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Pan D, Chung S, Nielsen E, Niederman MS. Aspiration Pneumonia. Semin Respir Crit Care Med 2024; 45:237-245. [PMID: 38211629 DOI: 10.1055/s-0043-1777772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
Aspiration pneumonia is a lower respiratory tract infection that results from inhalation of foreign material, often gastric and oropharyngeal contents. It is important to distinguish this from a similar entity, aspiration with chemical pneumonitis, as treatment approaches may differ. An evolving understanding of the human microbiome has shed light on the pathogenesis of aspiration pneumonia, suggesting that dysbiosis, repetitive injury, and inflammatory responses play a role in its development. Risk factors for aspiration events involve a complex interplay of anatomical and physiological dysfunctions in the nervous, gastrointestinal, and pulmonary systems. Current treatment strategies have shifted away from anaerobic organisms as leading pathogens. Prevention of aspiration pneumonia primarily involves addressing oropharyngeal dysphagia, a significant risk factor for aspiration pneumonia, particularly among elderly individuals and those with cognitive and neurodegenerative disorders.
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Affiliation(s)
- Di Pan
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Samuel Chung
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Erik Nielsen
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Michael S Niederman
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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Ayyal Salman H, Yaakop AS, Al-Rimawi F, Ahmad Makhtar AM, Mousa M, Semreen MH, Alharbi NS. Ephedra alte extracts' GC-MS profiles and antimicrobial activity against multidrug-resistant pathogens (MRSA). Heliyon 2024; 10:e27051. [PMID: 38444505 PMCID: PMC10912435 DOI: 10.1016/j.heliyon.2024.e27051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 02/08/2024] [Accepted: 02/22/2024] [Indexed: 03/07/2024] Open
Abstract
The extracts of E. alte offer promising potential as renewable resources for various chemical derivative products aimed at addressing antibiotic resistance. These extracts exhibited significant activity against methicillin-resistant Staphylococcus aureus (MRSA), a strain known for its resistance to multiple antibiotics. The extracts were found to be effective against several common antibiotics, including Imipenem, Ampicillin, Penicillin G, Oxacillin, and Amoxicillin-clavulanate. GC-MS analysis revealed that the phytoconstituents of E. alte extracts, obtained using both methanol and ethyl acetate, consist of a diverse range of 83 and 160 phytocompounds, respectively. These organic compounds serve as important biochemical precursors for the synthesis of vitamins E and K1, and exhibit antioxidant, antimicrobial, and anti-inflammatory properties in both plants and microorganisms. Notable compounds identified include fatty acids (such as palmitic acid, dodecanoic acid, sebacic acid, pentadecanoic acid, myristic acid, stearic acid, behenic acid, and linoelaidic acid), phytosterols (Campesterol, β-sitosterol, Stigmast-5-ene), sugars (D-fructose, Fructofuranans), terpenoids (Phytol, citronellol), and phenolic acids (Protocatechoic acid, shikimic acid). The antimicrobial activity of all E. alte extracts was found to be superior to that of mupirocin and ciprofloxacin, as observed in susceptibility testing against MRSA ATCC 43300 and other pathogenic bacteria and fungi. It is likely that the combined action of the antimicrobial components within the E. alte extract bypasses the mechanisms employed by MRSA to protect itself from antibiotics. Further experiments are needed to investigate the individual effects of each pure compound and their potential synergistic interactions, which may enhance their overall performance.
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Affiliation(s)
- Haya Ayyal Salman
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Amira Suriaty Yaakop
- School of Biological Sciences, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Fuad Al-Rimawi
- Chemistry Department, Faculty of Science and Technology, Al-Quds University, P.O. Box 2002, Jerusalem, Palestine
| | - Ana Masara Ahmad Makhtar
- Green Biopolymer Coating and Packaging Centre, School of Industrial Technology, Universiti Sains Malaysia, 11800, Penang, Malaysia
| | - Muath Mousa
- BIOSCOPE Research Group, LAQV-REQUIMTE, Department of Chemistry, NOVA School of Science and Technology, NOVA University Lisbon, 2829-516, Caparica, Portugal
| | - Mohammad H. Semreen
- Research Institute for Medical and Health Sciences (RIHMS), University of Sharjah, Sharjah, United Arab Emirates
| | - Naiyf S. Alharbi
- Department of Botany and Microbiology, College of Science, King Saud University, P. O. Box 2455, Riyadh, 11451, Saudi Arabia
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3
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Nigo M, Rasmy L, Mao B, Kannadath BS, Xie Z, Zhi D. Deep learning model for personalized prediction of positive MRSA culture using time-series electronic health records. Nat Commun 2024; 15:2036. [PMID: 38448409 PMCID: PMC10917736 DOI: 10.1038/s41467-024-46211-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/08/2024] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) poses significant morbidity and mortality in hospitals. Rapid, accurate risk stratification of MRSA is crucial for optimizing antibiotic therapy. Our study introduced a deep learning model, PyTorch_EHR, which leverages electronic health record (EHR) time-series data, including wide-variety patient specific data, to predict MRSA culture positivity within two weeks. 8,164 MRSA and 22,393 non-MRSA patient events from Memorial Hermann Hospital System, Houston, Texas are used for model development. PyTorch_EHR outperforms logistic regression (LR) and light gradient boost machine (LGBM) models in accuracy (AUROCPyTorch_EHR = 0.911, AUROCLR = 0.857, AUROCLGBM = 0.892). External validation with 393,713 patient events from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset in Boston confirms its superior accuracy (AUROCPyTorch_EHR = 0.859, AUROCLR = 0.816, AUROCLGBM = 0.838). Our model effectively stratifies patients into high-, medium-, and low-risk categories, potentially optimizing antimicrobial therapy and reducing unnecessary MRSA-specific antimicrobials. This highlights the advantage of deep learning models in predicting MRSA positive cultures, surpassing traditional machine learning models and supporting clinicians' judgments.
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Affiliation(s)
- Masayuki Nigo
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA.
- Division of Infectious Diseases, Department of Medicine, Houston Methodist Hospital, Texas Medical Center, Houston, TX, USA.
| | - Laila Rasmy
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bingyu Mao
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bijun Sai Kannadath
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ, USA
| | - Ziqian Xie
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Degui Zhi
- McWilliams School of Biomedical Informatics, University of Texas Health Science Center at Houston, Houston, TX, USA
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Zhou S, Hu X, Wang Y, Fei W, Sheng Y, Que H. The Global Prevalence of Methicillin-Resistant Staphylococcus Aureus in Patients with Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis. Diabetes Metab Syndr Obes 2024; 17:563-574. [PMID: 38333763 PMCID: PMC10849909 DOI: 10.2147/dmso.s446911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/16/2024] [Indexed: 02/10/2024] Open
Abstract
Objective Diabetic foot ulcer (DFU) frequently leads to infections, with infected DFUs being a common cause of amputation. Infection by methicillin-resistant Staphylococcus aureus (MRSA) notably increases the necessity for amputation and surgical debridement in affected individuals. Consequently, determining the prevalence and trends of MRSA in patients with DFU is of critical importance. This study aimed to assess the global prevalence and to identify trends in the occurrence of MRSA in tissue or wound swab samples from DFU patients. Methods We conducted a comprehensive literature search across PubMed, Embase, Scopus, and Ovid, spanning from the inception of these databases to July 2023, imposing no language restrictions. The inclusion criteria required that the studies report on 30 or more patients with DFU. Additionally, we categorized our analysis based on geographic region, publication date, and the economic status of the patient's domicile. Our primary endpoint was to ascertain the prevalence of MRSA in DFUs. This systematic review has been registered at (https://www.crd.york.ac.uk/prospero/), with the identifier CRD 42023444360. Results Our analysis encompassed 40 studies involving 12,924 patients across 20 countries. We found that the overall prevalence of MRSA in DFU was 17% (95% Confidence Interval [CI] 0.14-0.20). Regional prevalence varied significantly: in South America, it was 61% (95% CI 0.46-0.76), in North America 20% (95% CI 0.12-0.27), in Europe 19% (95% CI 0.14-0.25), in Africa 13% (95% CI 0.06-0.20), and in other subgroups 11% (95% CI 0.08-0.15). The prevalence of MRSA in DFUs also differed according to the economic status of the countries: 19% (95% CI 0.15-0.23) in high-income countries, 24% (95% CI 0.1-0.37) in upper-middle-income countries, 11% (95% CI 0.07-0.15) in lower-middle-income countries, and 20% (95% CI 0.13-0.27) in low-income countries. Notably, there has been a decline in MRSA prevalence, from 25% before 2010 to 9% thereafter. Conclusion This meta-analysis reveals a decreasing yet still significant global prevalence of MRSA in DFUs. This trend has important implications for antimicrobial resistance and underscores the need for developing targeted programs focusing on infection prevention and exploring alternative therapeutic strategies.
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Affiliation(s)
- Siyuan Zhou
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Xiaojie Hu
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yunfei Wang
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Wenting Fei
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Yuqin Sheng
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
| | - Huafa Que
- Department of Traditional Chinese Surgery, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
- Longhua Clinical Medical College, Shanghai University of Traditional Chinese Medicine, Shanghai, People’s Republic of China
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5
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Symons E, VanWanzeele D, McCulloh R. Methicillin-Resistant Staphylococcus aureus Surveillance Testing: More Than Meets the Nare. Hosp Pediatr 2024; 14:e113-e115. [PMID: 38247372 DOI: 10.1542/hpeds.2023-007614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Evan Symons
- Division of Hospital Medicine, Children's Nebraska, Omaha, Nebraska
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Devin VanWanzeele
- Division of Hospital Medicine, Children's Nebraska, Omaha, Nebraska
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
| | - Russell McCulloh
- Division of Hospital Medicine, Children's Nebraska, Omaha, Nebraska
- Division of Infectious Disease
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, Nebraska
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Haghpanah F, Lin G, Klein E. Deconstructing the effects of stochasticity on transmission of hospital-acquired infections in ICUs. ROYAL SOCIETY OPEN SCIENCE 2023; 10:230277. [PMID: 37711144 PMCID: PMC10498044 DOI: 10.1098/rsos.230277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 08/17/2023] [Indexed: 09/16/2023]
Abstract
The inherent stochasticity in transmission of hospital-acquired infections (HAIs) has complicated our understanding of transmission pathways. It is particularly difficult to detect the impact of changes in the environment on acquisition rate due to stochasticity. In this study, we investigated the impact of uncertainty (epistemic and aleatory) on nosocomial transmission of HAIs by evaluating the effects of stochasticity on the detectability of seasonality of admission prevalence. For doing so, we developed an agent-based model of an ICU and simulated the acquisition of HAIs considering the uncertainties in the behaviour of the healthcare workers (HCWs) and transmission of pathogens between patients, HCWs, and the environment. Our results show that stochasticity in HAI transmission weakens our ability to detect the effects of a change, such as seasonality patterns, on acquisition rate, particularly when transmission is a low-probability event. In addition, our findings demonstrate that data compilation can address this issue, while the amount of required data depends on the size of the said change and the degree of uncertainty. Our methodology can be used as a framework to assess the impact of interventions and provide decision-makers with insight about the minimum required size and target of interventions in a healthcare facility.
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Affiliation(s)
| | - Gary Lin
- One Health Trust, Washington, DC, USA
| | - Eili Klein
- One Health Trust, Washington, DC, USA
- Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Viola GM, Szvalb AD, Malek AE, Chaftari AM, Hachem R, Raad II. Prevention of device-related infections in patients with cancer: Current practice and future horizons. CA Cancer J Clin 2023; 73:147-163. [PMID: 36149820 PMCID: PMC9992006 DOI: 10.3322/caac.21756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022] Open
Abstract
Over the past several years, multifaceted advances in the management of cancer have led to a significant improvement in survival rates. Throughout patients' oncological journeys, they will likely receive one or more implantable devices for the administration of fluids and medications as well as management of various comorbidities and complications related to cancer therapy. Infections associated with these devices are frequent and complex, often necessitating device removal, increasing health care costs, negatively affecting quality of life, and complicating oncological care, usually leading to delays in further life-saving cancer therapy. Herein, the authors comprehensively review multiple evidence-based recommendations along with best practices, expert opinions, and novel approaches for the prevention of diverse device-related infections. The authors present many general principles for the prevention of these infections followed by specific device-related recommendations in a systematic manner. The continuous involvement and meaningful cooperation between regulatory entities, industry, specialty medical societies, hospitals, and infection control-targeted interventions, along with primary care and consulting health care providers, are all vital for the sustained reduction in the incidence of these preventable infections.
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Affiliation(s)
- George M Viola
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ariel D Szvalb
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alexandre E Malek
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Anne-Marie Chaftari
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ray Hachem
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Issam I Raad
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Miller LG, Singh R, Eells SJ, Gillen D, McKinnell JA, Park S, Tjoa T, Chang J, Rashid S, Macias-Gil R, Heim L, Gombosev A, Kim D, Cui E, Lequieu J, Cao C, Hong SS, Peterson EM, Evans KD, Launer B, Tam S, Bolaris M, Huang SS. Chlorhexidine and Mupirocin for Clearance of Methicillin-Resistant Staphylococcus aureus Colonization After Hospital Discharge: A Secondary Analysis of the Changing Lives by Eradicating Antibiotic Resistance Trial. Clin Infect Dis 2023; 76:e1208-e1216. [PMID: 35640877 PMCID: PMC10169430 DOI: 10.1093/cid/ciac402] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 05/11/2022] [Accepted: 05/18/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The CLEAR Trial demonstrated that a multisite body decolonization regimen reduced post-discharge infection and hospitalization in methicillin-resistant Staphylococcus aureus (MRSA) carriers. Here, we describe decolonization efficacy. METHODS We performed a large, multicenter, randomized clinical trial of MRSA decolonization among adult patients after hospital discharge with MRSA infection or colonization. Participants were randomized 1:1 to either MRSA prevention education or education plus decolonization with topical chlorhexidine, oral chlorhexidine, and nasal mupirocin. Participants were swabbed in the nares, throat, axilla/groin, and wound (if applicable) at baseline and 1, 3, 6, and 9 months after randomization. The primary outcomes of this study are follow-up colonization differences between groups. RESULTS Among 2121 participants, 1058 were randomized to decolonization. By 1 month, MRSA colonization was lower in the decolonization group compared with the education-only group (odds ration [OR] = 0.44; 95% confidence interval [CI], .36-.54; P ≤ .001). A similar magnitude of reduction was seen in the nares (OR = 0.34; 95% CI, .27-.42; P < .001), throat (OR = 0.55; 95% CI, .42-.73; P < .001), and axilla/groin (OR = 0.57; 95% CI, .43-.75; P < .001). These differences persisted through month 9 except at the wound site, which had a relatively small sample size. Higher regimen adherence was associated with lower MRSA colonization (P ≤ .01). CONCLUSIONS In a randomized, clinical trial, a repeated post-discharge decolonization regimen for MRSA carriers reduced MRSA colonization overall and at multiple body sites. Higher treatment adherence was associated with greater reductions in MRSA colonization.
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Affiliation(s)
- Loren G Miller
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Raveena Singh
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Samantha J Eells
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Daniel Gillen
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - James A McKinnell
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Steven Park
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Tom Tjoa
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Justin Chang
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Syma Rashid
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Raul Macias-Gil
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Lauren Heim
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Adrijana Gombosev
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Diane Kim
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Eric Cui
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Jennifer Lequieu
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Chenghua Cao
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Suzie S Hong
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Ellena M Peterson
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Kaye D Evans
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Bryn Launer
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Steven Tam
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
| | - Michael Bolaris
- Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, Torrance, California, USA
| | - Susan S Huang
- Division of Infectious Diseases and Health Policy Research Institute, University of California, Irvine School of Medicine, Irvine, California, USA
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Shoaib M, Aqib AI, Muzammil I, Majeed N, Bhutta ZA, Kulyar MFEA, Fatima M, Zaheer CNF, Muneer A, Murtaza M, Kashif M, Shafqat F, Pu W. MRSA compendium of epidemiology, transmission, pathophysiology, treatment, and prevention within one health framework. Front Microbiol 2023; 13:1067284. [PMID: 36704547 PMCID: PMC9871788 DOI: 10.3389/fmicb.2022.1067284] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/19/2022] [Indexed: 01/12/2023] Open
Abstract
Staphylococcus aureus is recognized as commensal as well as opportunistic pathogen of humans and animals. Methicillin resistant strain of S. aureus (MRSA) has emerged as a major pathogen in hospitals, community and veterinary settings that compromises the public health and livestock production. MRSA basically emerged from MSSA after acquiring SCCmec element through gene transfer containing mecA gene responsible for encoding PBP-2α. This protein renders the MRSA resistant to most of the β-lactam antibiotics. Due to the continuous increasing prevalence and transmission of MRSA in hospitals, community and veterinary settings posing a major threat to public health. Furthermore, high pathogenicity of MRSA due to a number of virulence factors produced by S. aureus along with antibiotic resistance help to breach the immunity of host and responsible for causing severe infections in humans and animals. The clinical manifestations of MRSA consist of skin and soft tissues infection to bacteremia, septicemia, toxic shock, and scalded skin syndrome. Moreover, due to the increasing resistance of MRSA to number of antibiotics, there is need to approach alternatives ways to overcome economic as well as human losses. This review is going to discuss various aspects of MRSA starting from emergence, transmission, epidemiology, pathophysiology, disease patterns in hosts, novel treatment, and control strategies.
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Affiliation(s)
- Muhammad Shoaib
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
| | - Amjad Islam Aqib
- Department of Medicine, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Iqra Muzammil
- Department of Medicine, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Noreen Majeed
- Institute of Microbiology, University of Agriculture, Faisalabad, Pakistan
| | - Zeeshan Ahmad Bhutta
- Laboratory of Biochemistry and Immunology, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | | | - Mahreen Fatima
- Faculty of Biosciences, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | | | - Afshan Muneer
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Maheen Murtaza
- Department of Zoology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Muhammad Kashif
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Furqan Shafqat
- Department of Microbiology, Cholistan University of Veterinary and Animal Sciences, Bahawalpur, Pakistan
| | - Wanxia Pu
- Key Laboratory of New Animal Drug Project, Gansu Province/Key Laboratory of Veterinary Pharmaceutical Development, Ministry of Agriculture and Rural Affairs/Lanzhou Institute of Husbandry and Pharmaceutical Sciences of the Chinese Academy of Agricultural Sciences, Lanzhou, China
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10
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Synergistic effects of length of stay and prior MDRO carriage on the colonization and co-colonization of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenemase-producing Enterobacterales across healthcare settings. Infect Control Hosp Epidemiol 2023; 44:31-39. [PMID: 35351218 DOI: 10.1017/ice.2022.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenemase-producing Enterobacterales (CPE) co-colonization and to compare risk factors between healthcare facility types. DESIGN, SETTING, AND PARTICIPANTS We conducted a 3-year cross-sectional study among patients admitted to an acute-care hospital (ACH) and its 6 closely affiliated intermediate- and long-term care facilities (ILTCFs) in Singapore in June and July of 2014-2016. METHODS Specimens were concurrently collected from nares, axillae, and groins for MRSA detection, and from rectum or stool for VRE and CPE detection. Co-colonization was defined as having >1 positive culture of MRSA/VRE/CPE. Multinomial logistic regression was performed to determine predictors of co-colonization. RESULTS Of 5,456 patients recruited, 176 (3.2%) were co-colonized, with higher prevalence among patients in ITCFs (53 of 1,255, 4.2%) and the ACH (120 of 3,044, 3.9%) than LTCFs (3 of 1,157, 0.3%). MRSA/VRE was the most common type of co-colonization (162 of 5,456, 3.0%). Independent risk factors for co-colonization included male sex (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.37-2.80), prior antibiotic therapy of 1-3 days (OR, 10.39; 95% CI, 2.08-51.96), 4-7 days (OR, 4.89; 95% CI, 1.01-23.68), >7 days (OR, 11.72; 95% CI, 2.81-48.85), and having an open wound (OR, 2.34; 95% CI, 1.66-3.29). Additionally, we detected the synergistic interaction of length of stay >14 days and prior multidrug-resistant organism (MDRO) carriage on co-colonization. Having an emergency surgery was a significant predictor of co-colonization in ACH patients, and we detected a dose-response association between duration of antibiotic therapy and co-colonization in ILTCF patients. CONCLUSIONS We observed common and differential risk factors for MDRO co-colonization across healthcare settings. This study has identified at-risk groups that merit intensive interventions, particularly patients with prior MDRO carriage and longer length of stay.
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Obanda BA, Cook EAJ, Fèvre EM, Bebora L, Ogara W, Wang SH, Gebreyes W, Ngetich R, Wandede D, Muyodi J, Blane B, Coll F, Harrison EM, Peacock SJ, Gitao GC. Characteristics of Staphylococcus aureus Isolated from Patients in Busia County Referral Hospital, Kenya. Pathogens 2022; 11:pathogens11121504. [PMID: 36558838 PMCID: PMC9781741 DOI: 10.3390/pathogens11121504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/05/2022] [Accepted: 12/08/2022] [Indexed: 12/13/2022] Open
Abstract
Staphylococcus aureus is an important pathogen associated with hospital, community, and livestock-acquired infections, with the ability to develop resistance to antibiotics. Nasal carriage by hospital inpatients is a risk for opportunistic infections. Antibiotic susceptibility patterns, virulence genes and genetic population structure of S. aureus nasal isolates, from inpatients at Busia County Referral Hospital (BCRH) were analyzed. A total of 263 inpatients were randomly sampled, from May to July 2015. The majority of inpatients (85.9%) were treated empirically with antimicrobials, including ceftriaxone (65.8%) and metronidazole (49.8%). Thirty S. aureus isolates were cultured from 29 inpatients with a prevalence of 11% (10.3% methicillin-susceptible S. aureus (MSSA), 0.8% methicillin resistant S. aureus (MRSA)). Phenotypic and genotypic resistance was highest to penicillin-G (96.8%), trimethoprim (73.3%), and tetracycline (13.3%) with 20% of isolates classified as multidrug resistant. Virulence genes, Panton-Valentine leukocidin (pvl), toxic shock syndrome toxin-1 (tsst-1), and sasX gene were detected in 16.7%, 23.3% and 3.3% of isolates. Phylogenetic analysis showed 4 predominant clonal complexes CC152, CC8, CC80, and CC508. This study has identified that inpatients of BCRH were carriers of S. aureus harbouring virulence genes and resistance to a range of antibiotics. This may indicate a public health risk to other patients and the community.
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Affiliation(s)
- Benear Apollo Obanda
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya
- Global One Health Initiative, Office of International Affairs, The Ohio State University, Columbus, OH 43210, USA
- Centre for Microbiology Research Nairobi, Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya
| | - Elizabeth A. J. Cook
- International Livestock Research Institute, Nairobi P.O. Box 30709-00100, Kenya
- Correspondence: (E.A.J.C.); (E.M.F.)
| | - Eric M. Fèvre
- International Livestock Research Institute, Nairobi P.O. Box 30709-00100, Kenya
- Institute of Infection, Veterinary & Ecological Sciences, Leahurst Campus, University of Liverpool, Chester High Road, Neston CH64 7TE, UK
- Correspondence: (E.A.J.C.); (E.M.F.)
| | - Lilly Bebora
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya
| | - William Ogara
- Department of Public Health, Pharmacology and Toxicology, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya
| | - Shu-Hua Wang
- Global One Health Initiative, Office of International Affairs, The Ohio State University, Columbus, OH 43210, USA
- Division of Infectious Disease, Department of Internal Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Wondwossen Gebreyes
- Global One Health Initiative, Office of International Affairs, The Ohio State University, Columbus, OH 43210, USA
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA
| | - Ronald Ngetich
- Centre for Microbiology Research Nairobi, Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya
| | - Dolphine Wandede
- Centre for Microbiology Research Nairobi, Kenya Medical Research Institute, Nairobi P.O. Box 54840-00200, Kenya
| | - Johnstone Muyodi
- The Centre for Infectious and Parasitic Diseases Control Research, Busia P.O. Box 3-50400, Kenya
| | - Beth Blane
- Department of Medicine, University of Cambridge, Cambridge CB2 2QQ, UK
| | - Francesc Coll
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, University of London, London WC1E 7HT, UK
| | - Ewan M. Harrison
- Department of Medicine, University of Cambridge, Cambridge CB2 2QQ, UK
- Wellcome Sanger Institute, Hinxton CB10 1SA, UK
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Sharon J. Peacock
- Department of Medicine, University of Cambridge, Cambridge CB2 2QQ, UK
| | - George C. Gitao
- Department of Veterinary Pathology, Microbiology and Parasitology, University of Nairobi, Nairobi P.O. Box 29053-00625, Kenya
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Ito H. A Potential Effect of Gram-Negative Bacilli Colonization on Periprosthetic Joint Infection. Arthroplast Today 2022; 17:136. [PMID: 36158458 PMCID: PMC9490568 DOI: 10.1016/j.artd.2022.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 11/27/2022] Open
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Hosry J, Wang T, Assaad M, Kamel R, Homsy S, Sleiman E, Glaser A, Mobarakai NK. The Clinical Value of Methicillin-Resistant Staphylococcus aureus Nasal Screening in the Management of Diabetic Foot Infections. INT J LOW EXTR WOUND 2022:15347346221125332. [PMID: 36113032 DOI: 10.1177/15347346221125332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) remains an important risk factor for diabetic foot infections (DFIs). We explored herein the clinical value of MRSA-nasal screening in the management of DFIs. In this retrospective case-control study, patients admitted with a DFI between 1/1/2014-6/30/2020 were studied and divided into cases (positive MRSA-nasal screening) and controls (negative MRSA-nasal). We included 171 patients (22 cases and 149 controls). MRSA nasal screening had a negative predictive value (NPV) of 86%. Compared to controls, cases were treated with intravenous vancomycin for a longer duration: (median [IQR], 5[3,11] vs 2[2,6]) days, P = .037). In multivariate analysis, a negative MRSA nasal screening was associated with a 74% decreased risk of AKI (OR = 0.26, 95% CI = 0.07-0.89). MRSA nasal screening in patients admitted with DFI has a high NPV. Obtained early, it can shorten the duration of intravenous vancomycin, consequently preventing AKI.
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Affiliation(s)
- Jeff Hosry
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Taylor Wang
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Marc Assaad
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Ralph Kamel
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Sylvester Homsy
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Elsa Sleiman
- Department of Internal Medicine, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Allison Glaser
- Department of Infectious Diseases, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
| | - Neville K Mobarakai
- Department of Infectious Diseases, 7601Staten Island University Hospital/Northwell Health, Staten Island, NY, USA
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Adediran T, Hitchcock S, O’Hara LM, Michalski JM, Johnson JK, Calfee DP, Miller LG, Hazen TH, Harris AD, Rasko DA. Comparative Genomics Identifies Features Associated with Methicillin-Resistant Staphylococcus aureus (MRSA) Transmission in Hospital Settings. mSphere 2022; 7:e0011622. [PMID: 35578992 PMCID: PMC9241550 DOI: 10.1128/msphere.00116-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 04/03/2022] [Indexed: 01/28/2023] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a serious public health concern in the United States. Patients colonized and/or infected can transmit MRSA to healthcare workers and subsequent patients However, the components of this transmission chain are just becoming evident, including certain patient factors, specific patient-healthcare worker interactions, and microbial factors. We conducted a comparative genomic analysis of 388 isolates from four hospitals in three states: Maryland, California, and New York. Isolates from nasal surveillance or clinical cultures were categorized as high, moderate, or low transmission surrogate outcomes based on the number of times the species was identified on the gloves or gowns of healthcare providers. The comparative analyses included a single gene, multigene, and core genome phylogenetic analysis, as well as a genome-wide association analysis to identify molecular signatures associated with the observed transmission surrogate outcomes, geographic origin, or sample source of isolation. Based on the phylogenetic analysis, 95% (n = 372) of the MRSA isolates were from four well-described genomic clades, with most of the isolates being part of the USA300 containing clade (n = 187; 48%). Genome-wide association studies also identified genes that were exclusive or prevalent among specific geographic locations. The identified genes provide insights into the transmission dynamics of MRSA isolates providing additional insights into the basis of the geographical differences of MRSA for molecular diagnostics. IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) is considered a serious threat to public health and contributes to the dissemination of S. aureus in both the healthcare and community setting. Transmission of MRSA between patients via healthcare worker (HCW) has been described. However, what is not understood are the genetic determinants that contribute to the transmission of MRSA from patients to HCWs. In this study, we demonstrated that certain genes may be associated with transmission in the hospital setting.
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Affiliation(s)
- Timileyin Adediran
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Stephanie Hitchcock
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Lyndsay M. O’Hara
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Jane M. Michalski
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - J. Kristie Johnson
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David P. Calfee
- Division of Infectious Diseases, Weill Cornell Medicine, New York, USA
| | - Loren G. Miller
- Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California, USA
| | - Tracy H. Hazen
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Anthony D. Harris
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - David A. Rasko
- Institute for Genome Sciences, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Microbiology and Immunology, University of Maryland School of Medicine, Baltimore, Maryland, USA
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Tălăpan D, Rafila A. Five-Year Survey of Asymptomatic Colonization with Multidrug-Resistant Organisms in a Romanian Tertiary Care Hospital. Infect Drug Resist 2022; 15:2959-2967. [PMID: 35706926 PMCID: PMC9191195 DOI: 10.2147/idr.s360048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 02/05/2023] Open
Abstract
Purpose To determine the rate of carriage of multidrug-resistant organisms (MDROs) between 2015 and 2019 among patients admitted to the National Institute of Infectious Diseases “Prof. Dr. Matei Balș,” from Bucharest, Romania. Methods Nasal, throat, and rectal/perirectal screening swabs were collected either immediately or during the first 24 hours of admission and sent to the microbiology laboratory where the following MDROs were identified: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)-producing Enterobacterales, carbapenem-resistant/carbapenemase-producing Enterobacterales (CRE/CPE), multidrug-resistant/extended drug-resistant Acinetobacter baumannii (MDR/XDR-AB), and multidrug-resistant/extended drug-resistant Pseudomonas aeruginosa (MDR/XDR-PA). Results A total of 5083 unique patients were screened for MRSA and 5008 for VRE, ESBL/CRE/CPE, MDR/XDR-AB, and MDR/XDR-PA. MRSA was detected in 8.24% of patients, VRE in 17.67%, ESBL Enterobacterales in 25.85%, and CPE in 6.13%. MDR/XDR-AB was found in 1.59% and MDR/XDR-PA in 1.91% of patients. The rates of carriage increased between 2015 and 2019 for MRSA (7.23–7.6%), VRE (9–16.68%), CPE (1.15–6.77%), MDR/XDR-PA (1.15–1.91%), and MDR/XDR-AB (1.15–2.04%). OXA-48-type carbapenemase was predominant in Klebsiella pneumoniae (68.62%) and Escherichia coli (89.47%). CPE bacteria other than Klebsiella pneumoniae and Escherichia coli identified in our study carried mostly metallo-beta-lactamase (n = 28, 84.85%). Conclusion In this study, 37% of the unique patients screened over five years were found to be MDRO carriers. The proportion of VRE and CPE rectal carriers increased significantly between 2015 and 2019. The most frequently isolated carbapenemase was the OXA-48 type.
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Affiliation(s)
- Daniela Tălăpan
- Microbiology Laboratory, National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania.,Department of Microbiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Alexandru Rafila
- Microbiology Laboratory, National Institute of Infectious Diseases "Prof. Dr. Matei Balș", Bucharest, Romania.,Department of Microbiology, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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Methicillin-resistant Staphylococcus aureus nasal colonization in people living with HIV and healthy people in Kathmandu, Nepal. Future Sci OA 2022; 8:FSO769. [PMID: 35070354 PMCID: PMC8765096 DOI: 10.2144/fsoa-2021-0103] [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: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 11/26/2022] Open
Abstract
Aim: This study aimed to compare methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization in people living with HIV (PLHIV) and healthy people from Kathmandu. Methods: MRSA isolated from 400 nasal swabs was screened using a cefoxitin disc and confirmed by the presence of the mecA gene. Results: MRSA nasal carriers among the PLHIV and control cohorts were 3.5% (7 out of 200) and 5.0% (10 out of 200), respectively. All the MRSA from PLHIV and most of MRSA from healthy controls were PVL positive. Longer duration of antiretroviral therapy significantly reduces the risk of MRSA nasal colonization in PLHIV. Conclusion: There is no significant difference in MRSA nasal colonization in PLHIV and healthy controls in this study region. People living with HIV (PLHIV) are more prone to the colonization of Staphylococcus aureus (S. aureus) and therefore to methicillin resistance S. aureus (MRSA). In this study, we compared the MRSA colonization in PLHIV with that in healthy people in the Kathmandu Valley and found no significant variation in the prevalence of MRSA in the two study groups. We found that longer antiretroviral therapy reduces the risk of MRSA colonization in PLHIV. Recent history of hospitalization increases the chances of MRSA colonization among PLHIV as well as healthy people.
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Forrester JD, Cao S, Schaps D, Liou R, Patil A, Stave C, Sokolow SH, Leo GD. Influence of Socioeconomic and Environmental Determinants of Health on Human Infection and Colonization with Antibiotic-Resistant and Antibiotic-Associated Pathogens: A Scoping Review. Surg Infect (Larchmt) 2022; 23:209-225. [DOI: 10.1089/sur.2021.348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Joseph D. Forrester
- Division of General Surgery, Department of Surgery, Stanford University, Stanford, California, USA
| | - Siqi Cao
- School of Medicine, Stanford University, Stanford, California, USA
| | - Diego Schaps
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Raymond Liou
- School of Medicine, Stanford University, Stanford, California, USA
| | | | - Christopher Stave
- School of Medicine, Stanford University, Stanford, California, USA
- Lane Medical Library, Stanford University, Stanford, California, USA
| | - Susanne H. Sokolow
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
- Marine Science Institute, University of California Santa Barbara, Santa Barbara, California, USA
| | - Giulio De Leo
- Woods Institute for the Environment, Stanford University, Stanford, California, USA
- Hopkins Marine Station, Stanford University, Stanford, California, USA
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18
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Agrawal V, Valson AT, Bakthavatchalam YD, Kakde S, Mohapatra A, David VG, Alexander S, Jacob S, Jude Prakash JA, Veeraraghavan B, Varughese S. Skin Colonizers and Catheter Associated Blood Stream Infections in Incident Indian Dialysis Patients. Indian J Nephrol 2022; 32:34-41. [PMID: 35283564 PMCID: PMC8916144 DOI: 10.4103/ijn.ijn_400_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/11/2020] [Accepted: 02/03/2021] [Indexed: 11/04/2022] Open
Abstract
Introduction Skin colonization is a risk factor for multi-drug resistant (MDR) catheter-associated bloodstream infections (CABSI). This study aimed to determine the prevalence and spectrum of skin colonizing MDR organisms in incident HD patients and their correlation with CABSI. Methods This single-center prospective cohort study included consecutive adult incident HD patients who underwent tunneled or non-tunneled internal jugular vein HD catheter insertion between June 1, 2017 and October 31, 2017. Nasal, axillary, and exit site swabs were obtained prior to catheter insertion, at 14-21 days, and 28-35 days after catheter insertion. Results Forty-three patients (69.7% male, 32.5% diabetic) were included and provided baseline swabs, while 29 and 10 patients respectively were available for follow-up swabs. MDR bacterial colonization, MRSA colonization, and MDR gram-negative colonization on the baseline set of swabs were seen in 76.7%, 69.7%, and 9.3% patients respectively. Of the 29 patients with at least two consecutive sets of swabs, 79.3% showed persistent colonization by MDR gram-positive organisms, most commonly by MRSA. Six patients developed a CABSI during the follow-up period (incidence rate 3.7 per 1000 patient days), 83.4% were gram negative, and in only one instance (16.6%) was the bacterial strain identical to that which had previously colonized the skin. Conclusions Three-fourths of HD patients were colonized by MDR bacteria prior to HD initiation. Despite the majority being persistently colonized by MDR gram-positive organisms, CABSIs were predominantly gram negative.
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Affiliation(s)
- Varun Agrawal
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Anna T. Valson
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Shailesh Kakde
- Department of Nephrology, Jupiter Hospital, Baner, Pune, Maharashtra, India
| | - Anjali Mohapatra
- Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Vinoi George David
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Suceena Alexander
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Shibu Jacob
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
| | | | - Balaji Veeraraghavan
- Department of Microbiology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Santosh Varughese
- Department of Nephrology, Christian Medical College, Vellore, Tamil Nadu, India
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Hirano Y, Shinmoto K, Okada Y, Suga K, Bombard J, Murahata S, Shrestha M, Ocheja P, Tanaka A. Machine Learning Approach to Predict Positive Screening of Methicillin-Resistant Staphylococcus aureus During Mechanical Ventilation Using Synthetic Dataset From MIMIC-IV Database. Front Med (Lausanne) 2021; 8:694520. [PMID: 34869405 PMCID: PMC8635043 DOI: 10.3389/fmed.2021.694520] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 10/22/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Mechanically ventilated patients are susceptible to nosocomial infections such as ventilator-associated pneumonia. To treat ventilated patients with suspected infection, clinicians select appropriate antibiotics. However, decision-making regarding the use of antibiotics for methicillin-resistant Staphylococcus aureus (MRSA) is challenging, because of the lack of evidence-supported criteria. This study aims to derive a machine learning model to predict MRSA as a possible pathogen responsible for infection in mechanically ventilated patients. Methods: Data were collected from the Medical Information Mart for Intensive Care (MIMIC)-IV database (an openly available database of patients treated at the Beth Israel Deaconess Medical Center in the period 2008-2019). Of 26,409 mechanically ventilated patients, 809 were screened for MRSA during the mechanical ventilation period and included in the study. The outcome was positivity to MRSA on screening, which was highly imbalanced in the dataset, with 93.9% positive outcomes. Therefore, after dividing the dataset into a training set (n = 566) and a test set (n = 243) for validation by stratified random sampling with a 7:3 allocation ratio, synthetic datasets with 50% positive outcomes were created by synthetic minority over-sampling for both sets individually (synthetic training set: n = 1,064; synthetic test set: n = 456). Using these synthetic datasets, we trained and validated an XGBoost machine learning model using 28 predictor variables for outcome prediction. Model performance was evaluated by area under the receiver operating characteristic (AUROC), sensitivity, specificity, and other statistical measurements. Feature importance was computed by the Gini method. Results: In validation, the XGBoost model demonstrated reliable outcome prediction with an AUROC value of 0.89 [95% confidence interval (CI): 0.83-0.95]. The model showed a high sensitivity of 0.98 [CI: 0.95-0.99], but a low specificity of 0.47 [CI: 0.41-0.54] and a positive predictive value of 0.65 [CI: 0.62-0.68]. Important predictor variables included admission from the emergency department, insertion of arterial lines, prior quinolone use, hemodialysis, and admission to a surgical intensive care unit. Conclusions: We were able to develop an effective machine learning model to predict positive MRSA screening during mechanical ventilation using synthetic datasets, thus encouraging further research to develop a clinically relevant machine learning model for antibiotics stewardship.
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Affiliation(s)
- Yohei Hirano
- Department of Emergency and Critical Care Medicine, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Keito Shinmoto
- Department of Internal Medicine, Tokyo bay Ichikawa Urayasu Medical Center, Chiba, Japan
| | - Yohei Okada
- Department of Primary Care and Emergency Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuhiro Suga
- Department of Mechanical Engineering, Faculty of Engineering, Kogakuin University, Tokyo, Japan
| | | | | | | | - Patrick Ocheja
- Graduate School of Informatics, Kyoto University, Kyoto, Japan
| | - Aiko Tanaka
- Department of Anesthesiology and Intensive Care Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
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He WP, Gu FF, Zhang J, Li XX, Xiao SZ, Zeng Q, Ni YX, Han LZ. Molecular characteristics and risk factor analysis of Staphylococcus aureus colonization put insight into CC1 colonization in three nursing homes in Shanghai. PLoS One 2021; 16:e0253858. [PMID: 34618818 PMCID: PMC8496869 DOI: 10.1371/journal.pone.0253858] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022] Open
Abstract
Research indicates that Staphylococcus aureus colonization in the elderly with predisposing risks is associated with subsequent infection. However, the molecular epidemiology and risk factors for S. aureus colonization among residents and staff in nursing homes (NHs) in China remain unclear. A multicenter study was conducted in three NHs in Shanghai between September 2019 and October 2019. We explored the prevalence, molecular epidemiology, and risk factors for S. aureus colonization. All S. aureus isolates were characterized based on antimicrobial resistance, virulence genes, multilocus sequence typing (MLST), staphylococcus protein A (spa) typing, and staphylococcal cassette chromosome mec (SCCmec) typing. NH records were examined for potential risk factors for S. aureus colonization. S. aureus and methicillin-resistant S. aureus (MRSA) isolates were detected in 109 (100 residents and 9 staff, 19.8%, 109/551) and 28 (24 residents and 4 staff, 5.1%, 28/551) subjects among 496 residents and 55 staff screened, respectively. Compared to methicillin-susceptible S. aureus isolates, all 30 MRSA isolates had higher resistance rates to most antibiotics except minocycline, rifampicin, linezolid, vancomycin, and teicoplanin. Sequence type (ST) 1 (21.3%) was the most common sequence type, and t127 (20.5%) was the most common spa type among 122 S. aureus isolates. SCCmec type I (70%) was the dominant clone among all MRSA isolates. CC1 (26/122, 21.3%) was the predominant complex clone (CC), followed by CC398 (25/122, 20.5%), CC5 (20/122, 16.4%) and CC188 (18/122, 14.8%). Female sex (OR, 1.70; 95% CI, 1.04-2.79; P = 0.036) and invasive devices (OR, 2.19; 95% CI, 1.26-3.81; P = 0.006) were independently associated with S. aureus colonization.
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Affiliation(s)
- Wei-Ping He
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei-Fei Gu
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji Zhang
- Department of Clinical Laboratory, Shanghai People’s Hospital of Putuo District, Shanghai, China
| | - Xin-Xin Li
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shu-Zhen Xiao
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Zeng
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yu-Xing Ni
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li-Zhong Han
- Department of Laboratory Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Clinical Microbiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Tafish RT, Alkhaldi AF, Bourghli A, Althunian TA. Effectiveness of topical vancomycin in the prevention of spinal surgical site infections: a retrospective cohort study. Antimicrob Resist Infect Control 2021; 10:136. [PMID: 34565484 PMCID: PMC8474778 DOI: 10.1186/s13756-021-01006-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 09/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The risk of surgical site infections (SSIs), particularly methicillin-resistant Staphylococcus aureus (MRSA) SSIs, after spinal surgeries is one of the most daunting experiences to patients and surgeons. Some authors suggest applying vancomycin powder on the wound before skin closure to minimize the risk of SSIs; however, this practice is not supported by well-established evidence. This study sought to assess the effectiveness of topical (i.e. intra-wound) vancomycin in minimizing the risk of SSIs in patients who underwent spinal surgeries at a Saudi hospital. METHODS A retrospective cohort study was conducted using the hospital database. Patients who underwent spinal surgeries from the period of 09/2013 to 09/2019 were included and followed up (observed from the time of the surgery) to 30 days (surgeries without implants) or 90 days (with implants). The odds ratio (OR) of the primary outcome between vancomycin treated versus non-treated patients was estimated using a logistic regression model adjusting for the measured confounders. A sensitivity analysis was conducted using propensity score analysis (inverse probability of treatment weighting [IPTW] with stabilized weights) to control for confounding by indication. All study analyses were completed using RStudio Version 1.2.5033. RESULTS We included 81 vancomycin treated vs. 375 untreated patients with 28 infections (8/81 vs. 20/375; respectively). The adjusted OR of SSIs between the two groups was 0.40 (95% confidence interval [CI] 0.11 to 1.34). The result of the propensity score analysis was consistent (OR: 0.97 [95% CI 0.35 to 2.68]). CONCLUSIONS We could not find a lower association of SSIs with intra-wound vancomycin in patients who underwent spinal surgeries. Further studies are needed to assess benefits of using topical vancomycin for this indication vs. the risk of antimicrobial resistance.
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Affiliation(s)
- Rawan T Tafish
- Kingdom Hospital and Consulting Clinics, Riyadh, Saudi Arabia
| | | | - Anouar Bourghli
- Kingdom Hospital and Consulting Clinics, Riyadh, Saudi Arabia
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22
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Pei S, Liljeros F, Shaman J. Identifying asymptomatic spreaders of antimicrobial-resistant pathogens in hospital settings. Proc Natl Acad Sci U S A 2021; 118:e2111190118. [PMID: 34493678 PMCID: PMC8449327 DOI: 10.1073/pnas.2111190118] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/03/2021] [Indexed: 12/14/2022] Open
Abstract
Antimicrobial-resistant organisms (AMROs) can colonize people without symptoms for long periods of time, during which these agents can spread unnoticed to other patients in healthcare systems. The accurate identification of asymptomatic spreaders of AMRO in hospital settings is essential for supporting the design of interventions against healthcare-associated infections (HAIs). However, this task remains challenging because of limited observations of colonization and the complicated transmission dynamics occurring within hospitals and the broader community. Here, we study the transmission of methicillin-resistant Staphylococcus aureus (MRSA), a prevalent AMRO, in 66 Swedish hospitals and healthcare facilities with inpatients using a data-driven, agent-based model informed by deidentified real-world hospitalization records. Combining the transmission model, patient-to-patient contact networks, and sparse observations of colonization, we develop and validate an individual-level inference approach that estimates the colonization probability of individual hospitalized patients. For both model-simulated and historical outbreaks, the proposed method supports the more accurate identification of asymptomatic MRSA carriers than other traditional approaches. In addition, in silica control experiments indicate that interventions targeted to inpatients with a high-colonization probability outperform heuristic strategies informed by hospitalization history and contact tracing.
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Affiliation(s)
- Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10027;
| | - Fredrik Liljeros
- Department of Sociology, Stockholm University, 114 19 Stockholm, Sweden
- Department of Public Health Sciences, Karolinska Institutet, 171 77 Solna, Sweden
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY 10027;
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Sharabiani HR, Sadeghi J, Pirzade T, Rezaee MA, Ghotaslou R, Laghousi D, Sefidan FY, Kafil HS, Nikbakht M, Mazraeh FN, Hematyar Y. Comparison of superantigens and attachment factors genes of Staphylococcus aureus in clinical isolates and nasal colonizers in the same patients. Microb Pathog 2021; 154:104860. [PMID: 33771631 DOI: 10.1016/j.micpath.2021.104860] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/12/2021] [Accepted: 03/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Staphylococcus aureus (S. aureus) is a bacterial pathogen can cause a wide range of nosocomial infections. Nasal colonization by S.aureus plays important role both in the epidemiology and pathogenesis of infection. OBJECTIVES The purpose of this study was to investigate the association of clinical isolates and nasal colonizers of S. aureus in the same patients by molecular methods, and their antibiotic susceptibility pattern. METHODS A total of 181 S. aureus isolates were collected from 100 patients admitted that including 100 clinical isolates and 81 nasal swabs from the same patients (19 cases were found as noncarriers). Superantigens and adhesion genes were identified by PCR. Molecular typing of the isolates was performed by repetitive element polymerase chain reaction (Rep-PCR). Antimicrobial susceptibility pattern of the isolates was conducted by disk diffusion. MIC of the isolates to vancomycin was determined by microbroth dilution. The ability of S. aureus isolates to form biofilm was determined by microtiter plate assay. RESULTS The most frequent adhesion gene in both clinical isolates and nasal colonizer was clfA with 93% and 76%, respectively. Staphylococcal enterotoxin A (SEA) was the most commonly superantigen (68%) in both nasal colonizers (71.6%) and clinical isolates (65%). The highest resistance rate was to erythromycin (45.3%) with 36% and 56.8% in clinical and nasal colonizer isolates, respectively. All S. aureus isolates were susceptible to linezolid and vancomycin. Multiple drug resistance (MDR) was detected in 36% (n = 65) of the isolates. Biofilm formation was identified in 160 (88.4%) isolates with 87% and 90% in clinical isolates and nasal colonizers, respectively. Repetitive element polymerase chain reaction (Rep-PCR) typing divided 181 S. aureus isolates into six clusters. Twelve isolates from clinical isolates and nasal carriers were closely related. CONCLUSION There is a high concordance rate between colonizing and clinical isolates of S. aureus in terms of adhesion factors and superantigen genes. It is suggested that nasal decolonization could be effective in the preventing of S. aureus infections.
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Affiliation(s)
- Hamideh Richi Sharabiani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Javid Sadeghi
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran; Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Tahere Pirzade
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Ahangarzadeh Rezaee
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Reza Ghotaslou
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Delara Laghousi
- Social Determinants of Health Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran.
| | - Fateme Yeghane Sefidan
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Samadi Kafil
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojtaba Nikbakht
- Meshginshahr Health Center Laboratory, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Fariba Naeimi Mazraeh
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Yalda Hematyar
- Department of Bacteriology and Virology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
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Popovich KJ, Snitkin ES, Zawitz C, Aroutcheva A, Payne D, Thiede SN, Schoeny M, Green SJ, Hayden MK, Hota B, Weinstein RA. Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks. Clin Infect Dis 2021; 71:323-331. [PMID: 31425575 DOI: 10.1093/cid/ciz818] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/16/2019] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. METHODS Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks.We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. RESULTS There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001). CONCLUSIONS A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.
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Affiliation(s)
- Kyle J Popovich
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Chad Zawitz
- Clinical Coordinator of HIV and Infectious Disease Services, Cermak Health Services, Cook County Health, Chicago, Illinois, USA
| | - Alla Aroutcheva
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
| | - Darjai Payne
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Stephanie N Thiede
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA
| | - Michael Schoeny
- Community, Systems, and Mental Health Nursing Rush University Medical Center, Chicago, Illinois, USA
| | - Stefan J Green
- Sequencing Core and Associate Director, Research Resources Center, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Mary K Hayden
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Bala Hota
- Division of Infectious Diseases, Chicago, Illinois, USA
| | - Robert A Weinstein
- Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA
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25
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Shih HI, Chang CM, Shen FC, Lee YJ, Wu CH, Hsu HC, Chi CY. High prevalence nasal carriage of methicillin-resistant Staphylococcus aureus among long term care facility healthcare workers in relation to patient contact. Infect Prev Pract 2021; 3:100117. [PMID: 34368736 PMCID: PMC8336196 DOI: 10.1016/j.infpip.2021.100117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/22/2020] [Indexed: 11/22/2022] Open
Abstract
Background Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern worldwide. Healthcare workers (HCWs) are an important source of transmission of MRSA. We conducted a prospective study to define the frequency of S. aureus nasal colonization with emphasis on the carriage of MRSA in HCWs in relation to the intensity of patient contact. Methods Out-of-hospital care emergency medical technicians and students, and HCWs in the emergency department, intensive care unit and a long-term care facility (LTCF) were enrolled to compare the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) nasal colonization. The MRSA isolates were further identified by their microbiological and molecular characteristics. Findings S. aureus was isolated from 63 of 248 HCWs (25.4%). The overall MRSA nasal carriage rate was 15/248, 6%, and the prevalence was higher in the HCWs who had worked for 5–10 years (12.8%), and among female HCWs (10.3%) than male HCWs (0.9%). LTCFs had the highest prevalence (12%). In contrast, the overall carriage of MSSA was 48/248, 19.4%, and most carriers worked for ≥5 years (52.1%). Hospital nurses had the highest rate of MSSA carriage (21.4%). Most of the MRSA isolates were SCCmec IV/ST59 or ST45 (60%), and were resistant to erythromycin and clindamycin (53%). Conclusions Hospital nurses have highest S. aureus nasal carriage, whereas HCWs in the LTCFs comprise a significant reservoir of MRSA colonization. The differences in the characteristics of MRSA and MSSA nasal carriage among HCWs highlights the importance on long-term nasal screening of S. aureus in healthcare facilities.
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Affiliation(s)
- Hsin-I Shih
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Ming Chang
- Division of Geriatrics, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Division of Geriatrics, Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Fan-Ching Shen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Yun-Ju Lee
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan
| | - Chiu Hui Wu
- Department of Nursing, National Cheng Kung University Hospital, Taiwan
| | - Hsiang-Chin Hsu
- Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,School of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Yu Chi
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Tainan, Taiwan.,Department of Paediatrics, National Cheng Kung University Hospital, Tainan, Taiwan.,The Doctoral Degree Program in Environmental and Occupational Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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26
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Abstract
Staphylococcus aureus infections are associated with increased morbidity, mortality, hospital stay, and health care costs. S aureus colonization has been shown to increase risk for invasive and noninvasive infections. Decolonization of S aureus has been evaluated in multiple patient settings as a possible strategy to decrease the risk of S aureus transmission and infection. In this article, we review the recent literature on S aureus decolonization in surgical patients, patients with recurrent skin and soft tissue infections, critically ill patients, hospitalized non-critically ill patients, dialysis patients, and nursing home residents to inform clinical practice.
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Affiliation(s)
- Sima L Sharara
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Lisa L Maragakis
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA
| | - Sara E Cosgrove
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287, USA.
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27
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Association between Clostridioides difficile infection and multidrug-resistant organism colonization or infection among hospitalized adults: A case-control study. Am J Infect Control 2020; 48:1276-1278. [PMID: 32145992 PMCID: PMC9840385 DOI: 10.1016/j.ajic.2020.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/10/2019] [Accepted: 01/09/2020] [Indexed: 01/17/2023]
Abstract
Using an ambidirectional case-control study, we found that the odds of Clostridioides difficile infection (CDI) were 3.38 (P = .01) times higher for patients with multidrug-resistant organism (MDRO) colonization compared to those without. MDRO colonization or infection 1-12 months before CDI testing significantly increased risk of positive CDI diagnosis (odds ratio 4.71, P = .02 and odds ratio = 5.03, P = .05, respectively) independent of antibiotic use, age, and comorbidity status. MDRO colonization and infection are associated with CDI, most significantly if they precede CDI.
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28
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Arnaíz de Las Revillas F, Sousa D, Ardunay C, García-Vidal C, Montejo M, Rodríguez-Álvarez R, Pasquau J, Bouza E, Oteo JA, Balseiro C, Méndez C, Lwoff N, Llinares P, Fariñas MC. Healthcare-associated pneumonia: a prospective study in Spain. REVISTA ESPANOLA DE QUIMIOTERAPIA 2020; 33:358-368. [PMID: 32693555 PMCID: PMC7528418 DOI: 10.37201/req/067.2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective The aim of the study was to describe the epidemiological characteristics and factors related to outcome in Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated pneumonia (HCAP). Patients and method A 3-year prospective observational epidemiological case study of HCAP was conducted in seven Spanish hospitals. Microbiological and patient characteristics and outcomes were collected and classified by causative pathogen into 4 categories: “S. pneumoniae”, “MRSA”, “Others” and “Unknown”. Patients were followed up 30 days after discharge. Results A total of 258 (84.6%) patients were enrolled (170 were men [65.9%]). Mean age was 72.4 years ± 15 years (95% CI [70.54-74.25]). The etiology of pneumonia was identified in 73 cases (28.3%):S. pneumoniae in 35 patients (13.6%), MRSA in 8 (3.1%), and other microorganisms in 30 patients (11.6%). Significant differences in rates of chronic obstructive pulmonary disease (p < 0.05), previous antibiotic treatment (p < 0.05), other chronic respiratory diseases, inhaled corticosteroids (p < 0.01), and lymphoma (p < 0.05) were observed among the four groups. Patients with MRSA pneumonia had received more previous antibiotic treatment (87.5%). Thirty-three (12.8%) patients died during hospitalisation; death in 27 (81.2%) was related to pneumonia. Conclusions The etiology of HCAP was identified in only one quarter of patients, with S. pneumoniae being the most prevalent microorganism. Patients with chronic respiratory diseases more frequently presented HCAP due to MRSA than to S. pneumoniae. Death at hospital discharge was related in most cases to pneumonia.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - M C Fariñas
- María Carmen Fariñas. Infectious Diseases Unit, Hospital Universitario Marqués de Valdecilla, Av. Valdecilla, 25, 39008 Santander, Cantabria, Spain.
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29
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Abstract
Hospital-acquired infections are a known menace to the primary disease, for which a patient is admitted. These infections are twenty times more common in developing countries than in the developed ones. Surveillance for colonised patients can be passive or active process. In many hospitals, active surveillance culture for certain sentinel organisms followed by contact precautions for the same is an important part of infection control policy. Specific measures can be taken on early detection of multidrug-resistant organism, allowing prevention of widespread transmission in hospitals. Cultures are the most conventional and economical microbiological method of detection. The cost of active surveillance is a major challenge, especially for developing nations. These nations lack basic infrastructure and have logistic issues. The guidelines regarding this are not very clearly delineated for developing countries. Each hospital has its own challenges and the process is to be tailor-made accordingly. The following review delineates the various aspects of active surveillance for the colonisation of various organisms and the advantages and disadvantages of the same.
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Affiliation(s)
- Manisha Biswal
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rimjhim Kanaujia
- Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
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30
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Manunga J, Olak J, Rivera C, Martin M. Prevalence of Methicillin-Resistant Staphylococcus aureus in Elective Surgical Patients at a Public Teaching Hospital: An Analysis of 1039 Patients. Am Surg 2020. [DOI: 10.1177/000313481207801019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasingly common cause of postoperative surgical site infections (SSIs). It is unclear, however, whether asymptomatic colonization or nosocomial acquisition of MRSA results in postoperative SSI. We conducted a retrospective review of patients screened for MRSA between May 2008 and October 2010 at our institution. End points included rates of MRSA infection, SSI, and the cost of routine MRSA screening of patients undergoing elective surgery. Of the 1039 patients screened preoperatively, 48 (4.6%) tested positive for MRSA by nasal or oral swab, whereas 991 (95.4%) tested negative. Forty-five (93.8%) MRSA-positive patients received vancomycin or linezolid and three (6.25%) received cefazolin peri-operatively. Three (6.25%) MRSA-positive patients developed postoperative SSIs. Two required rehospitalization for intravenous antimicrobials, whereas a third patient required removal of infected abdominal mesh. Twenty (2.02%) MRSA-negative patients and four (5.26%) unscreened patients developed non-MRSA SSIs. Regardless of MRSA status, none of 609 patients who had a laparoscopic procedure or inguinal hernia repair developed SSI. Twenty-two patients needed to be screened to obtain one positive test. The role of MRSA screening and longer perioperative coverage for MRSA-positive patients undergoing complex elective procedures remains to be determined.
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Affiliation(s)
- Jesse Manunga
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Jemi Olak
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Carmen Rivera
- Department of Surgery, Kern Medical Center, Bakersfield, California
| | - Maureen Martin
- Department of Surgery, Kern Medical Center, Bakersfield, California
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31
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Schweitzer D, Klaber I, García P, López F, Lira MJ, Botello E. Methicillin-resistant Staphylococcus aureus colonization in patients undergoing primary total hip arthroplasty. J Med Microbiol 2020; 69:600-604. [PMID: 32427561 DOI: 10.1099/jmm.0.001155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction. Nasal and skin colonization by methicillin-resistant Staphylococcus aureus (MRSA) are linked to a higher incidence of infection after total joint replacement. The prevalence of colonization is poorly defined in Latin American countries.Aim. The aim of the present study was to determine the prevalence of MRSA colonization in the nostrils and groin using real-time polymerase chain reaction (RT-PCR) in patients undergoing total hip arthroplasty (THA).Methodology. In this cross-sectional study, 146 patients undergoing THA between December 2015 and March 2017 in a tertiary-care university-affiliated hospital in Chile were screened for MRSA colonization before the procedure using RT-PCR independently in the nostrils and groin. Risk factors for colonization were documented.Results. Seven of the 146 (5 %) patients undergoing THA were carriers of MRSA in the nostrils and/or the groin. Recent antibiotic use was identified as a risk factor for colonization, OR=4.86 [95 % confidence interval (CI): 1.56-13.96]. Patients reporting at least one of the seven surveyed risk factors had an OR of 2.39 (95 % CI: 0.37-25.77) for colonization. MRSA colonization frequency was twofold higher in the groin as opposed to the nostrils (P=0.014).Conclusion. Five percent of the patients undergoing THA were identified as carriers of MRSA. Recent antibiotic use is a relevant risk factor for MRSA colonization in patients undergoing primary total hip arthroplasty.
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Affiliation(s)
- Daniel Schweitzer
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Orthopedic Surgery, Santiago, Chile
| | - Ianiv Klaber
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Orthopedic Surgery, Santiago, Chile
| | - Patricia García
- Pontificia Universidad Católica de Chile, Department of Orthopedic Surgery, Santiago, Chile
| | - Felipe López
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Orthopedic Surgery, Santiago, Chile
| | - María Jesús Lira
- Pontificia Universidad Católica de Chile, Department of Clinical Laboratories, Santiago, Chile
| | - Eduardo Botello
- Pontificia Universidad Católica de Chile, School of Medicine, Department of Orthopedic Surgery, Santiago, Chile
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Al-Tamimi M, Himsawi N, Abu-Raideh J, Khasawneh AI, Jazar DA, Al-Jawaldeh H, Hawamdeh H. Phenotypic and Molecular Screening of Nasal S. aureus from Adult Hospitalized Patients for Methicillin- and Vancomycin-resistance. Infect Disord Drug Targets 2020; 21:68-77. [PMID: 31916522 DOI: 10.2174/1871526520666200109143158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/12/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Nasal carriers of Staphylococcus aureus are common and play an important role in the transmission of infections. The aim of this study is a phenotypic and molecular investigation of nasal methicillin- and vancomycin-resistant S. aureus in hospitalized patients. METHODS 202 nasal swabs were collected from patients at Prince Hamzah Hospital, Jordan, through 2016-2017. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution and Vitek 2. Methicillin resistance was confirmed by testing for the mecA gene, while vancomycin resistance was screened by testing for the vanA and vanB genes. RESULTS The mean age of participants was 50.17±18.18 years and 59.4% were females. Nasal Staphylococci was isolated in 64/202 (31.7%), S. aureus was isolated from 33 samples (16.3%), MRSA was isolated from 13 samples (6.4%) and constitutive Macrolide-lincosamidestreptogramin B (MLSB) was isolated from 12 samples (5.9%). All MRSA isolates harbored the mecA gene. All isolates were sensitive to vancomycin using E-test and the microdilution test and were negative for the vanA and vanB genes. The highest resistance rate was observed for benzylpenicillin (>90%), while the lowest resistance rate was for tobramycin (<5%) among all isolates. Nasal Staphylococci, S. aureus and MRSA colonization significantly correlate with increased number of family members and previous hospitalization (P<0.05), while nasal S. aureus significantly correlates with a history of skin infection (P=0.003). CONCLUSION Nasal colonization by mecA-mediated MRSA is common among hospitalized patients, while vanA- and vanB-mediated vancomycin resistance was not detected in any nasal isolates.
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Affiliation(s)
- Mohammad Al-Tamimi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Nisreen Himsawi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Jumana Abu-Raideh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Ashraf I Khasawneh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Deaa Abu Jazar
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hussam Al-Jawaldeh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Hasan Hawamdeh
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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Popovich KJ. Intersection of HIV and community-associated methicillin-resistant Staphylococcus aureus. Future Virol 2020. [DOI: 10.2217/fvl-2019-0093] [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 epidemiology of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has evolved over the past approximately 20 years, with certain populations appearing to have disproportionate risk. Of concern is the potential worsening of S. aureus infections in light of the continued opioid crisis. This review will discuss how CA-MRSA has significantly impacted HIV-infected individuals and address additional factors and populations that are associated with increased risk for MRSA. It will review therapeutic options and infection control strategies as well as highlight how whole genome sequencing can be used to extend traditional epidemiologic analysis and ultimately, inform infection prevention efforts. Continued work identifying those at the highest risk for MRSA, what the best infection prevention settings are in community settings and how to effectively implement and target these strategies is needed. Ultimately, infection control efforts will likely need to extend beyond healthcare settings to effectively and sustainably reduce MRSA infections.
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Affiliation(s)
- Kyle J Popovich
- Associate Professor, Section of Infectious Diseases, Rush University Medical Center, 600 South Paulina St. Suite 143, Chicago, IL 60612, USA
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Mohammed AA, Hussein NR, Arif SH, Daniel S. Surgical site infection among patients with Staphylococcus aureus nasal carriage. INTERNATIONAL JOURNAL OF SURGERY OPEN 2020. [DOI: 10.1016/j.ijso.2020.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Effects of the proportion of high-risk patients and control strategies on the prevalence of methicillin-resistant Staphylococcus aureus in an intensive care unit. BMC Infect Dis 2019; 19:1026. [PMID: 31795957 PMCID: PMC6889565 DOI: 10.1186/s12879-019-4632-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 11/11/2019] [Indexed: 11/26/2022] Open
Abstract
Background The presence of nosocomial pathogens in many intensive care units poses a threat to patients and public health worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen endemic in many hospital settings. Patients who are colonized with MRSA may develop an infection that can complicate their prior illness. Methods A mathematical model to describe transmission dynamics of MRSA among high-risk and low-risk patients in an intensive care unit (ICU) via hands of health care workers is developed. We aim to explore the effects of the proportion of high-risk patients, the admission proportions of colonized and infected patients, the probability of developing an MRSA infection, and control strategies on MRSA prevalence among patients. Results The increasing proportion of colonized and infected patients at admission, along with the higher proportion of high-risk patients in an ICU, may significantly increase MRSA prevalence. In addition, the prevalence becomes higher if patients in the high-risk group are more likely to develop an MRSA infection. Our results also suggest that additional infection prevention and control measures targeting high-risk patients may considerably help reduce MRSA prevalence as compared to those targeting low-risk patients. Conclusions The proportion of high-risk patients and the proportion of colonized and infected patients in the high-risk group at admission may play an important role on MRSA prevalence. Control strategies targeting high-risk patients may help reduce MRSA prevalence.
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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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Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol 2019; 56:907-921. [PMID: 30955124 PMCID: PMC6597605 DOI: 10.1007/s00592-019-01301-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/11/2019] [Indexed: 12/19/2022]
Abstract
AIMS Diabetic patients have multiple risk factors for colonisation with methicillin-resistant Staphylococcus aureus (MRSA), a nosocomial pathogen associated with significant morbidity and mortality. This meta-analysis was conducted to estimate the prevalence of MRSA among diabetic patients. METHODS The MEDLINE, Embase, BIOSIS, and Web of Science databases were searched for studies published up to May 2018 that reported primary data on the prevalence of MRSA in 10 or more diabetic patients. Two authors independently assessed study eligibility and extracted the data. The main outcomes were the pooled prevalence rates of MRSA colonisation and infection among diabetic populations. RESULTS Eligible data sets were divided into three groups containing data about the prevalence of MRSA colonisation or in diabetic foot or other infections. From 23 data sets, the prevalence of MRSA colonisation among 11577 diabetics was 9.20% (95% CI, 6.26-12.63%). Comparison of data from 14 studies that examined diabetic and non-diabetic patients found that diabetics had a 4.75% greater colonisation rate (P < 0.0001). From 41 data sets, the prevalence of MRSA in 10994 diabetic foot infection patients was 16.78% (95% CI, 13.21-20.68%). Among 2147 non-foot skin and soft-tissue infections, the MRSA prevalence rate was 18.03% (95% CI, 6.64-33.41). CONCLUSIONS The prevalence of MRSA colonisation among diabetic patients is often higher than among non-diabetics; this may make targeted screening attractive. In the UK, many diabetic patients may already be covered by the current screening policies. The prevalence and impact of MRSA among diabetic healthcare workers requires further research. The high prevalence of MRSA among diabetic foot infections may have implications for antimicrobial resistance, and should encourage strategies aimed at infection prevention or alternative therapies.
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Affiliation(s)
- Helen J Stacey
- Edinburgh Medical School, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Caitlin S Clements
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
| | - Susan C Welburn
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK
- International Campus, ZJU-UoE Institute, Zhejiang University School of Medicine, Zhejiang University, 718 East Haizhou Road, 314400, Haining, Zhejiang, People's Republic of China
| | - Joshua D Jones
- Division of Infection and Pathway Medicine, Edinburgh Medical School, Biomedical Sciences, University of Edinburgh, Chancellor's Building, 49 Little France Crescent, EH16 4SB, Edinburgh, UK.
- International Campus, ZJU-UoE Institute, Zhejiang University School of Medicine, Zhejiang University, 718 East Haizhou Road, 314400, Haining, Zhejiang, People's Republic of China.
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Moremi N, Claus H, Vogel U, Mshana SE. The role of patients and healthcare workers Staphylococcus aureus nasal colonization in occurrence of surgical site infection among patients admitted in two centers in Tanzania. Antimicrob Resist Infect Control 2019; 8:102. [PMID: 31236269 PMCID: PMC6580651 DOI: 10.1186/s13756-019-0554-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background Colonization with Staphylococcus aureus has been identified as a risk for subsequent occurrence of infection. This study investigated the relationship between S. aureus colonization of patients and healthcare workers (HCWs), and subsequent surgical site infections (SSI). Methods Between December 2014 and September 2015, a total of 930 patients and 143 HCWs were enrolled from the Bugando Medical Centre and Sekou Toure hospital in Mwanza, Tanzania. On admission and discharge nasal swabs, with an additional of wound swab for those who developed SSI were collected from patients whereas HCWs were swabbed once. Identification and antimicrobial susceptibility testing were done by VITEK-MS and VITEK-2, respectively. Detection of Panton Valentine leukocidin (PVL) and mecA genes was done by PCR. S. aureus isolates were further characterized by spa typing and Multi-Locus Sequence Typing (MLST). Results Among 930 patients screened for S. aureus on admission, 129 (13.9%) were positive of which 5.4% (7/129) were methicillin-resistant S. aureus (MRSA). Amongst 363 patients rescreened on discharge, 301 patients had been tested negative on admission of whom 29 (9.6%) turned positive after their hospital stay. Three (10.3%) of the 29 acquired S. aureus were MRSA. Inducible Clindamycin resistance occurred more often among acquired S. aureus isolates than among isolates from admission [34.5% (10/29) vs. 17.1% (22/129), P = 0.018]. S. aureus contributed to 21.1% (n = 12) of the 57 cases of investigated SSIs among 536 patients followed. Seven out of eight S. aureus carriage/infection pairs had the same spa and sequence types. The previously reported dominant PVL-positive ST88 MRSA strain with spa type t690 was detected in patients and HCW. Conclusion A significant proportion of patients acquired S. aureus during hospitalization. The finding of more than 90% of S. aureus SSI to be of endogenous source underscores the need of improving infection prevention and control measures including screening and decolonization of high risk patients.
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Affiliation(s)
- Nyambura Moremi
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany.,2Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
| | - Heike Claus
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Ulrich Vogel
- 1Institute for Hygiene and Microbiology, University of Wuerzburg, Wuerzburg, Germany
| | - Stephen E Mshana
- 2Department of Microbiology and Immunology, Catholic University of Health and Allied Sciences, P. O. Box 1464, Mwanza, Tanzania
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Donkor ES, Dayie NT, Tette EMA. Methicillin-Resistant Staphylococcus aureus in Ghana: Past, Present, and Future. Microb Drug Resist 2019; 25:717-724. [DOI: 10.1089/mdr.2018.0115] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Affiliation(s)
- Eric S. Donkor
- Department of Medical Microbiology, University of Ghana, Accra, Ghana
| | | | - Edem M. A. Tette
- Department of Community Health, University of Ghana, Accra, Ghana
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Min KB, Min JY. Nasal colonization with methicillin-resistant Staphylococcus aureus associated with elevated homocysteine levels in the general US adults. Medicine (Baltimore) 2019; 98:e15499. [PMID: 31045837 PMCID: PMC6504329 DOI: 10.1097/md.0000000000015499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Given the emergence of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) as a global health threat, understanding the risk factors for MRSA infection in the community may be a reasonable strategy to prevent it. We investigated the associations between serum homocysteine levels and prevalence of nasal colonization with S aureus and MRSA among United States adults. We conducted a cross-sectional analysis of a nationally representative sample of 7832 adults (20 years or older). The main outcome variables were nasal colonization with S aureus and MRSA. Percentages of colonization with S aureus and MRSA were calculated by the quartiles of serum homocysteine. A total of 7832 of 2051 subjects (26.2%) were culture positive for S aureus, 98 (4.8%) of whom had nasal colonization with MRSA. In comparison with subjects having the lowest serum homocysteine, the odds of nasal colonization with MRSA were significantly higher in those with the highest homocysteine (odds ratio, 3.09; 95% confidence interval, 1.11-8.61) in multivariate analysis, adjusted for all confounding variables. By contrast, homocysteine elevation was not significantly associated with S aureus colonization. Nasal colonization with MRSA in the general community was significantly associated with increases in serum homocysteine levels.
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Affiliation(s)
- Kyoung-Bok Min
- Department of Preventive Medicine, Seoul National University College of Medicine
| | - Jin-Young Min
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Weterings V, Veenemans J, van Rijen M, Kluytmans J. Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus in patients at hospital admission in The Netherlands, 2010-2017: an observational study. Clin Microbiol Infect 2019; 25:1428.e1-1428.e5. [PMID: 30928560 DOI: 10.1016/j.cmi.2019.03.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/14/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES We determined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage upon hospital admission, among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. We also aimed to evaluate the prevalence of MRSA carriers without the standard risk factors. METHODS We conducted an observational study to determine the prevalence of MRSA nasal carriage among patients who were screened preoperatively for nasal S. aureus carriage between 2010 and 2017. Samples of cardiothoracic patients were tested by polymerase chain reaction (PCR), other samples were cultured using chromogenic agar plates. A Poisson regression model with robust error variance was used to assess whether there was a trend in the prevalence of MRSA over time. RESULTS In total, 31 093 nasal swabs were obtained from 25 660 patients. Three-hundred and seventy-five swabs (1.2%) had an invalid result. Therefore, 30 718 swabs (98.8%) were included in our analysis. Overall, S. aureus was detected in 7981/30 718 patients (26.0% 95% CI 25.5-26.5%) of whom 41 were MRSA (0.13% 95% CI 0.10-0.18%). The MRSA prevalence varied from 0.03% to 0.17% over the years without evidence of a changing trend over time (p = 0.40). Results of the questionnaire revealed that 30 of the 41 patients (73.2%) had no known risk factors for MRSA carriage (0.10%; 95% CI 0.07-0.14%). CONCLUSION Our study revealed a sustained low prevalence of MRSA carriage upon hospital admission over 7 years. This supports the effectiveness of the Dutch Search and Destroy policy, in combination with a restrictive antibiotic prescription policy.
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Affiliation(s)
- Veronica Weterings
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Medical Microbiology, Radboud University Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands.
| | - Jacobien Veenemans
- Laboratory for Microbiology, Admiraal De Ruyter Hospital, P.O. Box 15, 4460 AA Goes, the Netherlands
| | - Miranda van Rijen
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands
| | - Jan Kluytmans
- Department of Infection Control, Amphia Hospital, P.O. Box 90158, 4800 AK Breda, the Netherlands; Microvida Laboratory for Microbiology, Amphia Hospital, P.O. Box 90158, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. Box 85500 3508 GA, Utrecht University, Utrecht, the Netherlands
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Donkor ES, Kotey FCN, Dayie NTKD, Duodu S, Tetteh-Quarcoo PB, Osei MM, Tette EMA. Colonization of HIV-Infected Children with Methicillin-Resistant Staphylococcus aureus. Pathogens 2019; 8:E35. [PMID: 30884909 PMCID: PMC6470964 DOI: 10.3390/pathogens8010035] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/17/2019] [Accepted: 02/21/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) poses a public health threat owing to its extensive resistance to antibiotics, association with persistent outbreaks, and markedly increased healthcare costs. Moreover, HIV-infected individuals are at a greater risk for colonization with MRSA, and may act as reservoirs for subsequent transmission to other individuals. In Ghana, little is known about MRSA in relation to at-risk populations, such as HIV-infected children. The aim of this study was to investigate nasal carriage of S. aureus and MRSA among HIV-infected children in Accra, including the prevalence, risk factors and antibiotic resistance. METHODOLOGY The study was cross-sectional, and involved 107 children with HIV infection and an equal number of sex- and age group- matched apparently healthy controls recruited from the Princess Marie Louis Children's Hospital in Accra. Nasal swab specimens were collected from the study participants and cultured for bacteria. S. aureus isolates were confirmed by the coagulase test while MRSA was confirmed by PCR of the mecA gene. Antimicrobial susceptibility testing of S. aureus isolates was done by the Kirby Bauer method. A structured questionnaire was used to collect data on demographic, household and clinical features of the study participants. A logistic regression analysis was performed to identify determinants of S. aureus and MRSA carriage among participants of both study groups. RESULTS The carriage prevalence of S. aureus and MRSA were 44.9% (48) and 5.6% (6), respectively, among the HIV-infected individuals, and the corresponding values within the control group were 23.4% (25) and 0.9% (1). There was a significant association between HIV infection and S. aureus colonization (p < 0.001), but not MRSA colonization (p = 0.055). The main predictor of S. aureus colonization in both study groups was absence of colonization with coagulase negative staphylococcus (p < 0.001). Furthermore, the main predictor of MRSA colonization was regular hand washing with soap (p = 0.043); this was observed among HIV-infected individuals but not the control group. The proportion of S. aureus isolates that were multidrug resistant was 62.3% (33/53) in the HIV-infected group and 80% (20/25) in the control group (p = 0.192). CONCLUSIONS HIV infection is a risk factor for nasal colonization of S. aureus among children in Accra but may not be for MRSA. Both the HIV-infected and uninfected children are reservoirs of multidrug resistant S. aureus. Demographic, household and clinical features appear to have little or no relationship with S. aureus and MRSA colonization in the study children.
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Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Fleischer C N Kotey
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
- FleRhoLife Research Consult, P. O. Box TS 853, Teshie, Accra, Ghana.
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, P. O. Box LG 54, Legon, Accra, Ghana.
| | - Patience B Tetteh-Quarcoo
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Mary-Magdalene Osei
- Department of Medical Microbiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Korle Bu, Accra, Ghana.
| | - Edem M A Tette
- Department of Community Health, School of Public Health, University of Ghana, P. O. Box LG 13, Legon, Accra, Ghana.
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Sabbagh P, Riahi SM, Gamble HR, Rostami A. The global and regional prevalence, burden, and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV-infected people: A systematic review and meta-analysis. Am J Infect Control 2019; 47:323-333. [PMID: 30170767 DOI: 10.1016/j.ajic.2018.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Methicillin-resistant Staphylococcus aureus (MRSA) is among the most important opportunistic pathogens in HIV+ patients, resulting in considerable morbidity and mortality. METHODS The MEDLINE, Scopus, Web of Science, and EMBASE databases were comprehensively searched for studies that investigated the prevalence of MRSA colonization in HIV+ patients. We used a random effects model to calculate pooled prevalence estimates with 95% confidence intervals (CI) and analyzed data based on World Health Organization regions. RESULTS Among 9,772 records identified, 69 were included in the meta-analysis, comprising 30,050 HIV+ patients from 21 countries. We estimated the pooled worldwide prevalence of MRSA in people living with HIV to be 7% (95% CI 5%-9%, 1,623/30,050), with the highest prevalence in Southeast Asia (16%, 95% CI 9%-24%) and the region of the Americas (10%; 95% CI 7%-13%) and lowest prevalence in the European region (1%; 95% CI 0%-1%). Globally, we estimated approximately 2,659,000 (95% CI 1,835,000-3,303,000) HIV+ patients with colonized MRSA. Potential risk factors for MRSA colonization in HIV+ patients included previous MRSA infection (OR, 7.5; 95% CI, 3.91-14.37), hospitalization in the past year (OR, 1.87; 95% CI 1.11-3.16), and use of antibiotics (OR, 2.52; 95% CI 1.39-4.58). CONCLUSIONS Our findings emphasize the importance of routine screening for MRSA among all HIV+ patients throughout the world, especially in regions that have a high burden of disease.
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Pei S, Morone F, Liljeros F, Makse H, Shaman JL. Inference and control of the nosocomial transmission of methicillin-resistant Staphylococcus aureus. eLife 2018; 7:e40977. [PMID: 30560786 PMCID: PMC6298769 DOI: 10.7554/elife.40977] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 11/16/2018] [Indexed: 12/19/2022] Open
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) is a continued threat to human health in both community and healthcare settings. In hospitals, control efforts would benefit from accurate estimation of asymptomatic colonization and infection importation rates from the community. However, developing such estimates remains challenging due to limited observation of colonization and complicated transmission dynamics within hospitals and the community. Here, we develop an inference framework that can estimate these key quantities by combining statistical filtering techniques, an agent-based model, and real-world patient-to-patient contact networks, and use this framework to infer nosocomial transmission and infection importation over an outbreak spanning 6 years in 66 Swedish hospitals. In particular, we identify a small number of patients with disproportionately high risk of colonization. In retrospective control experiments, interventions targeted to these individuals yield a substantial improvement over heuristic strategies informed by number of contacts, length of stay and contact tracing.
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Affiliation(s)
- Sen Pei
- Department of Environmental Health Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUnited States
| | - Flaviano Morone
- Levich Institute and Physics DepartmentCity College of New YorkNew YorkUnited States
| | | | - Hernán Makse
- Levich Institute and Physics DepartmentCity College of New YorkNew YorkUnited States
| | - Jeffrey L Shaman
- Department of Environmental Health Sciences, Mailman School of Public HealthColumbia UniversityNew YorkUnited States
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Comparison of Nasal Colonization of Methicillin-Resistant Staphylococcus aureus in HIV-Infected and Non-HIV Patients Attending the National Public Health Laboratory of Central Nepal. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2018; 2018:4508757. [PMID: 30631385 PMCID: PMC6305024 DOI: 10.1155/2018/4508757] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 11/15/2018] [Indexed: 11/30/2022]
Abstract
Background Staphylococcus aureus is a cardinal source of community- and hospital-acquired infection. HIV infection is a well-recognized risk factor for methicillin-resistant S. aureus (MRSA) carriage and infection. Intrinsically developed antibiotic resistance has sharply increased the burden of MRSA which is often associated with morbidity and mortality of the patients. Moreover, nasal carriage of S. aureus plays a significant role in spread of community-associated (CA) S. aureus infections. Methods This study was conducted from June 2016 to December 2016 at National Public Health Laboratory (NPHL), Kathmandu, with an aim to assess the rate of S. aureus nasal carriage and MRSA carriage among HIV-infected and non-HIV patients. A total of 600 nonrepeated nasal swabs were analyzed following standard microbiological procedures, where 300 swabs were from HIV-infected patients while remaining 300 were from non-HIV patients. The isolates were identified on the basis of colony characteristics and a series of biochemical tests. The antibiotic susceptibility test (AST) was performed by the modified Kirby–Bauer disc diffusion method. Inducible clindamycin resistance in isolates was confirmed by the D-test method. Results Overall, out of 600 nasal swabs of patients tested, 125 (20.8%) were S. aureus nasal carriers which included 80 out of 300 (26.66%) among HIV-infected patients and 45 (15%) out of 300 among non-HIV patients, and the result was statistically significant (p=0.0043). Among the isolated S. aureus, 11 (13.8%) MRSA were confirmed in HIV-infected while 3 (6.7%) MRSA were detected from non-HIV patients. A higher number of S. aureus carriers was detected among HIV-infected males 40 (26.49%), whereas MRSA carriage was more prevalent among HIV-infected females 7 (5.1%). Among the HIV-infected, patients of age group 31–40 years were the ones with highest carriage rate 36 (45%), while in non-HIV patients, the highest rate 13 (28.9%) of carriage was detected among the patients of age group 21–30 years. Statistically significant difference was found between S. aureus carriage and HIV infection in patients (p < 0.05). Higher rate 2/3 (66.7%) of inducible clindamycin resistance in MRSA was detected from non-HIV patients in comparison to HIV-infected patients 7/11 (63.63%) while the result was statistically insignificant (p > 0.05). All the MRSA isolates (100%) were resistant against co-trimoxazole while ciprofloxacin showed high rate of sensitivity towards both MSSA and MRSA. None of the isolates were detected as VRSA. The major factors associated with nasal colonization of S. aureus were close personal contact, current smoking habit, and working or living in a farm (p < 0.05). Conclusion Regular surveillance and monitoring of MRSA nasal carriage and antibiotic susceptibility pattern are of prime importance in controlling S. aureus infections especially in high risk groups like HIV-infected patients.
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Nasser R, Kosty JA, Shah S, Wang J, Cheng J. Risk Factors and Prevention of Surgical Site Infections Following Spinal Procedures. Global Spine J 2018; 8:44S-48S. [PMID: 30574437 PMCID: PMC6295823 DOI: 10.1177/2192568218806275] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
STUDY DESIGN Focused literature review. OBJECTIVE The objective of this article was to help identify potential risk factors as well as strategies to help prevent surgical site infections (SSIs) in spine surgery. METHODS An article search was performed using PubMed, EMBASE, and the Cochrane database of systematic reviews using the terms "surgery" OR "surgical" AND "spine" OR "spinal" AND "infection". Systematic review articles, meta-analyses, and clinical trials with more than 100 patients were reviewed. RESULTS Both patient and perioperative factors contribute to the development of SSIs. Patient factors such as smoking, obesity, diabetes, Methicillin-resistant Staphylococcus aureus (MRSA) colonization, and malnutrition are all modifiable risk factors that can lead to SSIs. Procedural steps, including preoperative MRSA screening and treatment for colonization, preoperative antibiotics, skin preparation, minimizing operative time, antibiotic or betadine irrigation, avoiding personnel turnover, and postoperative wound care have also been shown to decrease infection rates. CONCLUSION There are several measures a spine practitioner may be able to take in the preoperative, intraoperative, and postoperative settings. Protocols to counsel patients regarding modification of preexisting risk factors and ensure adequate antimicrobial therapy in the perioperative period may be developed to reduce SSIs in spine surgery.
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Affiliation(s)
- Rani Nasser
- University of Cincinnati, Cincinnati, OH, USA,Rani Nasser, Department of Neurological Surgery, University of Cincinnati, Cincinnati, OH 45219, USA.
| | | | - Sanjit Shah
- University of Cincinnati, Cincinnati, OH, USA
| | - Jeffrey Wang
- University of Southern California, Los Angeles, CA, USA
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Uchiyama S, Dahesh S, Nizet V, Kessler J. Enhanced topical delivery of non-complexed molecular iodine for Methicillin-resistant Staphylococcus aureus decolonization. Int J Pharm 2018; 554:81-86. [PMID: 30395958 DOI: 10.1016/j.ijpharm.2018.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 10/29/2018] [Accepted: 11/02/2018] [Indexed: 02/05/2023]
Abstract
Staphylococcus aureus, a leading cause of serious human infections in both healthcare and community settings, is increasingly difficult to control due to expanding resistance to multiple antibiotic classes. Methicillin-resistant S. aureus (MRSA) strains have disseminated on a global scale and are associated with adverse patient outcomes, increased hospital stays, and significant economic costs to the healthcare system. A proximal step in S. aureus infection is colonization of the nasal mucosa, and effective strategies to decolonize high risk patients to reduce the risk of invasive infection and nosocomial spread represent an important clinical priority. With rising resistance to mupirocin, the most common antibiotic utilized for nasal MRSA decontamination, we are examining the use of pure molecular iodine (I2)-based formulations for this indication. Recently, an iodophor formulation of povidone-iodine (PVP-I) has shown significant promise for nasal MRSA decontamination by swabbing the anterior nares of patients in hospital settings, but the I2 concentration in this treatment is less than 0.01% of total iodine species present and like all providone-iodine formulations causes skin staining. Here we determine that a novel non-staining formulation of I2 combined with the safe organic emollient glycerin delivers high local concentrations of the active antimicrobial entity (I2) with minimal evaporative loss, exhibits activity at ∼1 part per million against MRSA and other important Gram-positive and -negative human pathogens. This formulation for I2 topical delivery produced similar reductions in mean bacterial burden and was associated with fewer treatment failures (<2-logfold reduction) than PVP-I in a murine model of MRSA nasal decontamination. Formulations of I2 in glycerin emollient merit further exploration as topical disinfectants for human medical indications.
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Affiliation(s)
- Satoshi Uchiyama
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093-0760, USA
| | - Samira Dahesh
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093-0760, USA
| | - Victor Nizet
- Division of Host-Microbe Systems and Therapeutics, Department of Pediatrics, University of California, San Diego, La Jolla, CA 92093-0760, USA; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of California, San Diego, La Jolla, CA 92093-0760, USA.
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Wong JW, Ip M, Tang A, Wei VW, Wong SY, Riley S, Read JM, Kwok KO. Prevalence and risk factors of community-associated methicillin-resistant Staphylococcus aureus carriage in Asia-Pacific region from 2000 to 2016: a systematic review and meta-analysis. Clin Epidemiol 2018; 10:1489-1501. [PMID: 30349396 PMCID: PMC6190640 DOI: 10.2147/clep.s160595] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging global public health threat. In response to a highlighted strategic priority of the World Health Organization Global Action Plan on Antimicrobial Resistance, to "strengthen the knowledge and evidence base through surveillance and research", we synthesized published articles to estimate CA-MRSA carriage prevalence in the Asia-Pacific region. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PROSPERO CRD:42017067399). We searched MEDLINE, EMBASE, and PubMed for articles published from 1 January 2000 to 19 May 2017, which reported CA-MRSA carriage (defined as either colonization or infection) in Asia-Pacific region from 2000 to 2016. Studies were stratified according to settings (community or hospital where CA-MRSA was isolated) and study populations (general public or subpopulations with specified characteristics). Ranges of CA-MRSA carriage prevalence were reported for study groups. RESULTS In total, 152 studies were identified. Large diversity was observed among studies in most study groups. In community-level studies, the CA-MRSA carriage prevalence among the general public ranged from 0% to 23.5%, whereas that ranged from 0.7% to 10.4% in hospital settings. From community-level studies, countries with the highest prevalence were India (16.5%-23.5%), followed by Vietnam (7.9%) and Taiwan (3.5%-3.8%). Children aged ≤6 (range: 0.5%-40.3%) and household members of CA-MRSA carriers (range: 13.0%-26.4%) are subgroups without specific health conditions but with much higher CA-MRSA carriage when compared to the general population. CONCLUSION Our CA-MRSA prevalence estimates serve as the baseline for future national and international surveillance. The ranges of prevalence and characteristics associated with CA-MRSA carriage can inform health authorities to formulate infection control policies for high-risk subgroups. Future studies should explore the heterogeneities in CA-MRSA carriage prevalence among subgroups and countries to clarify the predominant transmission mechanisms in Asia-Pacific and other regions.
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Affiliation(s)
- Jonathan Wh Wong
- Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,
| | - Margaret Ip
- Department of Microbiology, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Arthur Tang
- Department of Software, Sungkyunkwan University, Seoul, South Korea
| | - Vivian Wi Wei
- Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,
| | - Samuel Ys Wong
- Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,
| | - Steven Riley
- MRC Centre for Outbreak Analysis and Modelling, Department for Infectious Disease Epidemiology, Imperial College London, UK
| | - Jonathan M Read
- Centre for Health Informatics Computing and Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
- Institute of Infection and Global Health, The Farr Institute@HeRC, University of Liverpool, Liverpool, UK
| | - Kin On Kwok
- Faculty of Medicine, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China,
- Faculty of Medicine, Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, Hong Kong, Hong Kong Special Administrative Region, China,
- Shenzhen Research Institute of the Chinese University of Hong Kong, Shenzhen, China,
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Lakhundi S, Zhang K. Methicillin-Resistant Staphylococcus aureus: Molecular Characterization, Evolution, and Epidemiology. Clin Microbiol Rev 2018; 31:e00020-18. [PMID: 30209034 PMCID: PMC6148192 DOI: 10.1128/cmr.00020-18] [Citation(s) in RCA: 728] [Impact Index Per Article: 121.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Staphylococcus aureus, a major human pathogen, has a collection of virulence factors and the ability to acquire resistance to most antibiotics. This ability is further augmented by constant emergence of new clones, making S. aureus a "superbug." Clinical use of methicillin has led to the appearance of methicillin-resistant S. aureus (MRSA). The past few decades have witnessed the existence of new MRSA clones. Unlike traditional MRSA residing in hospitals, the new clones can invade community settings and infect people without predisposing risk factors. This evolution continues with the buildup of the MRSA reservoir in companion and food animals. This review focuses on imparting a better understanding of MRSA evolution and its molecular characterization and epidemiology. We first describe the origin of MRSA, with emphasis on the diverse nature of staphylococcal cassette chromosome mec (SCCmec). mecA and its new homologues (mecB, mecC, and mecD), SCCmec types (13 SCCmec types have been discovered to date), and their classification criteria are discussed. The review then describes various typing methods applied to study the molecular epidemiology and evolutionary nature of MRSA. Starting with the historical methods and continuing to the advanced whole-genome approaches, typing of collections of MRSA has shed light on the origin, spread, and evolutionary pathways of MRSA clones.
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Affiliation(s)
- Sahreena Lakhundi
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
| | - Kunyan Zhang
- Centre for Antimicrobial Resistance, Alberta Health Services/Calgary Laboratory Services/University of Calgary, Calgary, Alberta, Canada
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- The Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, Alberta, Canada
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Alzahrani T, Liappis AP, Baddour LM, Karasik PE. Preoperative antibiotics and cardiovascular implantable electronic device infection: A cohort study in veterans. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2018; 41:1513-1518. [PMID: 30221380 DOI: 10.1111/pace.13499] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 08/31/2018] [Accepted: 09/03/2018] [Indexed: 01/18/2023]
Abstract
BACKGROUND Cefazolin is used as standard preoperative prophylaxis for a variety of surgical procedures that involve the skin. In contrast, vancomycin is recommended for a minority of patients, specifically those with an IgE-mediated allergy to beta-lactams and considered in patients with known colonization with methicillin-resistant Staphylococcus aureus or at high risk for such. Vancomycin, however, has been overprescribed, has nephrotoxicity risk, and may be less effective due to its inferior coverage of methicillin-susceptible S. aureus and lack of Gram-negative coverage. This study was performed to assess whether vancomycin use was associated with an increased incidence of cardiovascular implantable electronic device infection (CIEDI) as compared to that of cefazolin or other antistaphylococcal beta-lactam antibiotics. METHODS The VA Informatics and Computing Infrastructure database, which included all veterans who underwent CIED placement or revision between 2008 and 2015, was used. A logistic regression model was constructed to estimate the adjusted odds of CIEDI. RESULTS Overall, 10,454 CIED procedures were included, and 98% of them were performed in men with a mean age of 71 ± 12 years. The logistic regression analysis showed that vancomycin use alone or in combination with other antibiotics was associated with an increased risk of CIEDI (odds ratio 2.99 [1.76-5.06], P-value < 0.001), after controlling for other effects. CONCLUSIONS Our study revealed that among patients who received surgical site infection prophylaxis for CIED placement or revision, there was: (1) an unanticipated high rate of vancomycin use, and (2) a threefold increase in the incidence of subsequent CIEDI among vancomycin recipient.
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Affiliation(s)
- Talal Alzahrani
- Medical Service, Washington DC VA Medical Center, Washington, DC, USA.,Department of Medicine, George Washington University, Washington, DC, USA
| | - Angelike P Liappis
- Medical Service, Washington DC VA Medical Center, Washington, DC, USA.,Department of Medicine, George Washington University, Washington, DC, USA
| | - Larry M Baddour
- Departments of Medicine and Cardiovascular Medicine, Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Pamela E Karasik
- Medical Service, Washington DC VA Medical Center, Washington, DC, USA
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