Non-multiresistant methicillin-resistant Staphylococcus aureus in the community. Next chapter in the story of staphylococcal sepsis?

Ask, speak up, and be proactive: Empowering patient infection control to prevent health care-acquired infections

BACKGROUND

Over the last decade, there has been a slow shift toward the more active engagement of patients and families in preventing health care-associated infections (HCAIs). This pilot study aimed to examine the receptiveness of hospital patients toward a new empowerment tool aimed at increasing awareness and engagement of patients in preventing HCAI.

METHODS

Patients from the surgical department were recruited and randomized into 2 groups: active and control. Patients in the active arm were given an empowerment tool, whereas control patients continued with normal practices. Pre- and postsurveys were administered.

RESULTS

At the baseline survey, just over half of the participants were highly willing to assist with infection control strategies. Participants were significantly more likely to be willing to ask a doctor or nurse a factual question then a challenging question. After discharge, 23 of the 60 patients reported discussing a health concern with a staff member; however, only 3 participants asked a staff member to wash their hands.

CONCLUSION

Our results suggest that patients would like to be more informed about HCAIs and are willing to engage with staff members to assist with the prevention of infections while in the hospital setting. Further work is going to need to be undertaken to ascertain the best strategies to promote engagement and participation in infection control activities.

Community-onset methicillin-resistant Staphylococcus aureus bacteremia in Northern Australia

BACKGROUND

Community-onset infections caused by methicillin-resistant Staphylococcus aureus (COMRSA) are being increasingly reported worldwide.

METHODS

A retrospective study was performed of 14 patients with 15 episodes of COMRSA bacteremia (COMRSAB) admitted to the Royal Darwin Hospital, Northern Territory, Australia from 1998 to 2001. Isolates from COMRSAB episodes underwent extended susceptibility testing and molecular typing by pulsed field gel electrophoresis and allotyping of the staphylococcal cassette chromosome mec (SCCmec) region by polymerase chain reaction.

RESULTS

The proportion of community-onset S. aureus bacteremia episodes that were due to COMRSA increased from 9% in 1998 to 20% in 2001. The clinical features of COMRSAB were similar to those seen with methicillin-susceptible strains, including sepsis, endocarditis and metastatic infection. Ineffective empiric antimicrobial therapy was administered in the majority (80%) of episodes. All COMRSAB isolates tested contained allotype IV SCCmec, which is commonly found in community isolates of MRSA and rarely found in isolates from healthcare-associated MRSA infection.

CONCLUSION

The increasing incidence of COMRSAB in our region has resulted in the addition of vancomycin to standard empiric therapy in certain patients with suspected S. aureus bacteremia acquired in the community.

Emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infection in Queensland, Australia

OBJECTIVES

To investigate the incidence and epidemiology of non-multiresistant methicillin-resistant Staphylococcus aureus (nmMRSA) infection in south-east Queensland, Australia.

STUDY DESIGN

A retrospective survey was done of hospital records of all patients who had non-multiresistant MRSA isolated at Ipswich Hospital (a 250-bed general hospital, 40 km south-west of Brisbane, Queensland, Australia) between March 2000 and June 2001. Laboratory typing of these isolates was done with antibiogram, pulsed-field gel electrophoresis, bacteriophage typing and coagulase gene typing.

RESULTS

There were 44 infections caused by nmMRSA. Seventeen infections (39%) occurred in patients from the south-west Pacific Islands (predominantly Samoa, Tonga and New Zealand). Laboratory typing showed that the isolates in Pacific Islanders were Pacific Island strains, and 16/17 of these infections were community acquired. Twenty-three infections (52%) occurred in Caucasians. Eleven of the isolates from Caucasians (48%) were a new predominantly community-acquired strain that we have termed the 'R' pulsotype, nine (39%) were Pacific Island strains, and three (13%) were health care institution-associated strains. Four infections occurred in patients who were not Caucasians or Pacific Islanders. Overall, 34 of all 44 infections (77%) were community acquired.

CONCLUSIONS

Non-multiresistant MRSA infection, relatively frequently observed in Pacific Islanders in south-east Queensland, is now a risk for Caucasians as well, and is usually community acquired. Clinicians should consider taking microbiological specimens for culture and antimicrobial susceptibility testing in patients with suspected staphylococcal infections who are not responding to empirical therapy with beta-lactam antibiotics.