Methicillin-resistant Staphylococcus Aureus Colonization Research Articles

Methicillin-Resistant Staphylococcus aureus Carriage among Neonate Mothers, Healthcare Workers, and Environmental Samples in Neonatal Intensive Care Units: A Systematic Review.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of morbidity and mortality among neonates admitted to neonatal intensive care units (NICUs). The MRSA colonization of neonates, attributed to various sources, including mothers, healthcare workers, and environmental surfaces, can lead to severe infection, prolonged hospital stays, and even death, imposing substantial economic burdens. Given the pressing need to mitigate MRSA spread in these vulnerable environments, further examination of the subject is warranted. This systematic review is aimed at synthesizing available evidence on MRSA carriage proportions among mothers of newborns, healthcare workers, and environmental surfaces in NICUs. Methodology. We included observational studies published in English or French from database inception to March 21, 2023. These studies focused on MRSA in nonoutbreak NICU settings, encompassing healthy neonate mothers and healthcare workers, and environmental surfaces. Literature search involved systematic scanning of databases, including Medline, Embase, Web of Science, Global Health, and Global Index Medicus. The quality of the selected studies was assessed using the Hoy et al. critical appraisal scale. The extracted data were summarized to calculate the pooled proportion of MRSA positives, with a 95% confidence interval (CI) based on the DerSimonian and Laird random-effects model. A total of 1891 articles were retrieved from which 16 studies were selected for inclusion. Most of the studies were from high-income countries. The pooled proportion of MRSA carriage among 821 neonate mothers across four countries was found to be 2.1% (95% CI: 0.3-5.1; I2 = 76.6%, 95% CI: 36.1-91.5). The proportion of MRSA carriage among 909 HCWs in eight countries was determined to be 9.5% (95% CI: 3.1-18.4; I2 = 91.7%, 95% CI: 87.1-94.6). The proportion of MRSA carriage among HCWs was highest in the Western Pacific Region, at 50.00% (95% CI: 23.71-76.29). In environmental specimens from five countries, a pooled proportion of 16.6% (95% CI: 3.5-36.0; I2 = 97.7%, 95% CI: 96.6-98.4) was found to be MRSA-positive. With a significant heterogeneity, our systematic review found high MRSA carriage rates in neonate mothers, healthcare workers, and across various environmental surfaces in NICUs, posing a potential risk of nosocomial infections. Urgent interventions, including regular screening and decolonization of MRSA carriers, reinforcing infection control measures, and enhancing cleaning and disinfection procedures within NICUs, are crucial. This trial is registered with CRD42023407114.

Clinical Efficacy of Nasal Screening and Methicillin-Resistant Staphylococcusaureus Decolonization in Total Hip Arthroplasty without Chlorhexidine Soap or Vancomycin.

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is a known risk factor for periprosthetic joint infection (PJI). In our facility, preoperative prophylaxis with mupirocin without the chlorhexidine soap scrub or vancomycin was consistently implemented for more than 15years. This study aimed to evaluate the current screening and treatment of intranasal MRSA colonization in our elective primary THA patient population. All patients who underwent primary THA between April 2011, and March 2021 were included in this analysis. All patients were screened preoperatively for nasal MRSA approximately 1month before surgery. Patients with nasal MRSA contamination are treated with topical mupirocin to eradicate the bacteria before surgery. The patients were examined again approximately two weeks before surgery. We evaluated the current screening and treatment of intranasal colonization with MRSA in our elective primary total hip arthroplasty (THA) patient population. Out of 6251 patients, 106 (1.7%) had nasal MRSA contamination. The bacteria were not eradicated in three (3.6%) patients at the second screening. Twenty-two joints (0.35%) out of the 6251 had deep infections. Only 1 patient out of the 106 MRSA nasal carriers suffered from PJI. Twenty-one of the 6145 non-carriers had PJI. The difference between the prevalence of nasal MRSA contamination and the incidence of deep infections was not statistically significant. Our findings suggest that screening of all patients for nasal MRSA before THA followed by mupirocin calcium treatment if needed is sufficient PJI prophylaxis.

Comparison of disease and economic burden between MRSA infection and MRSA colonization in a university hospital: a retrospective data integration study

BackgroundAlthough there is a growing concern and policy regarding infections or colonization caused by resistant bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), the prognosis of MRSA infections compared to that of methicillin-susceptible Staphylococcus aureus (MSSA) infections remains controversial. Moreover, there have not been any studies comparing both the burden of disease and its impact on the healthcare economy between MRSA infection and colonization while adjusting for confounding factors. These comparisons are crucial for developing effective infection control measures and healthcare policies. We aimed to compare the disease and economic burden between MRSA and MSSA infections and between MRSA infection and colonization.MethodsWe retrospectively investigated data of 496 in-patients with MRSA or MSSA infections and of 1178 in-patients with MRSA infections or MRSA colonization from a university hospital in Japan from 2016 to 2021. We compared in-hospital mortality, length of stay, and hospital charges between in-patients with MRSA and MSSA infections and those with MRSA infections and MRSA colonization using multiple regressions. We combined surveillance data, including all microbiological test results, data on patients with infections, treatment histories, and clinical outcomes, to create the datasets.ResultsThere was no statistically significant difference in in-hospital mortality rates between matched MRSA vs. MSSA infections and MRSA infection vs. colonization. On the contrary, the adjusted effects of the MRSA infection compared to those of MSSA infection on length of stay and hospital charges were 1.21-fold (95% confidence interval [CI] 1.03–1.42, P = 0.019) and 1.70-fold (95% CI 1.39–2.07, P < 0.00001), respectively. The adjusted effects of the MRSA infection compared to those of MRSA colonization on length of stay and hospital charges were 1.41-fold (95% CI 1.25–1.58, P < 0.00001) and 1.53-fold (95% CI 1.33–1.75, P < 0.00001), respectively. Regarding confounding factors, hemodialysis or hemofiltration was consistently identified and adjusted for in the multiple regression analyses comparing MRSA and MSSA infections, as well as MRSA infection and MRSA colonization.ConclusionsMRSA infection was associated with longer length of stay and higher hospital charges than both MSSA infection and MRSA colonization. Furthermore, hemodialysis or hemofiltration was identified as a common underlying factor contributing to increased length of stay and hospital charges.

An exploration of mechanisms underlying Desemzia incerta colonization resistance to methicillin-resistant Staphylococcus aureus on the skin.

Colonization of human skin and nares by methicillin-resistant Staphylococcus aureus (MRSA) leads to the community spread of MRSA. This spread is exacerbated by the transfer of MRSA between humans and livestock, particularly swine. Here, we capitalized on the shared features between human and porcine skin, including shared MRSA colonization, to study novel bacterial mediators of MRSA colonization resistance. We focused on the poorly studied bacterial species Desemzia incerta, which we found to exert antimicrobial activity through a secreted product and exhibited colonization resistance against MRSA in an in vivo murine skin model. Using parallel genomic and biochemical investigation, we discovered that D. incerta secretes an antimicrobial protein. Sequential protein purification and proteomics analysis identified 24 candidate inhibitory proteins, including a promising peptidoglycan hydrolase candidate. Aided by transcriptional analysis of D. incerta and MRSA cocultures, we found that exposure to D. incerta leads to decreased MRSA biofilm production. These results emphasize the value of exploring microbial communities across a spectrum of hosts, which can lead to novel therapeutic agents as well as an increased understanding of microbial competition.IMPORTANCEMethicillin-resistant Staphylococcus aureus (MRSA) causes a significant healthcare burden and can be spread to the human population via livestock transmission. Members of the skin microbiome can prevent MRSA colonization via a poorly understood phenomenon known as colonization resistance. Here, we studied the colonization resistance of S. aureus by bacterial inhibitors previously identified from a porcine skin model. We identify a pig skin commensal, Desemzia incerta, that reduced MRSA colonization in a murine model. We employ a combination of genomic, proteomic, and transcriptomic analyses to explore the mechanisms of inhibition between D. incerta and S. aureus. We identify 24 candidate antimicrobial proteins secreted by D. incerta that could be responsible for its antimicrobial activity. We also find that exposure to D. incerta leads to decreased S. aureus biofilm formation. These findings show that the livestock transmission of MRSA can be exploited to uncover novel mechanisms of MRSA colonization resistance.

Trends of antimicrobial susceptibilities and multidrug-resistant colonization rate in patients transferred from long-term care facilities during 2017-2022: a cross-sectional study.

With the global increase in the older population, the proportion of those receiving care in long-term care facilities (LTCFs) has also been increasing. We assessed the epidemiology, antibiotic susceptibility, and colonization status of drug-resistant organisms in patients transferred from LTCFs. We retrospectively reviewed the medical records of patients transferred from LTCFs between 2017 and 2022. The reasons for admission, antimicrobial susceptibility, and colonization rates of carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), and carbapenem-resistant Acinetobacter baumannii (CRAB) were recorded. We analyzed the susceptibility and colonization rates by year to identify trends. Of the 936 patients transferred from LTCFs, 54.3% were admitted to the intensive care unit and 12.5% died. The most common reason for admission was infection (n = 573, 61.2%), followed by gastrointestinal bleeding (n = 67, 7.2%) and cerebrovascular disorder (n = 65, 6.9%). A total of 452 Enterobacterales strains were isolated, and their susceptibility rates to ciprofloxacin and cefotaxime were 33.3% and 35.6%, respectively. A total of 54.9% were extended-spectrum beta-lactamase-producing strains, and 4.9% of them were carbapenem-resistant, both of which showed an increasing trend (P = 0.024 and P < 0.001, respectively). The prevalence rates of CRE, CRAB, and MRSA colonization were 9.2%, 7.1%, and 23.1%, respectively. CRE colonization showed a significant increase (P < 0.001), with carbapenemase-producing Enterobacterales accounting for 75.9% of cases. Patients transferred from LTCFs are primarily affected by infections and exhibit high resistance rates. The increasing trend in CRE colonization rates each year highlights the need for the implementation of rigorous infection control measures for effective management.

Prevalence of Methicillin-Resistant Staphylococcus aureus in Nasal Cavity of Medical Students at Shendi University, Sudan

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is becoming ever more prevalent in Sudan, and the proportion of MRSA to methicillin-sensitive Staphylococcus aureus (MSSA) seems to be increasing. New strains of MRSA are ever-developing resistance to antibiotic treatment, increasing morbidity and mortality rate.&#x0D; Objectives: To detect the prevalence of methicillin-resistant Staphylococcus aureus in the nasal cavity of medical students at Shendi University and to detect variations of MRSA Colonization between student smokers and non-smoker students.&#x0D; Methodology: 60 swabs were collected from medical students of Shendi University, culture, and direct gram stain were done, then the plates were examined for any significant bacterial growth. The isolated bacteria were then identified by colonial morphology, indirect gram stain, and biochemical tests.&#x0D; Results: All data were analyzed using Statistical Package for Social Sciences (SPSS). Of these, 66.7 % (40/60) were males. 33.3% (20/60) were females. The isolated organism was Staphylococcus aureus 24 (40%), with no growth 36 (60%). The study showed that the overall resistance of Staphylococcus aureus to Methicillin was 21 (35%) and 3 (5%) Sensitive to Methicillin. Methicillin-resistant Staphylococcus aureus cases were found in nine (100%) of the students who smoked and twelve (80%) of the students who did not smoke. Of the pupils who did not smoke, three (20%) had Staphylococcus aureus. Methicillin Sensitive.&#x0D; Conclusion: The carriage rate of S. aureus is consistent with similar studies. MRSA carriage in this university study appears high as compared to the general population. Although this study did not confirm a variety of risk factors for the carriage of MRSA previously identified by others, university healthcare personnel should be aware of the changing epidemiology of MRSA and the preventive measures needed to avoid outbreaks.

Global epidemiology of asymptomatic colonisation of methicillin-resistant Staphylococcus aureus in the upper respiratory tract of young children: a systematic review and meta-analysis

ObjectiveTo estimate the global prevalence of asymptomatic colonisation, and determine the associated risk factors, antibiotic resistance and genotypes of methicillin-resistant Staphylococcus aureus (MRSA) in the upper respiratory tract of young...

Investigating the relationship between muscle mass and nasal Methicillin-Resistant Staphylococcus aureus (MRSA) colonization: Analysis of the National Health and Nutrition Examination Survey (NHANES).

Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization is associated with an increased risk of infection disease. Low muscle mass has been linked to higher levels of inflammatory markers and weakened immune response, which may impact the susceptibility to nasal MRSA colonization. The relationship between muscle function and immune response to pathogens may be bidirectional. This study investigates the association between muscle mass and nasal MRSA colonization in adults. The present cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) conducted between 2001 and 2004. Appendicular skeletal muscle mass (ASM) adjusted by body mass index (BMI) (ASM/BMI) was used to evaluate muscle mass. Multivariate logistic regression, adjusted for demographic and infection factors, was used to analyze the association between muscle mass and nasal colonization by MRSA. A subgroup analysis based on age and gender was performed to assess the impact of muscle mass on nasal MRSA colonization. Nasal MRSA colonization was more prevalent in females, those with smaller household sizes, lower income, lower ASM/BMI, those who had stayed in healthcare facilities in the past 12 months, and individuals with diabetes and smoking habits. After adjusting for confounding factors, a dose-dependent association was found between decreasing quartiles of ASM/BMI and the risk of nasal MRSA colonization (p < 0.05). Additionally, per 1 unit increase in ASM/BMI was related to a 64% lower risk of nasal MRSA colonization. This study suggests a significant negative correlation between ASM/BMI and the risk of nasal MRSA colonization. However, more prospective studies are required to investigate the causal relationship between muscle mass and colonization.

When is vancomycin prophylaxis necessary? Risk factors for MRSA surgical site infection.

The 2022 SHEA/IDSA/APIC guidance for surgical site infection (SSI) prevention recommends reserving vancomycin prophylaxis to patients who are methicillin-resistant Staphylococcus aureus (MRSA) colonized. Unfortunately, vancomycin prophylaxis remains common due to the overestimation of MRSA risk and the desire to cover MRSA in patients with certain healthcare-associated characteristics. To optimize vancomycin prophylaxis, we sought to identify risk factors for MRSA SSI. This was a single-center, case-control study of patients with a postoperative SSI after undergoing a National Healthcare Safety Network operative procedure over eight years. MRSA SSI cases were compared to non-MRSA SSI controls. Forty-two demographic, medical, and surgical characteristics were evaluated. Of the 441 patients included, 23 developed MRSA SSIs (rate = 5.2 per 100 SSIs). In the multivariable model, we identified two independent risk factors for MRSA SSI: a history of MRSA colonization or infection (OR, 9.0 [95% CI, 1.9-29.6]) and hip or knee replacement surgery (OR, 3.8 [95% CI, 1.3-9.9]). Hemodialysis, previous hospitalization, and prolonged hospitalization prior to the procedure had no measurable association with odds of MRSA SSI. Patients with prior MRSA colonization or infection had 9-10 times greater odds of MRSA SSI and patients undergoing hip and knee replacement had 3-4 times greater odds of MRSA SSI. Healthcare-associated characteristics, such as previous hospitalization or hemodialysis, were not associated with MRSA SSI. Our findings support national recommendations to reserve vancomycin prophylaxis for patients who are MRSA colonized, as well as those undergoing hip and knee replacement, in the absence of routine MRSA colonization surveillance.

Prevalence of Methicillin Resistant Staphylococcus aureus Colonisation in Patients undergoing Total Joint Arthroplasty: A Retrospective Observational Study

Introduction: Methicillin Resistant Staphylococcus aureus (MRSA) presents a significant, yet preventable, complication in Total Joint Arthroplasties (TJAs). Surgical Site Infections (SSIs) of prosthetic joints resulting from MRSA lead to substantial patient morbidity, mortality, and impose a significant burden on healthcare budgets. One method to mitigate these risks is to screen for MRSA colonisation prior to elective surgeries. The prevalence of MRSA colonisation in nasal mucosa ranges from 0.18-7.2% in different patient populations, with a nosocomial prevalence of 1.7%. Aim: To determine the prevalence of MRSA colonisation in all patients undergoing elective TJA, including Total Hip Replacement (THR) or Total Knee Replacement (TKR). Materials and Methods: A retrospective observational study was conducted on a total of 407 patients scheduled for elective TJAs. Data from 407 patients who underwent elective TJA between January 2020 and December 2022 (a period of three years) were selected for the study. Data compilation and analysis of the study subjects were performed retrospectively until March 2023 at the Sanjay Gandhi Institute of Trauma and Orthopaedics, a tertiary care Orthopaedic centre in Bengaluru, Karnataka, India. The study subjects were screened for MRSA colonisation through nasal swab culture and sensitivity. Patients with positive MRSA culture results were treated with decolonisation therapy, which involved the local application of 2% mupirocin and chlorhexidine body wash for five days. Descriptive data analytics were employed in the study, and tables were generated using Microsoft Word 2010 and Microsoft Excel 2010 (Microsoft Corp, Redmond, WA, USA). Results: The prevalence rates of MRSA nasal colonisation were n1=8 (8.42%), n2=2 (2%), and n3=16 (7.55%) for the years 2020 (n1), 2021 (n2), and 2022 (n3), respectively, at the centre. The period prevalence rate of MRSA colonisation in the nasal mucosa over three years was N=26 (6.4%). Conclusion: The present study revealed a high period prevalence of MRSA colonisation (6.4%) in patients undergoing TJAs. Therefore, all elective TJAs should undergo MRSA screening and decolonisation using 2% intranasal mupirocin and daily chlorhexidine body wash for five days as a successful treatment modality for all patients with MRSA-positive nasal colonisation. This approach helps prevent postoperative SSIs caused by MRSA.

The Impact of MRSA Colonization on Healthcare-Associated Infections in Long-Term Care Facility Residents: A Whole-Genome Sequencing-Based Study.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.

Prevalence of methicillin resistant staphylococcus aureus (MRSA) colonization in pregnant females visiting at tertiary care hospital in Northern Mumbai

Methicillin resistant s (MRSA) screening is a routine practice at many hospitals for high-risk patients. However, its incidence and clinical significance in expectant mothers are poorly understood. Hence, the purpose of the current study was to look at MRSA colonization rates in our obstetric population.Prospective study was conducted for three months from December 2019 to February 2020. MRSA screening samples from pregnant women at 32-34 weeks of gestation were collected after informed consent. All screening samples underwent standard microbiological analysis. Women who tested positive for MRSA received a decolonization program and their care was monitored.Total 78 mothers were included in the study. The rate of MRSA colonisation was 2.5% at 32 – 34 week of gestation. Decolonization protocol was advised for MRSA carriers.Our obstetric population has a low colonization rate for MRSA. Infections could be decreased with targeted antenatal MRSA screening and decolonization in women at high risk. Continued monitoring of MRSA infections in obstetric population and their infants is required.

Comparison of risk factors for Methicillin Resistant Staphylococcus aureus (MRSA) colonization in healthy newborns, born to mothers with and without MRSA colonization.

To compare the risk factors for MRSA colonization in healthy newborns, born of mothers with and without MRSA colonization. This case control study was conducted in post-natal unit of Lady Willingdon Hospital, affiliated with King Edward Medical University/Mayo Hospital, Lahore from January to June 2017. The vaginal and anterior nares swabs for MRSA culture were collected from mothers within six hours before planned delivery and the neonatal anterior nares swabs for MRSA culture were taken within one hour of birth. All the samples were cultured in Paediatric Microbiology laboratory in Mayo Hospital. Data were analyzed through SPSS 20.0 and logistic regression was applied for risk factors analysis. Out of total 80 mothers and their newborns, 15 (18.75%) mothers and 16 neonates (20%) were MRSA colonized. The frequency of MRSA colonization in mothers' anterior nares and vaginal swab was 17.5% and 1.25% respectively. The significant risk factors were prolonged rupture of membranes for >18 hours (p-value 0.02, odds ratio 11.85, 95% CI 1.41-99.3), birth weight <2500 grams (p-value 0.01, odds ratio 5.39, 95% CI 1.35-21.4), history of presence of meconium (p-value 0.006, odds ratio 7.30, 95% CI 1.78-29.8). The non-significant factors were age of mother (p-value 0.682, odds ratio 0.765, 95% CI 1.0.212-2.76), parity (p-value 0.185, odds ratio 3.82, 95% CI 0.46-31.66) , gestation (p-value 0.615, odds ratio 0.797, 95% CI 0.714-0.89) , mode of delivery (p-value 0.576, odds ratio 0.543, 95% CI 0.062-4.76), sex of baby (p-value 0.546, odds ratio 0.683, 95% CI 0.196-2.37) and presentation of baby at birth (p-value 0.47, odds ratio 0.795, 95% CI 0.71-0.89). The presence of meconium, prolonged rupture of membranes and low birth weight were the significant risk factors for MRSA colonization in healthy new-borns, born to mothers with and without MRSA colonization.

Prevalence of surgical site wound infection after spine surgery in nasal colonization of methicillin-resistant Staphylococcus aureus: A meta-analysis.

The purpose of the meta-analysis was to evaluate and compare the prevalence of surgical site infection (SSI) after spine surgery (SS) in nasal colonization of methicillin-resistant Staphylococcus aureus (MRSA). The results of this meta-analysis were analysed, and the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) were calculated using dichotomous or contentious random- or fixed-effect models. For the current meta-analysis, 14 examinations spanning from 2014 to 2022 were included, encompassing 18 410 people who were tested for nasal colonization after SS. MRSA-positive had a significantly higher SSI (OR, 3.65; 95% CI, 2.48-5.37, p < 0.001) compared with MRSA-negative in SS subjects. However, no significant difference was found between methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus negative (OR, 0.94; 95% CI, 0.32-2.79, p = 0.91), and Staphylococcus aureus positive and negative (OR, 2.13; 95% CI, 0.26-17.41, p = 0.48) in SS subjects. The examined data revealed that MRSA colonization had a significant effect on SSI; however, methicillin-susceptible Staphylococcus aureus and Staphylococcus aureus had no significant effect on SSI in SS subjects. However, given that some comparisons included a small number of chosen studies, attention should be given to their values.

Bayesian modeling of the impact of antibiotic resistance on the efficiency of MRSA decolonization.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of morbidity and mortality. Colonization by MRSA increases the risk of infection and transmission, underscoring the importance of decolonization efforts. However, success of these decolonization protocols varies, raising the possibility that some MRSA strains may be more persistent than others. Here, we studied how the persistence of MRSA colonization correlates with genomic presence of antibiotic resistance genes. Our analysis using a Bayesian mixed effects survival model found that genetic determinants of high-level resistance to mupirocin was strongly associated with failure of the decolonization protocol. However, we did not see a similar effect with genetic resistance to chlorhexidine or other antibiotics. Including strain-specific random effects improved the predictive performance, indicating that some strain characteristics other than resistance also contributed to persistence. Study subject-specific random effects did not improve the model. Our results highlight the need to consider the properties of the colonizing MRSA strain when deciding which treatments to include in the decolonization protocol.

Comparison of prevalence and risk factors for methicillin-resistant &lt;i&gt;Staphylococcus aureus&lt;/i&gt; in two tertiary institutions, southern Nigeria.

Methicillin-resistant Staphylococcus aureus (MRSA) is an incessant public health challenge with a rising trend in community infection among students. This study compared the prevalence and risk factors for MRSA nasal colonization among students in two tertiary institutions in Southern(east and west) Nigeria. One hundred nasal swab samples were collected from healthy university students and questionnaire aided in the retrieval of demographic and possible risk data. Staphylococcus aureus isolates were identified using morphological and biochemical approach. MRSA was detected phenotypically using both cefoxitin test and double disk synergy test. The antibiotic susceptibility test was done on the MRSA isolates against 9 antibiotics. A total of18% (18/100) and 6% (6/100) Staphylococcus aureus and MRSA isolates was detected respectively. Of which, 8% (4/50) and 4% (2/50) MRSA strains was found in south eastern and south western Nigeria respectively (p = 0.036). The mean age of the students was 21.4 years ±1.81. Overall, the age-group and gender with the highest MRSA colonization was 20-24 years and females respectively. Significant association was found between MRSA colonization and regular hospital visitation, touching of nose/face, and use of antibiotics without doctor's prescription (P &lt;0.05) in both institutions. A total of 100% of the isolates were resistant to clotrimazole. High prevalence (67%) of multi-drug resistance was observed. The prevalence of MRSA in both institutions had significant difference; with the risk factors: regular hospital visitation, touching of nose/face and indiscriminate use of antibiotics among the students.

Trial of Vancomycin and Cefazolin as Surgical Prophylaxis in Arthroplasty

BackgroundThe addition of vancomycin to beta-lactam prophylaxis in arthroplasty may reduce surgical-site infections; however, the efficacy and safety are unclear.MethodsIn this multicenter, double-blind, superiority, placebo-controlled trial, we randomly assigned adult patients without known methicillin-resistant Staphylococcus aureus (MRSA) colonization who were undergoing arthroplasty to receive 1.5 g of vancomycin or normal saline placebo, in addition to cefazolin prophylaxis. The primary outcome was surgical-site infection within 90 days after surgery.ResultsA total of 4239 patients underwent randomization. Among 4113 patients in the modified intention-to-treat population (2233 undergoing knee arthroplasty, 1850 undergoing hip arthroplasty, and 30 undergoing shoulder arthroplasty), surgical-site infections occurred in 91 of 2044 patients (4.5%) in the vancomycin group and in 72 of 2069 patients (3.5%) in the placebo group (relative risk, 1.28; 95% confidence interval [CI], 0.94 to 1.73; P=0.11). Among patients undergoing knee arthroplasty, surgical-site infections occurred in 63 of 1109 patients (5.7%) in the vancomyin group and in 42 of 1124 patients (3.7%) in the placebo group (relative risk, 1.52; 95% CI, 1.04 to 2.23). Among patients undergoing hip arthroplasty, surgical-site infections occurred in 28 of 920 patients (3.0%) in the vancomyin group and in 29 of 930 patients (3.1%) in the placebo group (relative risk, 0.98; 95% CI, 0.59 to 1.63). Adverse events occurred in 35 of 2010 patients (1.7%) in the vancomycin group and in 35 of 2030 patients (1.7%) in the placebo group, including hypersensitivity reactions in 24 of 2010 patients (1.2%) and 11 of 2030 patients (0.5%), respectively (relative risk, 2.20; 95% CI, 1.08 to 4.49), and acute kidney injury in 42 of 2010 patients (2.1%) and 74 of 2030 patients (3.6%), respectively (relative risk, 0.57; 95% CI, 0.39 to 0.83).ConclusionsThe addition of vancomycin to cefazolin prophylaxis was not superior to placebo for the prevention of surgical-site infections in arthroplasty among patients without known MRSA colonization. (Funded by the Australian National Health and Medical Research Council; Australian New Zealand Clinical Trials Registry number, ACTRN12618000642280.)

Methicillin-Resistant Staphylococcus aureus Colonization in Intensive Care and Burn Units: A Narrative Review.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common hospital-acquired pathogen and can cause a wide spectrum of infections. In recent years, MRSA has emerged as a significant public health concern, particularly in hospitals. Intensive care units (ICUs) and burn units are high-risk areas for hospital-acquired MRSA infections, which can lead to increased morbidity, mortality, and healthcare costs. MRSA exhibits resistance to multiple antibiotics and can cause serious infections, including but not limited to pneumonia, endocarditis, and cutaneous infections, particularly in patients with burn injuries. The prevention and effective management of MRSA infections in both burn patients and those in ICUs is crucial, with strategies like isolation, regular disinfection, and prophylactic intranasal mupirocin. Early diagnosis of MRSA infection and isolation of patients is vital to prevent the spread of MRSA. Implementation of prevention strategies faces many challenges, such as cost, and the most successful infection management practices are still debated. This review has highlighted the substantial concern of MRSA colonization in intensive care and burn units. MRSA poses a significant risk to vulnerable patients, influenced by factors such as compromised immunity and invasive procedures. The prevalence of MRSA colonization varies, influenced by regional factors and infection control practices. Combating MRSA requires a multifaceted approach, including stringent infection control measures and education for healthcare workers and patients. As we move forward, continued research and cooperation are essential to reduce the burden of MRSA in these critical care settings.

SCREENING OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS AMONG HEALTHCARE WORKERS AND THEIR ANTIBIOTIC SUSCEPTIBILITY PATTERN IN A TERTIARY CARE HOSPITAL

Objective: Colonization of Staphylococcus aureus in the nasal flora has been proven to play an important role in the transmission of infections. Health care workers carrying Staphylococcus aureus in their nose or skin play an important role in cross-contamination and thus result in Methicillin-resistant Staphylococcus aureus (MRSA) related hospital-acquired or community-acquired infections. Implementation of hand hygiene methods and standard precautions are helpful in reducing transmission and controlling spread. Screening for carriage of MRSA is fundamental step in nosocomial infection control. The present study was undertaken to determine the prevalence of MRSA carriage rate and study their antibiogram.&#x0D; Methods: A cross-sectional study was conducted for a period of six months and samples from 185 HCWs working in high-risk areas were processed by standard protocols. As per CLSI guidelines, MRSA detection by disc diffusion method using Cefoxitin disc (30μg) and further determined by Epsilometer test (E-test) by interpreting Minimum inhibitory concentration (MIC) values (mcg/ml).&#x0D; Results: Out of 185 nasal swabs, 53 were Staphylococcus aureus isolates. MRSA colonization is seen in (8.64%) samples. Preponderance was seen in staff nurses (10.16%). Antibiogram of MRSA isolates showed sensitivity to Vancomycin and linezolid.&#x0D; Conclusion: The present study was undertaken to screen nasal carriage of MRSA among healthcare workers, as they pose a potential risk factor for nosocomial transmission leading to MRSA outbreaks. The strengthening of Infection prevention and control measures institutionalization of antimicrobial stewardship programs helps in curbing the spread of MRSA.

The Comparative Efficacy of Tea Tree Oil Body Wash versus Chlorhexidine Body Wash to Prevent Colonization with Methicillin-Resistant Staphylo-coccus Aureus in a Pediatric Unit

Background: Methicillin-resistant Staphylococcus Aureus (MRSA) stands for methicillin-resistant Staphylococcus aureus, a type of bacteria that is resistant to several antibiotics. Non-intact skin, such as when there are abrasions or incisions, is often the site of an MRSA infection. MRSA has become endemic in hospitals over the past years. The current recommendation for MRSA decolonization is to use a daily chlorohexidine skin wash for five days. Tea Tree Oil (TTO) can also be considered for the eradication of MRSA on the skin. However, no study has evaluated the TTO potential for MRSA decolonization in hospitalized children.&#x0D; Methods:In this single-center, comparative prospective, open-label clinical trial, the effect of TTO body wash on MRSA decolonization was compared to that of chlorhexidine body wash at Loghman-e-Hakim Hospital (Tehran, Iran). Several samples were taken from the catheter sites of children for MRSA detection. Patients were assigned to receive either TTO or chlorhexidine. After five days of applying the solutions, resampling was conducted to assess the colonization of MRSA.&#x0D; Results: Both TTO and chlorhexidine groups showed favorable results for MRSA decolonization. From 382 patients, 91 were MRSA-positive (about 23.82%), and of these 91 patients, 41 (45%) were female and 59 (55%) were male. The mean ± SD of the growth inhibition zone against MRSA was 19.20 ± 3.73 and 33.41 ± 9.53 for chlorhexidine and TTO, respectively.&#x0D; Conclusion: TTO body wash proved to be more effective than chlorhexidine in MRSA decolonization in hospitalized children. Implementation of such decolonization can improve patients’ outcomes and prevent MRSA transmission.