Flemming HC, Goroncy-Bermes P, Hartemann P, Heeg P, Ilschner C, Krämer I, Merkens W, Oltmanns P, Rotter M, Rutala WA, Sonntag HG, Trautmann M. Lesser-known or hidden reservoirs of infection and implications for adequate prevention strategies: Where to look and what to look for. GMS HYGIENE AND INFECTION CONTROL 2015; 10:Doc04. [PMID: 25699227 PMCID: PMC4332272 DOI: 10.3205/dgkh000247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In developing hygiene strategies, in recent years, the major focus has been on the hands as the key route of infection transmission. However, there is a multitude of lesser-known and underestimated reservoirs for microorganisms which are the triggering sources and vehicles for outbreaks or sporadic cases of infection. Among those are water reservoirs such as sink drains, fixtures, decorative water fountains and waste-water treatment plants, frequently touched textile surfaces such as private curtains in hospitals and laundry, but also transvaginal ultrasound probes, parenteral drug products, and disinfectant wipe dispensers. The review of outbreak reports also reveals Gram-negative and multiple-drug resistant microorganisms to have become an increasingly frequent and severe threat in medical settings. In some instances, the causative organisms are particularly difficult to identify because they are concealed in biofilms or in a state referred to as viable but nonculturable, which eludes conventional culture media-based detection methods. There is an enormous preventative potential in these insights, which has not been fully tapped. New and emerging pathogens, novel pathogen detection methods, and hidden reservoirs of infection should hence be given special consideration when designing the layout of buildings and medical devices, but also when defining the core competencies for medical staff, establishing programmes for patient empowerment and education of the general public, and when implementing protocols for the prevention and control of infections in medical, community and domestic settings.
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Affiliation(s)
- Sally Bloomfield
- London School of Hygiene and Tropical Medicine, International Scientific Forum on Home Hygiene, London, UK
| | - Martin Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | | | | | - Philippe Hartemann
- Departement Environment et Santé Publique S.E.R.E.S., Faculté de Médicine, Nancy, France
| | - Peter Heeg
- Institute of Medical Microbiology and Hygiene, Tübingen, Germany
| | - Carola Ilschner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - Irene Krämer
- Pharmacy Department of Mainz University, Mainz, Germany
| | | | | | | | | | | | - Matthias Trautmann
- Department of Hospital Hygiene at Stuttgart Hospital, Stuttgart, Germany
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Miller LG, Eells SJ, David MZ, Ortiz N, Taylor AR, Kumar N, Cruz D, Boyle-Vavra S, Daum RS. Staphylococcus aureus skin infection recurrences among household members: an examination of host, behavioral, and pathogen-level predictors. Clin Infect Dis 2014; 60:753-63. [PMID: 25428411 DOI: 10.1093/cid/ciu943] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many patients suffer from recurrent Staphylococcus aureus infections, but there are few data examining recurrence predictors. METHODS We followed adults and children after treatment for S. aureus skin infections and their household contacts in Los Angeles and Chicago. We surveyed subjects for S. aureus body colonization, household fomite contamination, and behavioral and clinical factors at baseline and 3 and 6 months later. Using repeated measures modeling, we examined host, pathogen, behavioral, and clinical factors associated with recurrence. RESULTS Among 330 index subjects, 182 (55%) were infected with an isolate of the USA300 methicillin-resistant S. aureus (MRSA) genetic background. Recurrences occurred in 39% by month 3 and 51% by month 6. Among 588 household contacts, 10% reported a skin infection by month 3 and 13% by month 6. Among index subjects, recurrence was associated with (P < .05) Los Angeles site, diabetes, recent hospitalization, recent skin infection, recent cephalexin use, and household S. aureus or MRSA fomite contamination; recurrence was inversely associated with recent contact sports participation. In the multivariate model, independent predictors of recurrence in index patients were recent hospitalization, household MRSA fomite contamination, and lack of recent contact sports participation. Among household contacts, independent predictors of subsequent skin infection were Chicago site, antibiotic use in the prior year, and skin infection in the prior 3 months. CONCLUSIONS In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites.
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Affiliation(s)
- Loren G Miller
- Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance
| | - Samantha J Eells
- Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance
| | - Michael Z David
- Section of Infectious Diseases and Global Health, Department of Medicine Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
| | - Nancy Ortiz
- Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance
| | - Alexis R Taylor
- Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
| | - Neha Kumar
- Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
| | - Denise Cruz
- Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance
| | - Susan Boyle-Vavra
- Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
| | - Robert S Daum
- Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois
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Hand and nasal carriage of discordant Staphylococcus aureus isolates among urban jail detainees. J Clin Microbiol 2014; 52:3422-5. [PMID: 24958796 DOI: 10.1128/jcm.01190-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In 928 Dallas County Jail detainees, nasal carriage of Staphylococcus aureus was found in 32.8% (26.5% methicillin-susceptible Staphylococcus aureus [MSSA] and 6.3% methicillin-resistant S. aureus [MRSA]), and hand carriage was found in 24.9% (20.7% MSSA and 4.1% MRSA). Among MRSA nasal carriers, 41% had hand MRSA carriage; 29% with hand MRSA carriage had no nasal S. aureus carriage. The prevalence of carriage was not associated with duration of the jail stay up to 180 days.
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Saffari M, Koenig HG, Pakpour AH, Sanaeinasab H, Jahan HR, Sehlo MG. Personal hygiene among military personnel: developing and testing a self-administered scale. Environ Health Prev Med 2014; 19:135-42. [PMID: 24194117 PMCID: PMC3944032 DOI: 10.1007/s12199-013-0366-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 10/16/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Good personal hygiene (PH) behavior is recommended to prevent contagious diseases, and members of military forces may be at high risk for contracting contagious diseases. The aim of this study was to develop and test a new questionnaire on PH for soldiers. METHODS Participants were all male and from different military settings throughout Iran. Using a five-stage guideline, a panel of experts in the Persian language (Farsi) developed a 21-item self-administered questionnaire. Face and content validity of the first-draft items were assessed. The questionnaire was then translated and subsequently back-translated into English, and both the Farsi and English versions were tested in pilot studies. The consistency and stability of the questionnaire were tested using Cronbach's alpha and the test-retest strategy. The final scale was administered to a sample of 502 military personnel. Explanatory and confirmatory factor analyses evaluated the structure of the scale. Both the convergent and discriminative validity of the scale were also determined. RESULTS Cronbach's alpha coefficients were >0.85. Principal component analysis demonstrated a uni-dimensional structure that explained 59 % of the variance in PH behaviors. Confirmatory factor analysis indicated a good fit (goodness-of-fit index = 0.902; comparative fitness index = 0.923; root mean square error of approximation = 0.0085). CONCLUSIONS The results show that this new PH scale has solid psychometric properties for testing PH behaviors among an Iranian sample of military personnel. We conclude that this scale can be a useful tool for assessing PH behaviors in military personnel. Further research is needed to determine the scale's value in other countries and cultures.
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Affiliation(s)
- Mohsen Saffari
- />Health Research Center, Baqiyatallah University of Medical Sciences, 1435814783 Tehran, Iran
- />Department of Health Education, School of Health, Baqiyatallah University of Medical Sciences, 1435814783 Tehran, Iran
| | - Harold G. Koenig
- />Department of Psychiatry and Behavioural Sciences, Duke University Medical Center, Durham, NC USA
- />King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amir H. Pakpour
- />Department of Public Health, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Hormoz Sanaeinasab
- />Department of Health Education, School of Health, Baqiyatallah University of Medical Sciences, 1435814783 Tehran, Iran
| | - Hojat Rshidi Jahan
- />Department of Health Education, School of Health, Baqiyatallah University of Medical Sciences, 1435814783 Tehran, Iran
| | - Mohammad Gamal Sehlo
- />Department of Psychiatry, King Abdulaziz University, Jeddah, Saudi Arabia
- />Zagazig University, Zagazig, Egypt
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Abstract
Furunculosis is a deep infection of the hair follicle leading to abscess formation with accumulation of pus and necrotic tissue. Furuncles appear as red, swollen, and tender nodules on hair-bearing parts of the body, and the most common infectious agent is Staphylococcus aureus, but other bacteria may also be causative. In some countries, methicillin resistant S. aureus is the most common pathogen in skin and soft tissue infections which is problematic since treatment is difficult. Furunculosis often tends to be recurrent and may spread among family members. Some patients are carriers of S. aureus and eradication should be considered in recurrent cases. Solitary lesions should be incised when fluctuant, whereas patients with multiple lesions or signs of systemic disease or immunosuppression should be treated with relevant antibiotics. The diagnostic and therapeutic approach to a patient suspected of staphylococcosis should include a thorough medical history, clinical examination, and specific microbiological and biochemical investigations. This is particularly important in recurrent cases where culture swabs from the patient, family members, and close contacts are mandatory to identify and ultimately control the chain of infection. Focus on personal, interpersonal, and environmental hygiene issues is crucial to reduce the risk of contamination and recurrences.
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Affiliation(s)
| | - Charles B Kromann
- Department of Dermatology, Roskilde Hospital, Copenhagen University, Denmark
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11
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Farr AM, Marx MA, Weiss D, Nash D. Association of neighborhood-level factors with hospitalization for community-associated methicillin-resistant Staphylococcus aureus, New York City, 2006: a multilevel observational study. BMC Infect Dis 2013; 13:84. [PMID: 23406159 PMCID: PMC3614542 DOI: 10.1186/1471-2334-13-84] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 01/17/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection have increased in New York City, with substantial geographic variation across neighborhoods. While individual-level risk factors, such as age, sex, HIV infection, and diabetes have been described, the role of neighborhood-level factors (e.g., neighborhood HIV prevalence or income) has not been examined. METHODS To explore plausible neighborhood-level factors associated with CA-MRSA-related hospitalizations, a retrospective analysis was conducted using New York City hospital discharges from 2006 and New York City-specific survey and health department surveillance data. CA-MRSA-related hospitalizations were identified using diagnosis codes and admission information. Associations were determined by using sex-specific multilevel logistic regression. RESULTS The CA-MRSA hospitalization rate varied by more than six-fold across New York City neighborhoods. Females hospitalized with CA-MRSA had more than twice the odds of residing in neighborhoods in the highest quintile of HIV prevalence (adjusted odds ratio [AOR](Q5 vs. Q1) 2.3, 95% CI: 1.2, 2.7). Both males and females hospitalized with CA-MRSA had nearly twice the odds of residing in neighborhoods with moderately high proportion of men who have sex with men (MSM) residing in the neighborhood (males: AOR(Q4 vs. Q1) 1.7, 95% CI: 1.1, 2.7; females: AOR(Q4 vs. Q1) 2.0, 95% CI: 1.1, 3.6); but this association did not hold for neighborhoods in the highest quintile (males: AOR(Q5 vs. Q1) 1.2, 95% CI: 0.76, 1.8; females: AOR(Q5 vs. Q1) 1.5, 95% CI: 0.82, 2.7). CONCLUSIONS Neighborhood-level characteristics were associated with CA-MRSA hospitalization odds, independent of individual-level risk factors, and may contribute to the population-level burden of CA-MRSA infection.
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Affiliation(s)
- Amanda M Farr
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
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López-Aguilera S, Goñi-Yeste MDM, Barrado L, González-Rodríguez-Salinas MC, Otero JR, Chaves F. [Staphylococcus aureus nasal colonization in medical students: importance in nosocomial transmission]. Enferm Infecc Microbiol Clin 2013; 31:500-5. [PMID: 23352260 DOI: 10.1016/j.eimc.2012.12.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 12/05/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Staphylococcus aureus is the main pathogen causing nosocomial infections. Health professionals, including medical students, could be a source of transmission. The aims of the study were to determine the rate of nasal carriage of S.aureus susceptible and resistant to methicillin (MRSA) and evaluate the knowledge and adherence that students had about hand hygiene. METHODS The study included medical students attached to the Hospital Universitario 12 de Octubre (Madrid, Spain). We collected samples from both nasal vestibules, and the antimicrobial susceptibility was determined on all isolates. Data collection was performed using a self-administered questionnaire that included risk factors for colonization, hygiene habits and knowledge of hand hygiene protocols. RESULTS Of the 140 students included, 55 (39.3%) were colonized by S.aureus, and 3 (2,1%) by MRSA. The exposure to antibiotics in the last 3 months was lower in colonized students (12.3% vs. 25.9%, P=.03). Self-assessment showed that 56.4% of students almost never washed their hands before to attending to the first patient, and only 38.6% always washed after examining patients. More than a third (35.7%) ignored the hand hygiene protocol, and 38.6% had not received specific formation. CONCLUSIONS Medical students should be included in hospital infection control programs. Hand hygiene training should be given to students before they begin their practices in the hospital.
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Affiliation(s)
- Sara López-Aguilera
- Servicio de Microbiología Clínica, Hospital Universitario 12 de Octubre, Madrid, España
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Miramonti C, Rinkle JA, Iden S, Lincoln J, Huffman G, Riddell E, Kozak MA. The prevalence of methicillin-resistant staphylococcus aureus among out-of-hospital care providers and emergency medical technician students. PREHOSP EMERG CARE 2012; 17:73-7. [PMID: 23098136 DOI: 10.3109/10903127.2012.717169] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We compared the methicillin-resistant Staphylococcus aureus (MRSA) carrier rate among out-of-hospital care providers with greater than six months' experience in emergency medical services (EMS) care with that of emergency medical technician (EMT) students with two months or less of observation time as part of their clinical training. METHODS We conducted a prospective study utilizing a convenience sample of out-of-hospital care providers and EMT students in an urban EMS system operating in the Midwest during October and November 2006. One hundred thirty-four out-of-hospital care providers and 152 EMT students were tested for MRSA susceptibility using the cefoxitin disk diffusion method. RESULTS Contrary to our hypothesis, we did not find a statistically significant difference in MRSA nasal colonization between out-of-hospital care providers (4.5%; 95% confidence interval [CI] 1.0, 8.0) and EMT students (5.3%; 95% CI 1.7, 8.8). A subgroup analysis showed that among out-of-hospital care providers, paramedics had a higher rate of nasal colonization than EMTs (5.6% vs. 2.2%). CONCLUSION We found that out-of-hospital care providers and EMT students had higher nasal colonization rates than the reported rate for the U.S. population (0.084% at the time the study was conducted and 1.5% currently). It is imperative that both groups adhere to infection control practices.
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Affiliation(s)
- Charles Miramonti
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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Watkins RR, David MZ, Salata RA. Current concepts on the virulence mechanisms of meticillin-resistant Staphylococcus aureus. J Med Microbiol 2012; 61:1179-1193. [PMID: 22745137 DOI: 10.1099/jmm.0.043513-0] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) strains are prevalent bacterial pathogens that cause both health care and community-associated infections. Increasing resistance to commonly prescribed antibiotics has made MRSA a serious threat to public health throughout the world. The USA300 strain of MRSA has been responsible for an epidemic of community-associated infections in the US, mostly involving skin and soft tissue but also more serious invasive syndromes such as pneumonia, severe sepsis and endocarditis. MRSA strains are particularly serious and potentially lethal pathogens that possess virulence mechanisms including toxins, adhesins, enzymes and immunomodulators. One of these is Panton-Valentine leukocidin (PVL), a toxin associated with abscess formation and severe necrotizing pneumonia. Earlier studies suggested that PVL was a major virulence factor in community-associated MRSA infections. However, some recent data have not supported this association while others have, leading to controversy. Therefore, investigators continue to search for additional mechanisms of pathogenesis. In this review, we summarize the current understanding of the biological basis of MRSA virulence and explore future directions for research, including potential vaccines and antivirulence therapies under development that might allow clinicians to more successfully treat and prevent MRSA infections.
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Affiliation(s)
- Richard R Watkins
- Division of Infectious Diseases, Akron General Medical Center, Akron, OH 44302, USA
| | - Michael Z David
- Departments of Medicine and Health Studies, The University of Chicago, Chicago, IL, USA
| | - Robert A Salata
- Division of Infectious Diseases and HIV Medicine, University Hospitals Case Medical Center, Cleveland, OH, USA
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Farr AM, Aden B, Weiss D, Nash D, Marx MA. Trends in hospitalization for community-associated methicillin-resistant Staphylococcus aureus in New York City, 1997-2006: data from New York State's Statewide Planning and Research Cooperative System. Infect Control Hosp Epidemiol 2012; 33:725-31. [PMID: 22669235 DOI: 10.1086/666329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe trends in hospitalizations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection in New York City over 10 years and to explore the demographics and comorbidities of patients hospitalized with CA-MRSA infections. DESIGN Retrospective analysis of hospital discharges from New York State's Statewide Planning and Research Cooperative System database from 1997 to 2006. PATIENTS All patients greater than 1 year of age admitted to New York hospitals with diagnosis codes indicating MRSA who met the criteria for CA-MRSA on the basis of admission information and comorbidities. METHODS We determined hospitalization rates and compared demographics and comorbidities of patients hospitalized with CA-MRSA versus those hospitalized with all other non-MRSA diagnoses by multivariable logistic regression. RESULTS Of 18,226 hospitalizations with an MRSA diagnosis over 10 years, 3,579 (20%) were classified as community-associated. The CA-MRSA hospitalization rate increased from 1.47 to 10.65 per 100,000 people overall from 1997 to 2006. Relative to non-MRSA hospitalizations, men, children, Bronx and Manhattan residents, the homeless, patients with human immunodeficiency virus (HIV) infection, and persons with diabetes had higher adjusted odds of CA-MRSA hospitalization. CONCLUSIONS The CA-MRSA hospitalization rate appeared to increase between 1997 and 2006 in New York City, with residents of the Bronx and Manhattan, men, and persons with HIV infection or diabetes at increased odds of hospitalization with CA-MRSA. Further studies are needed to explore how changes in MRSA incidence, access to care, and other factors may have impacted these rates.
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Affiliation(s)
- Amanda M Farr
- Custom Data Analytics, Thomson Reuters, Washington, DC, USA.
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Uhlemann AC, Knox J, Miller M, Hafer C, Vasquez G, Ryan M, Vavagiakis P, Shi Q, Lowy FD. The environment as an unrecognized reservoir for community-associated methicillin resistant Staphylococcus aureus USA300: a case-control study. PLoS One 2011; 6:e22407. [PMID: 21818321 PMCID: PMC3144231 DOI: 10.1371/journal.pone.0022407] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 06/21/2011] [Indexed: 01/28/2023] Open
Abstract
Background Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are spreading, but the source of infections in non-epidemic settings remains poorly defined. Methods We carried out a community-based, case-control study investigating socio-demographic risk factors and infectious reservoirs associated with MRSA infections. Case patients presented with CA-MRSA infections to a New York hospital. Age-matched controls without infections were randomly selected from the hospital's Dental Clinic patient population. During a home visit, case and control subjects completed a questionnaire, nasal swabs were collected from index respondents and household members and standardized environmental surfaces were swabbed. Genotyping was performed on S. aureus isolates. Results We enrolled 95 case and 95 control subjects. Cases more frequently reported diabetes mellitus and a higher number of skin infections among household members. Among case households, 53 (56%) were environmentally contaminated with S. aureus, compared to 36 (38%) control households (p = .02). MRSA was detected on fomites in 30 (32%) case households and 5 (5%; p<.001) control households. More case patients, 20 (21%) were nasally colonized with MRSA than were control indexes, 2 (2%; p<.001). In a subgroup analysis, the clinical isolate (predominantly USA300), was more commonly detected on environmental surfaces in case households with recurrent MRSA infections (16/36, 44%) than those without (14/58, 24%, p = .04). Conclusions The higher frequency of environmental contamination of case households with S. aureus in general and MRSA in particular implicates this as a potential reservoir for recolonization and increased risk of infection. Environmental colonization may contribute to the community spread of epidemic strains such as USA300.
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Affiliation(s)
- Anne-Catrin Uhlemann
- Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, United States of America.
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Prevalence of methicillin-resistant Staphylococcus aureus in a Canadian inner-city shelter. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 18:249-52. [PMID: 18923739 DOI: 10.1155/2007/264257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/28/2006] [Accepted: 02/21/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) colonization is increasingly of concern in community settings. However, despite a recent outbreak in Calgary, Alberta, data on the prevalence of MRSA in Canadian communities are lacking. Globally, few studies have been performed in high-risk groups such as inner-city populations. METHODS A cross-sectional study of the prevalence of MRSA among residents and staff at three Ottawa, Ontario, shelters was conducted. All participants completed a questionnaire, and provided nasal swabs as well as one of rectal, anal or groin swabs. RESULTS Among 84 participants, the prevalence of MRSA colonization was 2.4%. Among the resident subgroup, the prevalence was 4.5%, while no MRSA isolates were found among 40 staff participants. All isolates were USA100 (CMRSA-2) subtypes. CONCLUSIONS The prevalence of MRSA colonization among residents is higher than baseline population rates, but is consistent with other inner-city populations. Although community outbreaks of USA300 and USA400 strains are increasingly reported, movement of nosocomial strains (ie, USA100 [CMRSA-2]) into communities remains an important avenue in the spread of MRSA and underscores the importance of nosocomial MRSA control.
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18
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Prevalence of USA300 colonization or infection and associated variables during an outbreak of community-associated methicillin-resistant Staphylococcus aureus in a marginalized urban population. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2011; 18:357-62. [PMID: 18978986 DOI: 10.1155/2007/597123] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2007] [Accepted: 08/07/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND In 2004, an outbreak of the USA300 strain of methicillin-resistant Staphylococcus aureus (MRSA) was identified in persons with histories of homelessness, illicit drug use or incarceration in the Calgary Health Region (Calgary, Alberta). A prevalence study was conducted to test the hypotheses for factors associated with USA300 colonization or infection. METHODS Participants were recruited at sites accessed by this marginalized population. Health care staff administered a questionnaire and collected crack pipes and nasal, axillary and skin infection swabs. Pipes and swabs were cultured according to standard techniques. MRSA isolates were further characterized by polymerase chain reaction (mecA, Panton-Valentine leukocidin and Staphylococcal cassette chromosome mec) and typing methods (pulsed-field gel electrophoresis, staphylococcal protein A typing and multilocus sequence typing). Colonization or infection was determined by having any one of nasal, axillary, skin infection or pipe swabs positive for USA300. Colonized participants had one or more nasal, axillary or pipe swab positive for USA300; infected participants had one or more skin infection swab positive for USA300. RESULTS The prevalence of USA300 colonization or infection among 271 participants was 5.5% (range 3.1% to 9.0%). USA300 cases were more likely to report manipulation of skin infections (OR 9.55; 95% CI 2.74 to 33.26); use of crack pipes was not significant despite identification of the USA300 strain on two of four crack pipes tested. USA300 cases were more likely to report drug use between sex trade workers and clients (OR 5.86; 95% CI 1.63 to 21.00), and with casual sex partners (OR 5.40; 95% CI 1.64 to 17.78). CONCLUSION Ongoing efforts to promote the appropriate treatment of skin infections in this population are warranted. The association of USA300 colonization or infection and drug use with sexual partners suggest a role for sexual transmission of the USA300 strain of MRSA.
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Phenotypic and molecular characterization of Acinetobacter clinical isolates obtained from inmates of California correctional facilities. J Clin Microbiol 2011; 49:2121-31. [PMID: 21450955 DOI: 10.1128/jcm.02373-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Acinetobacter spp. increasingly have been wreaking havoc in hospitals and communities worldwide. Although much has been reported regarding Acinetobacter isolates responsible for nosocomial infections, little is known about these organisms in correctional facilities. In this study, we performed species identification, examined the antibiotic resistance profiles, and determined the mechanisms of resistance and clonal relationships of 123 Acinetobacter isolates obtained from inmates of 20 California correctional facilities (CCFs). We found that 57.7% of the isolates belong to A. baumannii, followed by isolates of Acinetobacter genomic species 3 (gen. sp. 3; 23.6%) and of Acinetobacter gen. sp. 13TU (10.6%). Multidrug-resistant (MDR) CCF isolates were found in only six CCFs. Additionally, DNA sequences of gyrA and parC genes were consistent with fluoroquinolone (FQ) susceptibility phenotypes. Furthermore, the presence of class 1 integrons was detected in 15 CCF isolates, all of which are MDR. Integron-associated gene cassettes encode several aminoglycoside modification enzymes, which correlate with most of the aminoglycoside-resistant phenotypes. Antimicrobial susceptibility testing in the presence of Phe-Arg-β-naphthylamide dihydrochloride and 1-(1-naphthylmethyl)-piperazine indicated the involvement of efflux pumps in the FQ resistance of only a few CCF isolates. Finally, genetic profiling showed that there was no evidence of A. baumannii outbreaks in CCFs. Instead, our analyses revealed only limited clonal dissemination of mostly non-MDR A. baumannii strains in a few facilities. This study represents the first report to characterize phenotypic and molecular features of Acinetobacter isolates in correctional facilities, which provides a baseline for monitoring the antimicrobial resistance changes and dissemination patterns of these organisms in such specialized institutions.
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Weiss C, Kaminsky P, Boggs J, Ley C. Skin and soft-tissue infections in suburban primary care: epidemiology of methicillin-resistant Staphylococcus aureus and observations on abscess management. BMC Res Notes 2011; 4:33. [PMID: 21299887 PMCID: PMC3044093 DOI: 10.1186/1756-0500-4-33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Accepted: 02/07/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Reports from urban medical centers suggest that methicillin-resistant Staphylococcus aureus (MRSA) has become the most common cause of skin and soft-tissue infections (SSTIs). Risk factors for MRSA have been identified but have not been clinically useful. FINDINGS From May 2006-April 2007, we performed an observational study of 529 SSTIs among ambulatory patients in the urgent care departments of a large suburban primary-care practice. SSTIs were included if they produced pus or fluid. The proportion of MRSA was determined overall (defined as prevalence) and by SSTI diagnosis. Potential risk factors for MRSA were examined with multivariate analysis, and descriptive statistics were generated for follow-up and abscess management. The prevalence of MRSA was 22% and did not rise during the study. MRSA was isolated from 36% of abscesses, 15% of cellulitis, and 14% of other SSTIs. Independent risk factors for MRSA included a prior history of MRSA (adjusted odds ratio [aOR], 41.05; 95% confidence interval [CI], 11.4-147.3), a close contact with prior MRSA (aOR, 12.83; 95% CI, 4.2-39.2), erythema ≥10 cm (aOR, 2.59; 95% CI, 1.5-4.4), and abscess diagnosis (aOR, 3.19; 95% CI, 2.1-5.0). Prior MRSA had a positive predictive value of 88% for current MRSA. When both abscess diagnosis and erythema ≥10 cm were present, the proportion of MRSA was 59%. The vast majority of SSTIs (96 percent) resolved or improved within one week. Most abscesses, even small ones, were treated with antibiotics. Resource utilization was highest in those abscesses with erythema ≥10 cm. CONCLUSIONS The prevalence of MRSA is relatively low among SSTIs in suburban primary care. However, MRSA is common in the subgroup of abscesses with large erythema. While the effectiveness of adjunctive antibiotic therapy for large abscesses is unknown, drugs chosen for these infections should be active against MRSA. Most non-abscess SSTIs do not require treatment with a MRSA-active drug, and antibiotics are probably overused for small abscesses. A history of prior MRSA should be recorded in a patient's health record.
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Affiliation(s)
- Charles Weiss
- Urgent Care Palo Alto Medical Foundation 795 El Camino Real Palo Alto, CA 94301, USA
| | - Peggy Kaminsky
- Infection Control Palo Alto Medical Foundation 795 El Camino Real Palo Alto, CA 94301, USA
| | - John Boggs
- Infectious Diseases, Internal Medicine Palo Alto Medical Foundation 795 El Camino Real Palo Alto, CA 94301, USA
| | - Catherine Ley
- Caradon Consulting 338 Oakview Dr. San Carlos, CA 94070, USA
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Abstract
Multidrug-resistant bacteria have emerged as an increasing threat in many areas of medicine. The most prominent multidrug-resistant pathogens are methicillin-resistant S. aureus (MRSA), vancomycin-resistant MRSA (VMRSA), vancomycin-resistant enterococci (VRE), and Enterobacteriaceae with extended-spectrum beta-lactamase (ESBL). In particular, MRSA and VRE cause infections seen in ophthalmology. The lids, lacrimal duct, and ocular surface are frequently involved.
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Affiliation(s)
- T Ness
- Universitäts-Augenklinik Freiburg, Killianstr. 5, 79106 Freiburg.
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Methicillin-resistant Staphylococcus aureus colonization in HIV-infected outpatients is common and detection is enhanced by groin culture. Epidemiol Infect 2010; 139:998-1008. [PMID: 20843384 DOI: 10.1017/s0950268810002013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
SUMMARYAlthough high rates of clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in HIV-infected adults, data on MRSA colonization are limited. We enrolled HIV-infected adults receiving care at the Atlanta VA Medical Center. Swabs from each participant's nares and groin were cultured with broth enrichment for S. aureus. Of 600 HIV-infected adults, 79 (13%) were colonized with MRSA and 180 (30%) with methicillin-susceptible S. aureus. MRSA pulsed-field gel electrophoresis types USA300 (n=44, 54%) and USA500/Iberian (n=29, 35%) predominated. Inclusion of groin swabs increased MRSA detection by 24% and USA300 detection by 38%. In multivariate analysis, MRSA colonization compared to no MRSA colonization was associated with a history of MRSA clinical infection, rarely or never using condoms, and contact with prisons and jails. In summary, the prevalence of MRSA colonization was high in this study of HIV-infected adults and detection of USA300 was enhanced by groin culture.
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Todd ECD, Michaels BS, Greig JD, Smith D, Holah J, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 7. Barriers to reduce contamination of food by workers. J Food Prot 2010; 73:1552-65. [PMID: 20819372 DOI: 10.4315/0362-028x-73.8.1552] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Contamination of food and individuals by food workers has been identified as an important contributing factor during foodborne illness investigations. Physical and chemical barriers to prevent microbial contamination of food are hurdles that block or reduce the transfer of pathogens to the food surface from the hands of a food worker, from other foods, or from the environment. In food service operations, direct contact of food by hands should be prevented by the use of barriers, especially when gloves are not worn. Although these barriers have been used for decades in food processing and food service operations, their effectiveness is sometimes questioned or their use may be ignored. Physical barriers include properly engineered building walls and doors to minimize the flow of outside particles and pests to food storage and food preparation areas; food shields to prevent aerosol contamination of displayed food by customers and workers; work clothing designated strictly for work (clothing worn outdoors can carry undesirable microorganisms, including pathogens from infected family members, into the work environment); and utensils such as spoons, tongs, and deli papers to prevent direct contact between hands and the food being prepared or served. Money and ready-to-eat foods should be handled as two separate operations, preferably by two workers. Chemical barriers include sanitizing solutions used to remove microorganisms (including pathogens) from objects or materials used during food production and preparation and to launder uniforms, work clothes, and soiled linens. However, laundering as normally practiced may not effectively eliminate viral pathogens.
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Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
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Risk factors for community-associated Staphylococcus aureus infections: results from parallel studies including methicillin-resistant and methicillin-sensitive S. aureus compared to uninfected controls. Epidemiol Infect 2010; 139:419-29. [PMID: 20513251 DOI: 10.1017/s0950268810001111] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Despite the increasing burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections, the risk factors are not well understood. We conducted a hypothesis-generating study using three parallel case-control studies to identify risk factors for CA-MRSA and community-associated methicillin-susceptible S. aureus (CA-MSSA) infections. In the multivariate model, antimicrobial use in the 1-6 months prior to culture was associated with CA-MRSA infection compared to CA-MSSA [adjusted odds ratio (aOR) 1·7, P=0·07] cases. Antimicrobial use 1-6 months prior to culture (aOR 1·8, P=0·04), history of boils (aOR 1·6, P=0·03), and having a household member who was a smoker (aOR 1·3, P=0·05) were associated with CA-MRSA compared to uninfected community controls. The finding of an increased risk of CA-MRSA infection associated with prior antimicrobial use highlights the importance of careful antimicrobial stewardship.
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Otter JA, French GL. Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Europe. THE LANCET. INFECTIOUS DISEASES 2010; 10:227-39. [DOI: 10.1016/s1473-3099(10)70053-0] [Citation(s) in RCA: 231] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Okano JT, Blower S. Are correctional facilities amplifying the epidemic of community-acquired methicillin-resistant Staphylococcus aureus? Nat Rev Microbiol 2010; 8:83. [DOI: 10.1038/nrmicro2200-c1] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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"Spider bite" lesions are usually diagnosed as skin and soft-tissue infections. J Emerg Med 2009; 41:473-81. [PMID: 19939602 DOI: 10.1016/j.jemermed.2009.09.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 09/06/2009] [Accepted: 09/20/2009] [Indexed: 11/22/2022]
Abstract
BACKGROUND Many people seek medical attention for skin lesions and other conditions they attribute to spider bites. Prior experience suggests that many of these lesions have alternate causes, especially infections with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). OBJECTIVES This study determined the percentage of emergency department (ED) patients reporting a "spider bite" who received a clinical diagnosis of spider bite by their physician vs. other etiologies, and if the diagnoses correlated with demographic risk factors for developing CA-MRSA infections. METHODS ED patients who reported that their condition was caused by a "spider bite" were prospectively enrolled in an anonymous, voluntary survey regarding details of their illness and demographic information. Discharge diagnoses were also collected and categorized as: spider bite, bite from other animal (including unknown arthropod), infection, or other diagnosis. RESULTS There were 182 patients enrolled over 23 months. Seven patients (3.8%) were diagnosed with actual spider bites, 9 patients (4.9%) with bites from other animals, 156 patients (85.7%) with infections, and 6 patients (3.3%) were given other diagnoses. Four patients were given concurrent diagnoses in two categories, and 8 (4.4%) did not have the diagnosis recorded on the data collection instrument. No statistically significant associations were found between the patients' diagnostic categories and the demographic risk factors for CA-MRSA assessed. CONCLUSION ED patients reporting a "spider bite" were most frequently diagnosed with skin and soft-tissue infections. Clinically confirmed spider bites were rare, and were caused by black widow spiders when the species could be identified.
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Predominance of methicillin-resistant Staphylococcus aureus among pathogens causing skin and soft tissue infections in a large urban jail: risk factors and recurrence rates. J Clin Microbiol 2008; 46:3222-7. [PMID: 18685002 DOI: 10.1128/jcm.01423-08] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains emerged as pathogens outside of the health care environment. Epidemic foci of CA-MRSA infections were reported in jails and prisons, but risk factors for MRSA infection there are not known. All skin and soft tissue infections (SSTIs) cultured in the Cook County Jail in March 2004 to August 2005 were reviewed. Demographic and clinical risk factors were compared among patients with methicillin-susceptible S. aureus (MSSA) SSTIs and those with MRSA SSTIs. Antibiotic susceptibilities were recorded, and we performed multilocus sequence typing on a sample of MRSA isolates. There were 378 SSTIs from different patients requiring culture, of which 240 (63.5%) were of MRSA and 43 (11.4%) were of MSSA; 84.8% of S. aureus isolates were MRSA. MRSA- and MSSA-infected patients were similar with regard to age, gender, ethnicity, previous exposure to the jail, and comorbidities. In the 12 months prior to the index culture, MRSA patients were more likely to have received a beta-lactam antibiotic (25% versus 9%; P = 0.02). Among 26 MRSA strains, 24 (92%) had the sequence type 8 (ST8) genotype. Within 6 months, 14% (95% confidence interval, 8.7% to 22.3%) of MRSA SSTI patients in the jail had a recurrent SSTI compared with 8.8% (95% confidence interval, 2.1% to 32.6%) of MSSA SSTI patients (P = 0.004). MRSA is the predominant cause of SSTIs requiring culture in the jail. Few risk factors differentiated MRSA from MSSA SSTIs, and detainee patients with MRSA SSTIs are at high risk for recurrent SSTIs.
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Multiclonal outbreak of methicillin-resistant Staphylococcus aureus infections on a collegiate football team. Epidemiol Infect 2008; 137:85-93. [DOI: 10.1017/s095026880800068x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
SUMMARYAn outbreak of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) occurred in a college football team in August 2006. Of 109 players on the team roster, 88 (81%) were interviewed during a cohort investigation. Twenty-five cases were identified, six of which were culture-confirmed. Available culture isolates were typed by pulsed-field gel electrophoresis (PFGE), which identified two different MRSA strains associated with the outbreak. Playing positions with the most physical contact (offensive linemen, defensive linemen, and tight ends) had the greatest risk of infection [risk ratio (RR) 5·1, 95% confidence interval (CI) 2·3–11·5. Other risk factors included recent skin trauma (RR 1·9, 95% CI 0·95–3·7), use of therapeutic hydrocollator packs (RR 2·5, 95% CI 1·1–5·7), and miscellaneous training equipment use (RR 2·1, 95% CI 1·1–4·1). The outbreak was successfully controlled through team education and implementation of improved infection-control practices and hygiene policies.
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McBrien S, Felizardo GR, Orr DG, Raymond MJ. Using focus groups to revise an educational booklet for people living with methicillin-resistant Staphylococcus aureus (MRSA). Health Promot Pract 2008; 9:19-28. [PMID: 18166664 DOI: 10.1177/1524839907312095] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of methicillin-resistant staphylococcus aureus (MRSA) has grown in epidemic proportions; in many individuals, MRSA causes recurrent infections. MRSA infections can be transmitted from person to person through direct contact or contact with contaminated objects. Once confined to hospitalized individuals, MRSA is now seen in otherwise healthy individuals and congregate community settings. There is a demand for educational materials to guide MRSA patients in self-care, preventing recurrences, and reducing transmission. In 2004, Tacoma-Pierce County Health Department in Washington State led the effort to create an educational booklet for people with MRSA. Due to resource constraints, it was created without audience testing. In 2005, the revision of Living With MRSA involved audience testing using two focus groups comprising people living with MRSA and their families. This report describes the work of an interdisciplinary professional work group using focus groups to revise an educational booklet for people living with MRSA as patients, family members, and caregivers.
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Affiliation(s)
- Shawn McBrien
- Tacoma-Pierce County Health Department in Tacoma, Washington, USA
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Bloomfield SF, Aiello AE, Cookson B, O'Boyle C, Larson EL. The effectiveness of hand hygiene procedures in reducing the risks of infections in home and community settings including handwashing and alcohol-based hand sanitizers. Am J Infect Control 2007. [PMCID: PMC7115270 DOI: 10.1016/j.ajic.2007.07.001] [Citation(s) in RCA: 156] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kajita E, Okano JT, Bodine EN, Layne SP, Blower S. Modelling an outbreak of an emerging pathogen. Nat Rev Microbiol 2007; 5:700-9. [PMID: 17703226 DOI: 10.1038/nrmicro1660] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
To illustrate the usefulness of mathematical models to the microbiology and medical communities, we explain how to construct and apply a simple transmission model of an emerging pathogen. We chose to model, as a case study, a large (>8,000 reported cases) on-going outbreak of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA) in the Los Angeles County Jail. A major risk factor for CA-MRSA infection is incarceration. Here, we show how to design a within-jail transmission model of CA-MRSA, parameterize the model and reconstruct the outbreak. The model is then used to assess the severity of the outbreak, predict the epidemiological consequences of a catastrophic outbreak and design effective interventions for outbreak control.
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Affiliation(s)
- Emily Kajita
- Semel Institute of Neuroscience & Human Behavior & Department of Psychiatry, UCLA AIDS Institute, David Geffen School of Medicine at UCLA, 1100 Glendon Avenue PH2, Los Angeles, California 90024, USA
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Cook HA, Furuya EY, Larson E, Vasquez G, Lowy FD. Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007; 44:410-3. [PMID: 17205449 DOI: 10.1086/510681] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2006] [Accepted: 10/19/2006] [Indexed: 11/03/2022] Open
Abstract
Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus has not been documented. As part of a survey conducted in northern Manhattan, we encountered 3 households in which heterosexual transmission was responsible for new community-associated methicillin-resistant S. aureus infection. The vaginal and inguinal isolates obtained from the sexual partners were USA 300. This report documents an important and previously unrecognized means of community-associated methicillin-resistant S. aureus colonization and transmission for these potentially invasive strains.
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Affiliation(s)
- Heather A Cook
- Department of Medicine, Division of Infectious Diseases, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA
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Gilbert M, MacDonald J, Gregson D, Siushansian J, Zhang K, Elsayed S, Laupland K, Louie T, Hope K, Mulvey M, Gillespie J, Nielsen D, Wheeler V, Louie M, Honish A, Keays G, Conly J. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006; 175:149-54. [PMID: 16804118 PMCID: PMC1490001 DOI: 10.1503/cmaj.051565] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The USA300 strain of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause severe infection and is increasingly recognized as a cause of community outbreaks. In 2004, an outbreak was identified in the Calgary Health Region (CHR). METHODS MRSA isolates were identified with standard methods at a central regional laboratory and typed via pulsed-field gel electrophoresis (PFGE). Isolates were tested by PCR for mecA, Panton-Valentine leukocidin (PVL), SCCmec, and spa genes. Cases were defined as such if a clinical isolate of the USA300 strain was noted between January 1 and September 30, 2004, and the patient had lived or traveled in CHR within 2 years before symptom onset. Demographic, clinical and risk data on all such cases were collected from several sources for statistical analysis. A case was defined as high-risk if the patient had a history of drug use, homelessness or incarceration. RESULTS Of 40 isolates with the USA300 PFGE pattern, all tested positive for PVL, SCCmec type IVa and spa type 008. Almost all infections (39/40, 98%) involved skin and soft tissues, except for 1 death from necrotizing hemorrhagic pneumonia; a notable proportion (38%) required hospital admission or intravenous antimicrobial therapy. The outbreak centred on the high-risk population in CHR (70%; risk ratio 169.4, 95% confidence interval 86.1-333.0). INTERPRETATION People with histories of illicit drug use, homelessness or recent incarceration were at highest risk for infection with CA-MRSA. The emergence and spread of this virulent strain has important implications for treatment and public health in Canada.
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Affiliation(s)
- Mark Gilbert
- Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, Ont
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