MRSA Cases Research Articles

Decoding the Decade: Exploring the Efficacy of Platelet-Rich Plasma (PRP) in Complex Wound Management - A Comprehensive Study.

Autologous platelet-rich plasma (PRP) therapy has emerged as a promising regenerative treatment modality, offering potential improvements in healing outcomes through its rich content of growth factors and cytokines. We evaluated the effectiveness of PRP therapy in the management of complex wounds, using a decade-long retrospective analysis of treatments conducted at a tertiary care center from 2010 to 2020. The study introduces and assesses the efficacy of the Sandeep's Technique for Assisted Regeneration of Skin (STARS) in enhancing wound healing and quality of life for patients with complex wounds. A prospective interventional study was conducted, involving two phases: the development and initial testing of PRP therapy (2010-2015) and the application and evaluation of the STARS protocol (2015-2020). The study included patients with complex wounds, utilizing autologous PRP prepared through a double spin centrifuge technique. Outcome measures included wound-healing rates, infection management, and complication rates, compared to conventional treatment methods. The study treated 500 wounds in 432 patients with autologous PRP, noting significant improvements in wound-healing rates, 97.7% had infection control without antibiotics (even in MRSA cases), and all had a good pain control. Histopathological examinations confirmed collagen-rich healing with minimal scarring. The STARS protocol demonstrated the potential of PRP therapy in accelerating wound healing, reducing the need for additional surgical interventions, and enhancing patient outcomes. PRP therapy, particularly when administered following the STARS protocol, represents a safe, effective, and patient-friendly approach for the management of complex wounds. This study supports the integration of PRP therapy into regenerative care strategies, suggesting a shift toward more innovative and efficacious treatments in wound management.

Antimicrobial susceptibilities and genomic characteristics of methicillin-resistant Staphylococcus aureus resistant to mupirocin in Stockholm, Sweden.

The aim of this study was to investigate antimicrobial susceptibilities and genomic characteristics of mupirocin-resistant MRSA isolates in Stockholm, Sweden. In total, 44 non-duplicate mupirocin-resistant MRSA isolates detected in Stockholm during 2010-2022 were investigated. Antimicrobial susceptibility testing was performed using broth microdilution method and further tested for high-level mupirocin-resistance (MuH) and rifampicin by Etest®. All isolates were subjected to whole genome sequencing. 41 isolates presented MuH with MICs ≥1024 mg/L whilst three isolates displayed low-level mupirocin resistance (MuL). mupA-gene was detected in all MuH isolates. Point mutations in ileS gene leading to N213D and V588F were identified in the three MuL isolates. Mutation in rpoB (H481N) was detected in a rifampicin-resistant isolate. Among the isolates, 15 multi-locus sequence types (MLST) were identified, with the four most common sequence types (ST22, ST72, ST8, and ST125) accounting for 66% of the isolates. Mupirocin-resistant MRSA in Stockholm was uncommon, with a percentage of <0.5% among MRSA cases during 2010-2022. In the present study, most mupirocin-resistant isolates were MuH and mupA-positive, predominantly linked to ST22 or ST72 isolates. MuL-resistance was associated with a point mutation in the IleS protein. A multidrug-resistant ST1-MRSA-IV strain was resistant to both mupirocin and rifampicin.

The Incidence Rate, Microbiological Etiology, and Results of Treatments of Prosthetic Joint Infection following Total Knee Arthroplasty.

Periprosthetic joint infection (PJI) remains among the most challenging and costly complications. PJI rates vary from 0.39% to 3.9% after total knee arthroplasty (TKA). This study aimed to identify the causative microorganisms involved and to report our experience of subsequent treatment of PJI following over 7000 TKAs performed over 19 years. A retrospective study was conducted on 4547 patients (7019 cases) from March 2000 to September 2019. The incidence rate of PJI was 0.5%. Gram-positive bacteria accounted for 88.8% (n = 16) of the 18 cases, and S. aureus was the most commonly isolated pathogen (n = 7, 38.8%). There were six cases of MSSA and one case of MRSA. Streptococcus species (n = 7, 38.8%) also showed the same pattern. The CoNS species (n = 2, 11.1%) and Gram-negative bacteria (n = 1, 5.5%) were also reported. Candida species were isolated from 1 patient (5.5%). Successful I&D and implant retention (DAIR procedures) was achieved at the final follow-up in 19 patients (82.6%). The incidence of causative microorganisms was different for each PJI onset type. The overall infection rate of PJI was less than 1%. Although the success rate of DAIR procedures is lower than the two-stage exchange arthroplasty in this study, it is possible to achieve acceptable success rates if DAIR procedures are carefully selected considering the virulence of the microorganism, duration since symptom onset, and early-onset infection.

BACTERIOLOGY AND ANTIMICROBIAL SUSCEPTIBILITY OF OSTEOARTICULAR INFECTIONS AT A REGIONAL PAEDIATRIC UNIT IN SOUTH AFRICA

Osteoarticular infections (OAI) are a common cause of morbidity in children, and as opposed to adults is usually caused by haematogenous spread. The bacteriology of OAI in children is not well described in the South African context, therefore this study was designed to determine the bacteriology of OAI in our population.All patients that underwent surgery for the treatment of OAI over a 3-year period were identified and those with positive cultures where organisms were identified from tissue, pus, fluid or blood were included. Duplicate cultures from the same patient were excluded if the organism and antibiotic susceptibility profile was the same. Patients were categorised according to age and class of infection (Septic arthritis, acute osteomyelitis, fracture related infection, post-operative sepsis and chronic osteomyelitis) and organisms were stratified according to these categories.We identified 132 organisms from 123 samples collected from 86 patients. Most cultured organisms were from children older than 3-years with acute haematogenous septic arthritis, osteomyelitis, or both. Methicillin sensitive Staphylococcus aureus accounted for 56% (74/132) of organisms cultured. There were no cases of MRSA. The Enterobacterales accounted for 17% (22/132) of organisms cultured, mostly in the fracture related and post-operative infection groups. Of these, 6 each were extended spectrum B-lactamase producers and AmpC producers. There were no carbapenemase producing Enterobacterales. Kingella kingae was not isolated in any patient.Methicillin sensitive S. aureus is the most common infecting organism in paediatric OAI and an anti-staphylococcal penicillin such as cloxacillin or flucloxacillin is the most appropriate empiric treatment for haematogenous OAI in our environment. In fracture related or post-operative infections, Enterobacterales were more frequently cultured, and treatment should be guided by culture and susceptibility results.

989. Role of Bone Biopsy and Deep Tissue Culture for Antibiotic Stewardship in Diabetic Foot Infections

Abstract Background Bone biopsy is the gold standard for identifying the etiology of infectious osteomyelitis (OM) but is not always done in the setting of diabetic foot infections (DFIs), even in settings where resistant organisms are common. This study aimed to describe organisms most frequently identified on bone biopsy or deep tissue culture and determine how culture data impacted antibiotic management in patients with DFIs. Methods We retrospectively reviewed all patients admitted with a DFI between 2018 and 2020 and selected for patients diagnosed with infectious OM of the lower extremity for whom bone biopsy or deep tissue culture was obtained. Statistics were performed in R version 4.2.0. Results Of 305 patients with DFI, 47 patients received 41 deep tissue cultures and 29 bone biopsies for a total of 70 cultures. Of 45 (64%) positive cultures, 36 (80%) had gram positive organisms and 24 (34%) had gram negative organisms. Multidrug resistant organisms were isolated in 7 (14.9%) patients, including 5 cases of MRSA (10.2%) and 2 cases of ESBL-producing organisms (4.3%). Pseudomonas aeruginosa was isolated in 3 (6.4%) patients. Culture data resulted in antibiotic changes in 41 (87.2%) patients. Therapy was narrowed in 29 (61.7%) patients and broadened due to inadequate empiric coverage in 4 patients (8.5%). Culture-directed therapy was started in 4 (8.5%) patients in which it had initially been withheld. Culture data from 18 (40%) patients showed sensitivity to an oral treatment regimen with high bioavailability. There was no significant difference in rates of antibiotic utilization at discharge between patients who underwent bone biopsy or deep tissue culture relative to those who did not (80% vs 75%, p=0.857). There was a trend towards utilization of less MRSA coverage (38.2% vs 50.5%, p=0.16) and Pseudomonas coverage (34.0% vs 41.9%, p=0.36) in patients undergoing bone biopsy or deep tissue culture, but this did not reach statistical significance. Table 1:Bacteria isolated from deep tissue culture or bone biopsy and effect on antibiotic therapyFigure 1:Empiric antibiotics in hospital vs culture directed antibiotics on discharge Conclusion In patients with DFIs, deep tissue and bone biopsy cultures were infrequently obtained but resulted in targeted therapy changes in most patients. While culture data usually allowed for narrowing of antibiotics, it revealed inadequate empiric coverage in a subset of patients. Disclosures Janna L. Williams, MD, Abbvie: COVID19 Infection Prevention Consultant Shannon Galvin, MD, Gilead: Grant/Research Support.

Risk factors and prognosis of acute lactation mastitis developing into a breast abscess: A retrospective longitudinal study in China.

Breast abscess is developed on the basis of acute mastitis, which will cause damage to the physical and mental health of lactating women and is an important factor affecting the rate of breastfeeding. This study examined the risk factors for mastitis to develop into breast abscess, and analyzed the distribution of pathogenic bacteria, bacterial resistance, and treatment outcome. The medical records of 316 cases of mastitis and 219 cases of breast abscess were retrospectively collected. We analyzed the bacterial distribution of mastitis and breast abscess, and compared the differences of bacterial drug resistance. Univariate analysis and binary logistic regression were used to analyze the following aspects: age, primiparity or not, history of breast surgery, body temperature, puerperium or not, onset time, located in the nipple/areolar complexe area or not, history of massage by non-professionals, staphylococcus aureus/methicillin-resistant staphylococcus aureus (MRSA) infection or not, diabetes and white blood cell count. Of the 535 patients, 203 (37.9%) were positive for staphylococcus aureus. There were 133 (65.5%) cases of methicillin-sensitive staphylococcus aureus (MSSA) and 70 (34.5%) cases of MRSA. Concerning bacterial drug resistance, a statistical analysis showed that MSSA had high resistance rate to penicillin (96.2%), ampicillin (91%), clindamycin (42.9%) and erythromycin (45.9%). MRSA had a high resistance rate to penicillin (100%), ampicillin (98.6%), oxacillin (95.7%), erythromycin (81.4%), clindamycin (80%), and amoxicillin (31.7%). Risk factors for progression of mastitis to breast abscess include a body temperature<38.5°C, a postpartum time ≥ 42 days, an onset time ≥ 2 days, lesions in the nipple/areolar complex area, a history of massage by non-medical staff and bacterial cultures for milk or pus that test positive for staphylococcus aureus or MRSA (P < 0.001). The most common pathogenic bacteria of mastitis and breast abscess is staphylococcus aureus. There are many risk factors for mastitis to develop into breast abscess. We should take effective measures for its risk factors and select sensitive antibiotics according to the results of bacterial culture to reduce the formation of breast abscess.

MecC MRSA in Israel-genomic analysis, prevalence and global perspective.

BackgroundMRSA is a major global healthcare problem. In 2011, a new mec variant designated mecC was described, presenting partial identity at the DNA level, thus undetectable by routine mecA PCR.ObjectivesUntil now, no reliable information regarding mecC MRSA prevalence was available in Israel. In this study, to the best of our knowledge, we describe the first case of mecC MRSA in Israel, with focus on genomic analysis and global context.MethodsThe mecC MRSA isolate was analysed by WGS with focus on phylogeny, global contextualization, virulence and resistance genes. The strain was characterized by antibiotic susceptibility testing, spa typing and presence of mecA/C and pvl genes.ResultsAn MRSA strain (SA10610), isolated from a urine sample of an 83-year old patient, was found negative for the mecA and pvl genes. The MLST and spa type were ST130 and t1736, respectively. SA10610 presented resistance to oxacillin, penicillin and cefoxitin, and susceptibility to all non-β-lactam agents tested. Phylogenetic comparison with a global dataset of 586 mecC MRSA genomes revealed substantial genomic divergence. The nearest genomic relatives were human and animal isolates from Denmark. A screen of 12 761 S. aureus isolates collected during 2011–18 in Israel indicated this is the only mecC-positive strain.ConclusionsA high degree of genetic variability was found between the SA10610 strain and previously sequenced mecC MRSA isolated worldwide. The genomic and phylogenetic analysis suggest that mecC MRSA isolates have evolved independently rather than from a common ancestor.

Identifying patient-level risk factors associated with non-β-lactam resistance outcomes in invasive MRSA infections in the United States using chain graphs.

BackgroundMRSA is one of the most common causes of hospital- and community-acquired infections. MRSA is resistant to many antibiotics, including β-lactam antibiotics, fluoroquinolones, lincosamides, macrolides, aminoglycosides, tetracyclines and chloramphenicol.ObjectivesTo identify patient-level characteristics that may be associated with phenotype variations and that may help improve prescribing practice and antimicrobial stewardship.MethodsChain graphs for resistance phenotypes were learned from invasive MRSA surveillance data collected by the CDC as part of the Emerging Infections Program to identify patient level risk factors for individual resistance outcomes reported as MIC while accounting for the correlations among the resistance traits. These chain graphs are multilevel probabilistic graphical models (PGMs) that can be used to quantify and visualize the complex associations among multiple resistance outcomes and their explanatory variables.ResultsSome phenotypic resistances had low connectivity to other outcomes or predictors (e.g. tetracycline, vancomycin, doxycycline and rifampicin). Only levofloxacin susceptibility was associated with healthcare-associated infections. Blood culture was the most common predictor of MIC. Patients with positive blood culture had significantly increased MIC of chloramphenicol, erythromycin, gentamicin, lincomycin and mupirocin, and decreased daptomycin and rifampicin MICs. Some regional variations were also observed.ConclusionsThe differences in resistance phenotypes between patients with previous healthcare use or positive blood cultures, or from different states, may be useful to inform first-choice antibiotics to treat clinical MRSA cases. Additionally, we demonstrated multilevel PGMs are useful to quantify and visualize interactions among multiple resistance outcomes and their explanatory variables.

Incidence of Methicillin Resistant Staphylococcus Aureus (MRSA) Among Patients Necessitating Reconstructive Surgery

Purpose: Staphylococcus aureus is an important nosocomial pathogen and the progression of methicillin resistance stances a most important threat for its control. The current study was directed to govern the MRSA prevalence and its susceptibility to various antibiotics given for anti-staphylococcal strains in OPD treated patients. Study design: Prospective descriptive study. Place and duration: This study was conducted in the East Surgical Ward of Mayo Hospital, Lahore for two-year duration from January 2020 to December 2021. Methods: A total of 200 patients with septic wounds of both sexes were encompassed in the study. Swabs were taken from wounds which were infected and Stuart's medium was used to transport them. The samples were grown onto MacConkey agar, nutrient agar and blood agar and for 24 hours; incubated at 37 ° C. All MRSA isolates were biochemically and morphologically identified using standard procedures of laboratory by processing clinical specimens submitted to a microbiology laboratory. All isolates were tested for patterns of resistance and sensitivity. Results: A total of 200 patients were included, 115 (57.5%) were men and 85 (42.5%) were women with 27.3 years of mean age and age range from 15-70 years. The incidence of positive cases confirmed by culture was 118 (59%) and the MRSA incidence was 78 (39%). Of the 78 cases of MRSA, 50 (64.10%) are men and 28 (35.90%) are women. The incidence of other microorganisms was 40 (33.8%). MRSA was 100% sensitive to vancomycin, teicoplanin and linezolid. Of these, 24.4% were sensitive to cotrimoxazole, 47.4% were sensitive to fucidic acid and 28.2% were sensitive tetracycline antibiotics. Cultured MRSAs were resistant 100% to main antibiotic groups including penicillin, macrolides, cephalosporins, fluoroquinolones, meropenem, imipenem, gentamicin, and tazobactum/ pipracillin. Of all 78 MRSA patients, &gt; 50% were from general surgery and orthopaedics departments, and the remainder from other related specialties, such as Gynecology, pediatric surgery, maxillofacial surgery, neurosurgery and otolaryngology. Of 78 patients with MRSA, 70 (89.7%) were hospitalized with a history of hospitalization, and 60 (76.9%) were hospitalized for &gt;1-week. The organism was institute to be hundred percent resistant to the generally directed antibiotics. Conclusions: The incidence of MRSA is increasing. The organism spreads readily in a hospital setting, causing morbidity, mortality and higher costs. Special infection control actions and precautions should be taken to stop and prevent the MRSA spreading. Keywords: Nosocomial infections, MRSA and Antibiotic resistance

UJI SENSITIVITAS PROPOLIS TERHADAP BAKTERI Staphylococcus aureus Dan Eschericia coli

The threat of infectious diseases from strains of pathogenic bacteria Staphylococcus aureus and Eschericia coli is capable of causing resistance to antibiotics. The prevalence of MRSA cases was 8.2%. One of the efforts to control infections caused by antibiotic-resistant bacteria is to utilize several antimicrobial compounds derived from natural ingredients, namely propolis. Contains polyphenolic compounds and flavonoids that function as antimicrobials. The purpose of this study was to analyze the inhibition zone formed due to the antimicrobial activity of propolis extract against the growth of Staphylococcus aureus and Eschericia coli bacteria. This research was conducted in vitro at the Microbiology Laboratory of the Medical Laboratory Technology Department of Health Poltekkes Surabaya in February – April 2021. This study used the Kirby Bauer diffusion method with paper blank discs on MHA media by measuring the diameter of the inhibition zone formed from the growth of Staphylococcus aureus and Eschericia coli with units of mm. Research The concentration of propolis extract used was 5%, 10%, 15%, and 20%. In this study, it was concluded that propolis extract can be used as an antimicrobial compound, there is a different effect of concentration of propolis extract on Staphylococcus aureus from Eschericia coli. Data analysis on the Kruskal Wallis test has a value of 0.004 (&lt;0.05) which indicates that there is a significant difference between each concentration of propolis extract both against Staphylococcus aureus and Eschericia coli. The effect of the effective concentration is at a concentration of 20% against Staphylococcus aureus which has an average inhibition zone diameter of 13 mm while that of Eschericia coli is 22.5 mm.

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1–9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.

The efficacy of bactrim in reducing surgical site infections after spine surgery

BackgroundPrevious studies show an increasing incidence of gram-negative organisms in surgical site infections after spine surgery. This study is looking for the association of the post-operative prophylactic use of Bactrim and the gram-negative surgical site infection after lumbar spine surgery MethodsPatients who underwent lumbar spine surgery between August 2010 and December 2019 at the institution were retrospectively reviewed. ResultsThere were 11 infections out of 511 cases where no oral antibiotics were given (2.2%). There were 2 infections out of 84 cases where Bactrim was given (2.4%). This was not statistically significant (P=0.89). The organisms cultured from the no oral antibiotic group were 8 cases of methicillin sensitive Staphylococcus aureus (MSSA), 1 case of E. coli, 1 case of Pseudomonas aeruginosa, 1 case of MRSA. The organisms cultured from the Bactrim group were 1 case of MRSA, and 1 case of combined Citrobacter freundii and methicillin sensitive Staphylococcus aureus (MSSA). ConclusionThere was no statistically significant difference in SSIs when Bactrim was given for two weeks after surgery. However, two subjects who developed infection from the Bactrim group were paradoxically affected by gram-negative and antibiotic resistant organisms. So, clinicians should be judicious in their use of oral antibiotics after spine surgery. Level of Evidence: III

POS-566 CATHETER RELATED BLOODSTREAM INFECTION (CRBSI) IN A MIDDLE-EASTERN COHORT OF HEMODIALYSIS PATIENTS: AN ANALYSIS OF 5 YEARS OF FOLLOW UP DATA

Bloodstream infections (BSI) are the second commonest cause of morbidity and mortality in end stage renal failure (ESRF) patients. Dialysis catheters are believed to be the most common contributors to BSI in this cohort. Therefore, patients who are receiving hemodialysis via long term central venous catheters (CVC) are at significantly high risk of CRBSI and its associated morbidity and mortality. Although there are several studies on CRBSI from different cohorts around the world, long-term follow up data are scarce particularly from middle eastern cohorts. We aim to fill this knowledge gap as well as to develop an antibiogram and antibiotic stewardship for this unique cohort of patients. This is a single center retrospective longitudinal study of a middle eastern cohort receiving three times a week regular hemodialysis via permanent CVC in a large out-patient setting. We analyzed all the data from December 2015 to November 2020. Data on incidents of CRBSI, etiology, antimicrobial susceptibility, CRBSI risk factors, and comorbidities were collected. For the sake of our study, we defined CRBSI with the isolation of the same microorganism from the CVC and peripheral blood culture without any other apparent source. The incidence of CRBSI was expressed as incidence per 1000 catheter days. A total of 39 incidents of CRBSI were identified during these 5 years study period. Of the reported cases, 94% grew a single organism while 6% grew polymicrobial. Of the multitude of organisms isolated, 39% were gram positives while the rest were gram negatives. Staphylococcus aureus and enterococcus were predominant gram positives while pseudomonas and klebsiella were the predominant gram negatives. No case of MRSA or fungi were isolated. The distribution of organisms is illustrated in the bar chart below. Interestingly only 70% of cases presented with the typical triad of fever, rigors, and exit site exudates, while around 20% presented with only hypotension. 10% of the cases were completely asymptomatic and were only incidental findings. The incidence of CRBSI per 1000 catheter days was calculated for every month and as illustrated by the graph below, the CRBSI rates seem quite variable throughout this study period. However, interestingly, since the beginning of the COVID19 pandemic outbreak, the CRBSI rates are conspicuously low. This might be explainable by enhanced focus on hand hygiene by both the staff and the patients themselves during this pandemic. CRBSI incidences were higher among patients with longer duration of catheter use, previous bacteremia, old age, diabetes mellitus, and recent hospitalization.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The incidence of CRBSI reported from our center seems to be comparable to other international centers around the world. The causative microorganisms and their antibiotic susceptibilities also seem to be in concordance with the rest of the world despite variations in geography, climate, and ethnicity. We conclude, that irrespective of the differences in the geographical location and study cohorts, strict adherence and attention to hand hygiene and infection control practices by both the staff and the patients are the keys to keeping CRBSI low.

Diagnosis and treatment of 11 cases of subperiosteal orbital abscess caused by acute sinusitis

Objective:The aim of this study is to explore the diagnosis, clinical manifestations and surgical treatment experience of acute sinusitis complicated with orbital subperiosteal abscess. Methods:The clinical data of 11 patients with acute sinusitis complicated by orbital subperiosteal abscess from 1 year and 8 months to 50 years were retrospectively analyzed, including clinical manifestations, imaging manifestations, bacteriological examinations, surgical methods and therapeutic effects. All patients were given antibacterial drugs, glucocorticoids, and surgery. Results:All 11 patients had unilateral lesions. The imaging examinations all supported the appearance of orbital subperiosteal abscess. Nine patients underwent nasal endoscopic sinus opening+SPOA incision and drainage, 2 patients underwent nasal endoscopic sinus opening+ultrasound guided abscess puncture. Eyelid swelling and exophthalmia of all patients were alleviated when discharged. Ten of the 11 patients had no visual acuity change, and one patient had light perception only when she came to the hospital and recovered to 0.05 when discharged, there was no change in visual acuity after 3 months follow-up. The bacterial cultures of nasal secretion or pus were positive in 7 cases, the main pathogenic bacteria were Staphylococcus aureus（3 cases, includes one case of MRSA）, Streptococcus anginosus（2 cases）, and Streptococcus intermedius（2 cases）. Conclusion:Rhinogenous orbital subperiosteal abscess has a rapid onset and progresses quickly. Once an abscess is formed, patients with poor conservative treatment should choose surgical treatment as soon as possible. The most common surgical method is nasal endoscopic sinus opening+SPOA incision and drainage. If the abscess is located above or above the eyeball, puncture or incision and drainage should be combined with ultrasound guidance.

Less than you'd think-a prospective study on MRSA-colonization in healthy travellers.

International travel has been identified as a major contributing factor to the global spread of MRSA. We examined the incidence of MRSA-colonization in a cohort of 196 travellers. We observed a low rate of only one case of MRSA, indicating a low risk of acquisition of MRSA-colonization in travel.

Long Term Evaluation of Radiographically Undetected Acute Osteomyelitis Resulting Chronic Osteomyelitis with MRSA

Osteomyelitis is an infection and inflammation of the bone that can spread into all parts of the bone. Methicillin-resistant Staphylococcus aureus or MRSA made the disease’s management far more complex and constrained and 28% of hospitals in Indonesia are suspected to be MRSA endemic. Osteomyelitis combined with MRSA have obscured prognosis knowing its assessment and management are still being developed.&#x0D; Presenting a case of Chronic Osteomyelitis and MRSA of 11-year old girl that has been monitored for 5 years after the reported onset since July 2015.&#x0D; The patient complained of severe pain in the left hip region causing her to stop using her left limb in July 2015. Signs of acute osteomyelitis couldn’t be confirmed by sequential assessments of X-Ray and USG examination. Cefazolin and Gentamicin injections were administered for 23 days. The family requested the patient to be sent home, due to no significant clinical improvement as indicated by them. Antibiotic regimens changed into oral regimens, which were Co-Amoxiclav and Gentamicin. The patient never appeared for routine check-up, her family conceded that they went to traditional alternative medication and stated the patient's clinical outcomes were showing signs of improvement; where the patient was able to walk normally. 6 months after, the patient's mother observed abnormal gait, however the patient didn't mention nor complain anything. X-ray assessment was then performed, with the result of the entire left femoral head being reportedly destroyed. In January 2016 the patient was referred to dr. Soetomo Academic General Hospital, the patient was diagnosed with chronic osteomyelitis and pathological fracture of 1/3 proximal left femur with a suspicion of avascular necrosis.&#x0D; &#x0D; The patient was given prophylactics antibiotics. Closed biopsy couldn't be performed hence open biopsy was suggested. The patient had routine check-ups to monitor the disease progression, alongside radiologic assessment and laboratory assessment prior to the operation. Episodes of localised swollen and tenderness in the hip area were accounted. Scenes of seropurulent discharges were additionally reported. In june 2017 patients had surgical debridement and sequestrectomy alongside an open biopsy, where MRSA was diagnosed. No antibiotics had been given after the surgery and the patient routinely washed up with Chlorhexidine Gluconate 4%. The patient still does routine check-ups at the outpatient facility, as radiologic and laboratory examination are routinely observed.&#x0D; As of now, the patient has no issue in its daily living activities. There is still limited range of movement at the infected site, with 90 degree of hip flexion and constrained internal rotation. A lower limb length discrepancy is present due to local growth aggravation at the left hip, currently patient using shoe with lift modifications on her left leg. In any case, there has been no complaint of pain, swollen or seropurulent releases throughout the last 18 months

Community-Acquired Methicillin-Resistant Staphylococcus aureus Infections in Acutely Ill Children: A Retrospective Case-Control Study.

To test if admission clinical and laboratory variables could reliably discriminate community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections from methicillin-sensitive Staphylococcus aureus (MSSA) infections in acutely ill children, and to describe the epidemiology, clinical features and outcomes among children with Staphylococcal infections admitted to the hospital. The authors conducted this retrospective case-control study comparing children with CA-MRSA and MSSA infections admitted to hospital between June 2014 and June 2017. They describe the evolving epidemiology and attempt to identify clinical and laboratory variables that can differentiate MRSA cases from MSSA controls. They used multivariate logistic regression to identify independent predictors of MRSA infection and Cox-proportional hazard analysis to compare survival times. Seventy-three children were enrolled, of which 35 had CA-MRSA and 38 had MSSA infections. Children in MRSA group were younger [median (IQR) age in months: 36 (12, 62) vs. 56 (37, 96); p = 0.032]. MRSA and MSSA groups had similar rate of skin and soft tissue involvement (SSTI) [62.9% vs. 54.1%; p = 0.449]. Median duration of illness was lower in MRSA, 6 vs. 8.5 d (p = 0.001). TLC of 8100 or less was 82% sensitive and 94% specific for MRSA sepsis at admission [AUROC = 0.64 (0.51-0.77), p = 0.04]. Mortality (8.6% vs. 10.5% p = 1.0) and length of ICU stay (7.2 vs. 9.3 d, p = 0.24) were similar in both. None of the admission variables were predictive of MRSA culture-positivity on regression analysis. The hospital-based incidence of CA-MRSA infections among children appears to be increasing. None of the admission clinical or laboratory variables could reliably identify CA-MRSA infections. As there seems to be no reliable way to differentiate children with MSSA and MRSA infections, physicians may consider empiric initiation of broad-spectrum antibiotics at admission to cover both MSSA and MRSA, especially in critically ill children with suspected Staphylococcal infections.

Molecular surveillance of methicillin-resistant Staphylococcus aureus genomes in hospital unexpectedly reveals discordance between temporal and genetic clustering

The objective of this study was to identify sources and linkages among methicillin-resistant Staphylococcus aureus infections using whole-genome sequencing (WGS). A total of 56 samples were obtained from all patients with a confirmed MRSA infection over 6 months at University of Florida-Health Jacksonville. Samples were cultured and sequenced; data was analyzed on an automated cloud-based platform. Genetic Clusters were defined as <40 single nucleotide polymorphisms. Temporal Clusters were defined as ≥5 MRSA cases over 3 days. We found 7 Genetic Clusters comprising 15 samples. Four Genetic Clusters contained patients with non-overlapping stays (3-10 weeks apart), 3 of which contained patients who shared the same Unit. We also found 5 Temporal Clusters comprising 23 samples, although none of the samples were genetically related. Results showed that temporal clustering may be a poor indicator of genetic linkage. Shared epidemiological characteristics between patients in Genetic Clusters may point toward previously unidentified hospital sources. Repeated observation of related strains is also consistent with ongoing MRSA transmission within the surrounding high-risk community. WGS is a valuable tool for hospital infection prevention and control.

Mortality from necrotizing fasciitis: a cross-sectional study

Background: Necrotizing fasciitis refers to the rapidly progressive inflammation of the fascia, with secondary necrosis of subcutaneous tissues. Due to the high mortality, it is considered a surgical emergency, needing timely diagnosis and appropriate treatment with early debridement. The aim of the study was to analyse the clinical profile of patients with necrotizing fasciitis so as to determine the mortality and the risk factors associated with mortality and other poor outcomes.Methods: This retrospective cross-sectional study was conducted in a tertiary hospital in Kerala, from January 2016 through January 2018. 175 cases were identified through the ICD codes for necrotizing fasciitis and Fournier’s gangrene in the discharge and death registers; and data were obtained about these patients. The data were analyzed to assess the study objectives.Results: In this study mortality was found to be 22.7%. Diabetes mellitus was found to be the most common co-morbid disease and had a significant association with increased risk of amputation. Mixed growth (type I NF) was the most common microbiological isolate and Pseudomonas was the most common gram-negative isolate. 4 cases of MRSA were recorded. Klebsiella infection was found to have increased risk of undergoing limb amputation. 7.4% of the patients required amputation during hospital stay for infection control.Conclusions: Necrotizing fasciitis has a high mortality. Diabetes mellitus was found to be the most common co-morbid disease. Increased blood glucose and low serum albumin had a significant association with an increased risk of amputation. Proper control of these factors is essential to reduce mortality from this condition.

Staphylococcus aureus nasal carriage among healthcare workers, inpatients and caretakers in the Tamale Teaching Hospital, Ghana

BackgroundStaphylococcus aureus associated nosocomial infection is an important health challenge as isolates may involve multidrug resistant strains. Sources of S.aureus infection in healthcare settings include colonized healthcare workers, inpatients, and caretakers. This study investigates S. aureus carriage rate and associated antimicrobial resistance among healthcare workers, inpatients, and caretakers in the Tamale Teaching Hospital (TTH), Ghana. MethodsNasal swabs and demographic data were collected from a cross-section of healthcare workers, inpatients, and caretakers. The swabs were culture and S. aureus isolates subjected to antibiotic susceptibility assay. ResultsResults: S. aureus nasal carriage rate was 25.5% (27/106) while MRSA and non-MRSA prevalence were 8.5% (9/106) and 17.0% (18/106) respectively. The proportion of S. aureus carriage distribution was highest among neonates 42.1% (8/19), follow by participant in the age group 11–20 years, 36.8% (7/19). Inpatients, healthcare workers, and caretakers recorded S. aureus carriage rate of 30.0% (15/50), 27.8% (10/36), and 10% (2/20), respectively. Healthcare workers had the highest proportion of MRSA 40% (4/10) and inpatients recorded a rate of 33.3% (5/15), while no case of MRSA was recorded among caretakers. Antibiotic resistance pattern of the isolates was generally higher in MRSA compared to non-MRSA. ConclusionsThere exist relatively high rate of S. aureus nasal carriage among healthcare workers, inpatients, and caretakers in the wards/units of the TTH. However, MRSA were only isolated from healthcare workers and inpatients but not caretakers.