Nosocomial Methicillin-resistant Staphylococcus Aureus Infections Research Articles

Effectiveness evaluation of antibiotic use in patients with Methicillin-resistant Staphylococcus aureus (MRSA) infection: a review

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen that become a public health problem due to its ability to be resistant to more than three classes of antibiotics. Evaluation of the effectiveness of antibiotic use in patients with MRSA is important to optimize antibiotic use and to control antibiotic resistance. This article review attempted to evaluate the effectiveness of antibiotics in patients with MRSA. This review explored the results of previous research from PubMed as a literature source and the PRISMA flow diagram as a protocol for the article selection process. Eight studies reviewed the evaluation of the effectiveness of antibiotic use in MRSA patients with various clinical conditions, such as uncomplicated wound infections, cellulitis and no wound, purulent drainage or abscess, cSSSI infections caused by MRSA, infections caused by MRSA bacteremia and nosocomial infections caused by MRSA. In conclusion, the effectiveness of antibiotics in patients with MRSA infection depends on the clinical condition of each patient. Therefore, the use of antibiotics is adjusted based on the type of infection and the efficacy of the antibiotics. Combination therapy is recommended for MRSA patients considering its life-threatening ability.

Nasal carriage of methicillin and inducible clindamycin resistant Staphylococcus aureus among healthcare workers in a tertiary care hospital, Kathmandu, Nepal

Introduction and Objectives: Transmission of methicillin-resistant Staphylococcus aureus (MRSA) from healthcare workers is one of the most frequent causes of nosocomial infections globally. There is a significant burden of nosocomial MRSA infections in low and low-middle income countries (LMICs), including Nepal. The present study investigated the rate of nasal carriage of MRSA among the healthcare workers in a tertiary care hospital, in Kathmandu, Nepal with emphasis on inducible macrolide-lincosamide-streptogramin B (iMLSB) resistance. Material and method: The study was conducted at Star Hospital, Lalitpur, Nepal, from September 2022 to November 2022. Healthcare workers (HCWs) working at the diffeerent departments of the hospital were enrolled. Nasal swabs from both anterior nares of HCWs were collected aseptically and cultured on Mannitol Salt agar. S. aureus was identified by Gram stain and standard biochemical tests. Antibiotic susceptibility of S. aureus was performed by disc diffusion method. MRSA isolates were detected phenotypically by disc diffusion method using cefoxitin disc (30 µg), and inducible clindamycin resistance was detected phenotypically by the D-zone test. Results: Total 105 HCWs were enrolled in the study. Out of 105 HCWs, 14 (13.3%) were positive for S. aureus among which 6 (5.7%) were MRSA carriers. The nasal carriage of MRSA was highest among doctors (16.7%) and the HCWs of the post-operative department (14.3%). All the isolated MRSA were susceptible to chloramphenicol and vancomycin. Inducible MLSB resistance was detected in 33.3% MRSA while the rate was 21.4% in all isolated S. aureus. Conclusion: The study demonstrated that HCWs could be the potential source of nosocomial infection by methicillin and inducible clindamycin resistant S. aureus. Thus, preventive measures should be initiated to mitigate the risk of its spread and the test for detection of inducible clindamycin resistance should be incorporated into the routine antibiotic susceptibility testing in hospital settings. IMC J Med Sci. 2024; 18(1):005. DOI: https://doi.org/10.55010/imcjms.18.005 *Correspondence: Gaurab Pandey, Non-Communicable Disease Laboratory, National Public Health Laboratory, Teku, Kathmandu, 44600, Nepal; E-mail: pandeygaurab67@gmail.com

MRSA as an indicator of infection control measures in Turaif General Hospital, Northern Area-Saudi Arabia.

Saudi Arabia can be considered a hot spot for Methicillin-resistant Staphylococcus aureus (MRSA) infections with significant regional variations. As far as we know, this is the first study to evaluate the prevalence of MRSA in clinical samples obtained from Turaif general hospital (TGH), Northern Area-Saudi Arabia, and screening the resistance profile to the most regularly used antimicrobials as an indicator for evaluation of the implemented infection control measures. Totally, 410 Samples were collected from patients in TGH with clinically suspected nosocomial infections. MRSA isolates were identified by the classical bacteriological, biochemical, and cefoxitin-based methods as recommended by the Clinical Laboratory Standard Institute. Confirmation of isolates and testing of their antimicrobial susceptibilities were performed by the automated Vitek 2 compact system. Totally, 130 nosocomial isolates were detected. Staphylococcus aureus (29.23%) was the most frequently isolated Gram-positive pathogen. MRSA represented 39.47% of Staphylococcus aureus and 11.54% of all isolates. MRSA-causing surgical site infections were the most predominant type of MRSA nosocomial infections representing (25.00%). Recent antibiotic therapy, prolonged hospital stays, and indwelling devices were significant risk factors for the development of MRSA infections. Although all MRSA isolates were sensitive to vancomycin, teicoplanin, linezolid, Fosfomycin, and tigecycline, many isolates were resistant to other tested antimicrobials. Hospital administrators should strengthen the ideal use of antibiotics according to the local hospital policy to control the selective drug pressure on Staphylococcus aureus strains with minimizing exposure to the risk factors by implementing the proper infection control policies.

Prevalence of Methicillin-Resistant Staphylococcus aureus at a Tertiary Teaching Hospital in Malaysia

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity, mortality and high medical expenses in many hospitals worldwide. The present study aimed to determine the prevalence of MRSA nosocomial infection, its associated factors, and its antimicrobial susceptibility pattern. This was a retrospective analysis of a database of Multidrug- Resistant Organism (MDRO) that was cultured from patients admitted to Hospital Canselor Tuanku Mukhriz (HCTM) over a period of 2 years (2018-2019). MRSA accounted for 23.6% of total MDRO isolates. The male gender had a higher risk for MRSA acquisition (p<0.05), while the most prevalent setting for MRSA was the orthopaedic ward (47.5%) followed by the medical ward (29.4%). The MRSA strains were significantly isolated from respiratory specimens (55.6%) followed by tissue (50.8%) and blood (27.8%). All MRSA isolates were resistant to penicillin G, oxacillin followed by ciprofloxacin (83.8%) erythromycin (71.5%) and clindamycin (53.5%). MRSA isolates were most susceptible to teicoplanin (99.7%), mupirocin (99.3%), co-trimoxazole (98.4%), rifampicin (97.8%), doxycycline (97.4%), linezolid (95.8%), gentamicin (93.9%) and fusidic acid (86.2%). The trend for MRSA’s antibiotic susceptibility in HCTM for the past 2 years (2018 to 2019) remains unchanged. Further research will be required to investigate the predictor of MRSA by clearly differentiating between MRSA infections and colonisations, hospitalacquired MRSA and community-acquired MRSA.

Discontinuation of Contact Precautions in Patients with Nosocomial MRSA and VRE Infections During the COVID-19 Pandemic

Background: Gaps exist in the evidence supporting the benefits of contact precautions for the prevention of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). The Centers for Disease Control and Prevention allow suspending contact precautions for MRSA and VRE in cases of gown shortages, as we have seen during the COVID-19 pandemic. We evaluated the impact of discontinuing isolation precautions in hospitalized patients with MRSA and VRE infection, due to gown shortage, on the rate of hospital-acquired (HA) MRSA and VRE infections. Methods: A retrospective chart review was performed on adult patients (n = 2,200) with established MRSA or VRE infection at 5 hospitals in CommonSpirit Health, Texas Division, from March 2019 to October 2020. Data including demographics, infection site, documented symptoms, and antibiotic use were stratified based on patient location (floor vs ICU). Rates of hospital-acquired MRSA and VRE infection before and after the discontinuation of isolation (implemented in March 2020) were compared. Incidence density rate was used to assess differences in the rate of MRSA and VRE infections between pre- and postintervention groups. Results: The rate of hospital-acquired (HA) MRSA infection per 10,000 patient days before the intervention (March 19–February 20) was 12.19, compared to 10.64 after the intervention (March 20–July 20) (P = .038). The rates of HA MRSA bacteremia were 1.13 and 0.93 for the pre- and postintervention groups, respectively (P = .074). The rates of HA VRE per 10,000 patient days were 3.53 and 4.44 for the pre- and postintervention groups, respectively (P = .274). The hand hygiene rates were 0.93 before the intervention and 0.97 after the intervention (P = .028). Conclusions: Discontinuing isolation from MRSA and VRE in the hospital setting did not lead to a statistically significant increase in hospital-acquired MRSA or VRE infections. In fact, rates of hospital-acquired MRSA decreased, likely secondary to improvements in hand hygiene during this period. These results support the implementation of policies for discontinuing contact isolation for hospitalized patients with documented MRSA or VRE infection, particularly during shortages of gowns.Funding: NoDisclosures: None

Safety and efficacy of linezolid treatment in comparison with vancomycin for methicillin-resistant Staphylococcus aureus nosocomial infection: A prospective study in Mysore City, South India

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent causative agent of nosocomial infection in health-care setups causing morbidity and mortality. Treatment with vancomycin remains the standard protocol for the antibiotic treatment. However, the emergence of vancomycin-resistant strains has prompted the use of alternate drug therapies. Linezolid is the best alternative to combat this resistant strain. In the present study, we aim to evaluate the clinical evidence of linezolid treatment in MRSA-infected patients within Mysore city. METHODS: This prospective study assessed the efficacy of linezolid and vancomycin for the treatment of MRSA infections. Fifty patients who fit into the inclusion criteria were considered from four tertiary hospitals. Five milliliters venous blood (only once), pus, urine, sputum, and aspirates were collected from MRSA patients and evaluated by culture studies for its susceptibility to various antibiotics. RESULTS: Results of this study demonstrate that linezolid treatment as oral and intravenous preparations is as effective as vancomycin with 100% efficiency and fewer adverse effects (79 in 40 patients vs. 64 in 16 patients) for the treatment of MRSA nosocomial infection. The observed adverse effects includes local pain (P = 0.312) and thrombophlebitis (P = 0.005) with vancomycin; and anemia (P = 0.348) and thrombocytopenia (P = 0.313) with the use of linezolid. The findings were consistent with the existing knowledge database. CONCLUSION: The results from the study indicate that linezolid offers the same benefit as vancomycin with far fewer drawbacks.

The incidence of toxic shock syndrome due to nosocomial methicillin-resistant Staphylococcus aureus infection in burn patients: A four-year retrospective cohort study

Among adult and pediatric patients, concern is growing in regard to toxic shock syndrome (TSS) resulting from methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection. We investigated the incidence and characteristics of this form of TSS in patients with burn injury who were admitted to our burn care units from January 2008 to December 2011. Of the 244 patients with nosocomial MRSA infection admitted during the study period, TSS occurred in 20 (8.2%) patients whose average age was 42.9 years, average total burn surface area (TBSA) was 31.7%, and average day of TSS appearance was 9.5 days after injury. There were no particular characteristics associated with age, TBSA or day of TSS appearance in these patients. All but 1 patient recovered from TSS within an average of 9.4 days. The incidence of TSS due to nosocomial MRSA infection in these burn patients was higher than expected. TSS due to nosocomial MRSA infection should be considered in burn care.

Risk Factors And Clinical Outcomes Of Hospital-Acquired MRSA Infections In Chongqing, China.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of hospital infection with multi-drug resistant characteristics. Its spread and epidemic pose great challenges to nosocomial infection control. This study was aimed to identify risk factors for hospital-acquired MRSA (HA-MRSA) infections and investigate its clinical outcome, developing infection control strategies and improving patient outcomes.MethodsA retrospective case-case-control study was conducted to compare patients in Southwest Hospital, Chongqing, People's Republic of China from January 2018 to December 2018 with control patients. In this study, 251 patients with MRSA nosocomial infection, 339 patients with methicillin-sensitive Staphylococcus aureus strains (MSSA) nosocomial infection, and 300 patients with non-Staphylococcus aureus infection were included.ResultsMultivariate analysis showed that presence of central venous catheters (odds ratio [OR], 1.932; 95% confidence interval [CI], 1.074–3.477; P=0.028), sputum suction (OR, 2.887; 95% CI, 1.591–5.240; p<0.001), and total hospital stays more than 30 days (OR, 3.067; 95% CI, 2.063–4.559; P<0.001) were independent risk factors for HA-MRSA. Renal insufficiency (OR, 2.744; 95% CI, 1.089–6.914; P=0.032) and receipt of immunosuppressors (OR, 3.140; 95% CI, 1.284–7.678; P=0.012) were independent predictors of poor prognosis of MRSA nosocomial infection. Moreover, empirical use of antibiotics (OR, 0.514; 95% CI, 0.282–0.935; P=0.029) was a protective factor for poor prognosis of MRSA nosocomial infection. In-hospital mortality in the MRSA group was not statistically significant compared with the other two groups; however, the rate of poor prognosis in the MRSA group was higher than that of the MSSA group (27.5% vs 17.1%, χ2=9.200, P=0.002) and the control group (27.5% vs 16.0%, χ2=19.190, P=0.001).ConclusionOur results have shown presence of central venous catheters, sputum suction, and total hospital stays more than 30 days were associated with nosocomial MRSA infection. Patients with renal insufficiency and immunosuppressive therapy were more likely to cause poor prognosis with MRSA infection, and the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by MRSA infection. Based on above findings, strategies to control MRSA infection should emphasize more attention to these patients and appropriate empirical use of antibiotics.

Prevalence and characteristics of methicillin-resistant Staphylococcus aureus colonization among healthcare professionals in a university hospital in Japan.

BackgroundAsymptomatic carriers of methicillin‐resistant Staphylococcus aureus (MRSA) are important sources of nosocomial transmission. MRSA may be transmitted from hospitalized patients to healthcare professionals and vice versa.MethodsThe prevalence of MRSA colonization among forty‐five healthcare professionals in a Japanese hospital was determined by performing surveillance cultures to identify unrecognized carriers of MRSA. All MRSA isolates were evaluated using multilocus sequence typing (MLST) to identify the transmission routes.ResultsThe proportion of MRSA colonization was significantly higher in healthcare professionals (11.1%) than in community residents (0.72%; P < 0.0001) or admission case (2.5%; P = 0.018). MLST analysis revealed that both the ST8 and ST764 strains were identified in residents, patients, and healthcare professionals. MRSA colonization was more frequently observed among physicians (4/13; 31%) than nurses (1/32; 3%) (P = 0.020).ConclusionMultilocus sequence typing results suggest that ST8 and ST764 are involved in the occurrence of nosocomial MRSA infections. These findings emphasize the necessity for the effective education of physicians to prevent MRSA transmissions.

Distribution of sasX, pvl, and qacA/B genes in epidemic methicillin-resistant Staphylococcus aureus strains isolated from East China.

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Various virulence and antiseptic-resistant factors increase the pathogenicity of MRSA strains and allow for increased infection rates.PurposeThe purpose of this study was to investigate the prevalence and distribution of virulence-associated and antiseptic-resistant genes from epidemic MRSA strains isolated from East China.MethodsA newly designed multiplex PCR assay was used to assess whether the virulence-associated genes sasX and pvl and the chlorhexidine tolerance gene qacA/B were present in 189 clinical isolates of MRSA. Multilocus sequence typing (MLST) and Staphylococcal protein A (spa) typing of these isolates were also performed. The frequency of these genes in isolates with epidemic sequence types (STs) was investigated.ResultsTwenty STs and 36 spa types with five epidemic clones (ST5-t311, ST59-t437, ST5-t002, ST239-t030, and ST239-t037) were identified. The prevalence of sasX, pvl, and qacA/B in all isolates was 5.8%, 10.1%, and 20.1%, respectively. The prevalences of these genes in isolates with ST5, ST59, ST239, and other ST genetic backgrounds were all significantly different (P<0.001). Isolates that had the highest frequency of sasX, pvl, or qacA/B were ST239 (33.3%), ST59 (28.9%), and ST5 (34.1%), respectively. The gene distribution pattern from all of the isolates showed that sasX−pvl−qacA/B+, sasX−pvl+qacA/B−, and sasX+pvl−qacA/B− were closely associated with epidemic clones ST5-t311, ST59-t437, and ST239-t037, respectively.ConclusionThere are significant differences in the prevalence of virulence-associated and antiseptic-resistant genes in epidemic MRSA strains. Using this information, more effective control and prevention strategies for nosocomial MRSA infections can be developed.

Antimicrobial resistance profile of Methicillin-resistant Staphylococcus aureus colonizing the anterior nares of health-care workers and outpatients attending the remotely located tertiary care hospital of North India.

INTRODUCTION:Resistance to antimicrobial agents is a major concern worldwide and is exemplified by the global spread of the Methicillin resistant Staphylococcus aureus (MRSA). Health care workers (HCWs) and asymptomatically colonized patients are important sources of nosocomial MRSA infections.AIMS AND OBJECTIVES:To determine the prevalence of MRSA colonisation, two hundred HCWs and 200 consecutive outpatients attending our tertiary care hospital were studied.MATERIAL AND METHODS:Two sterile pre-moistened cotton tipped swabs were used to collect specimens from their anterior nares. These were inoculated immediately on Blood agar with oxacillin, Mannitol salt agar with oxacillin and CHROM agar. Resistance to cefoxitin was confirmed by PCR by demonstration of mecA gene. Antibiotic susceptibility was determined by Kirby Bauer's disc diffusion method and MIC of vancomycin by using broth dilution and Vitek-2 Compact system.RESULTS:The nasal carriage of MRSA among HCWs was found to be 7.5% and in outpatients 3%. All strains of MRSA from HCWs and outpatients grew on three selective media and mecA gene amplified in all of them. All the isolated strains of MRSA showed high degree of resistance to co-trimoxazole (93.3%), ciprofloxacin (80%) and erythromycin (66.66%). However, there was 100% susceptiability to vancomycin, teicoplanin, linezolid and Rifampicin.CONCLUSION:Although a direct casual relationship could not be established, it could be assumed that the transmission from colonised health care worker is responsible atleast in part for MRSA infection among patients. Therefore emphasis should be laid on strict implementation of standard infection control practices which would help in minimizing the carriage and transmission of MRSA in the hospital.

Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland

BackgroundThe proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia.MethodsThis is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years.ResultsThe prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14–0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06–7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098–4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years.ConclusionsMRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections.

Emergence of Community-Genotype Methicillin-Resistant Staphylococcus aureus in Korean Hospitals: Clinical Characteristics of Nosocomial Infections by Community-Genotype Strain.

BackgroundAs community-genotype methicillin-resistant Staphylococcus aureus (MRSA) strains spread into hospitals, the genotypes of the MRSA strains causing hospital-acquired (HA) infections have become more diverse. We describe clinical characteristics of nosocomial MRSA infections by a community-genotype of sequence type (ST) 72.Materials and MethodsA case-control study was designed among patients with HA-MRSA infections. Forty patients with infections caused by ST72-MRSA SCCmec type IV were selected as cases. Cases were matched to the controls with 106 patients infected with ST5/ST239 MRSA, which are representative hospital genotypes in Korea.ResultsPatients infected with ST72 isolates were younger than those with ST5/ST239 isolates. Female gender predominated among ST72 MRSA group compared to ST5/ST239 MRSA group. Solid tumor was a more frequent underlying disease in MRSA infections by ST72 isolates, whereas underlying renal, lung, heart, and neurologic diseases were more frequently found in those by ST5/ST239 isolates. The most common type of infection was pneumonia in both ST72 and ST5/ST239 groups (45.0% vs. 51.9%), followed by skin and soft tissue infection (SSTI). Female gender and underlying solid tumor were identified to be independent predictors for MRSA infections by ST72 isolates. All-cause mortality rates (20.0% vs. 30.2%) were not different between the groups.ConclusionA community-genotype MRSA, ST72 isolate has emerged as a nosocomial pathogen presenting as hospital-acquired pneumonia and SSTI. Although differences in underlying disorders were found, the distribution of infection type and mortality rate did not differ between the groups.

Multidrug-Resistant Staphylococcus aureus, India, 2013-2015.

To the Editor: Methicillin-resistant Staphylococcus aureus (MRSA) is a versatile pathogen capable of causing a wide variety of human diseases. Increased frequency of S. aureus infections imposes a high and increasing burden on healthcare resources. In many countries, MRSA infections in hospitals are common. Data from the National Nosocomial Infections Surveillance system suggest that, in the United States, incidence of nosocomial MRSA infections is steadily increasing and that these infections account for >60% of intensive care unit admissions (1,2). S. aureus has developed resistance to several antimicrobial drugs, including second- and third-line drugs. Only a few drugs, such as vancomycin (a glycopeptide), daptomycin (a lipopeptide), and linezolid (an oxazolidinone), have been approved for the treatment of serious infections caused by MRSA. Another drug, tigecycline (a glycylcycline), has shown good activity against MRSA strains in vitro (3). The epidemiology of MRSA is constantly changing, which results in variation in its drug-resistance patterns throughout regions and countries (4). Therefore, to support clinicians in preventing and treating infection, epidemiologic surveillance is essential. We report resistance patterns of S. aureus collected over 2 years (December 2013–November 2015) from blood samples of patients admitted to 1 hospital in Odisha, eastern India.

Low Level of TSST-1 Antibody in Burn Patients With Toxic Shock Syndrome Caused by Methicillin-Resistant Staphylococcus aureus

Toxic shock syndrome (TSS) caused by methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infection is a growing concern in both adult and pediatric patients. The reason why TSS appears in only some patients with MRSA infection remains unclear. In this study, we analyzed serial TSS toxin-1 (TSST-1) antibody in patients with burn injury to investigate the mechanisms of TSS caused by MRSA nosocomial infection. This study comprised of patients with burn injury in our burn care unit from September, 2010 to August, 2011. Serum samples were collected serially on admission, at 48 to 72 hours after injury, on the day MRSA infection appeared, and on the day MRSA infection resolved. TSST-1 antibody was measured by enzyme-linked immunosorbent assay (ELISA). TSS was diagnosed according to the criteria of the Centers for Disease Control. Serial serum samples were collected from 24 patients and nosocomial MRSA infection was detected in 12 patients. In these 12 patients, TSS occurred in five patients (TSS+ group) but did not occur in the other seven patients (TSS- group). TSST-1 antibody level was significantly lower in the TSS+ group than TSS- group on admission and on the day MRSA infection appeared. All patients in the TSS+ group received intravenous immune globulin when TSS was diagnosed, and no patients died of TSS. Patients suffering from TSS had a lower level of TSST-1 antibody than patients not suffering from TSS. Testing for TSST-1 antibody in the clinical setting might help to predict and prevent the appearance of TSS caused by nosocomial MRSA infection.

MRSA screening in ambulatory upper limb trauma day cases

Aims: Approximately 3% of the UK population are carriers for methicillin-resistant Staphylococcus aureus (MRSA). The NHS set a target of reducing MRSA nosocomial infections by 20% in 2012/13. The Department of Health instigated mandatory universal screening for elective and trauma surgery at significant cost and increased resource demand. Patients presenting to our service with simple upper limb trauma requiring day case surgical intervention are included in mandatory universal MRSA screening, despite being discharged post-operatively before any screening result is known. The aim of this study was to examine the effectiveness of mandatory screening in our patient cohort. Methods: We undertook a retrospective audit of 500 consecutive day case upper limb trauma cases that were managed in our hand unit between 1 May and 31 October 2011. Patient demographics, injury, operative intervention, pre-operative MRSA screening result and post-operative wound swab results were examined. Patients with frankly infective conditions such as abscesses and flexor tenosynovitis were excluded. Results: 78% of our patients were male. 91% were less than 60 years old. 98% of patients had a pre-operative MRSA screening swab. None were positive. 2% had positive post-operative swabs for organisms other than MRSA. Conclusion: We approached our trust and successfully proposed that young, ambulatory, day-case upper limb trauma patients be exempt from mandatory screening. At an average throughput of 1000 cases per annum and an estimated cost of £42.50 per MRSA screen, excluding this cohort of patients from mandatory screening has saved approximately £42 500. The true savings would be likely far greater if applied to similar cohorts across the trust, bringing with it a reduction in screening infrastructure.

Shaking Up Clostidium Difficile Infections: Implementation of a Fecal Microbiota Transplant Program

ISSUE: Recent studies demonstrated an increased risk of acquisition of MDR-Ab when patients are admitted to rooms that were previously occupied by patients who were positive for this pathogen. A cluster of 6 patients with healthcare-associated MDR-Ab was identified at our facility. Four of these patients were transferred from other healthcare facilities. In response, we instituted a comprehensive environmental hygiene program aimed at eliminating the risk of transmission of this pathogen. PROJECT: An interdisciplinary team implemented the following intervention plan: First, staff was educated on the significance of MDR-Ab, the importance of hand hygiene, and proper cleaning of equipment. Second, a process was initiated to ensure compliance with policies and procedures. In addition, a competency-based training programwas also instituted. Third, a new disinfectant was chosen for daily and terminal cleaning in isolation rooms. The disinfectant has a faster dwell time, which promoted compliance with the required drying time. It also offered an improved safety rating which instilled confidence in our staff. RESULTS: Surveillance data showed thatMDR-Abwas eliminated at our facility. The number of cases of MDR-Ab dropped to zero as of November 2012 (figure 1). Only one new case was identified since then (September 2013). Not surprisingly, the rate of methicillin resistant Staphylococcus aureus (MRSA) dropped significantly. As shown in figure 2, the rate of hospital admissions with MRSA Nosocomial Infection Marker (NIM) dropped from 0.67% in the third quarter 2012 to 0.25% in the 3rd quarter 2013.

Elimination of Multi-drug Resistant Acinetobacter Baumannii Through Improvements in Environmental Hygiene

ISSUE: Recent studies demonstrated an increased risk of acquisition of MDR-Ab when patients are admitted to rooms that were previously occupied by patients who were positive for this pathogen. A cluster of 6 patients with healthcare-associated MDR-Ab was identified at our facility. Four of these patients were transferred from other healthcare facilities. In response, we instituted a comprehensive environmental hygiene program aimed at eliminating the risk of transmission of this pathogen. PROJECT: An interdisciplinary team implemented the following intervention plan: First, staff was educated on the significance of MDR-Ab, the importance of hand hygiene, and proper cleaning of equipment. Second, a process was initiated to ensure compliance with policies and procedures. In addition, a competency-based training programwas also instituted. Third, a new disinfectant was chosen for daily and terminal cleaning in isolation rooms. The disinfectant has a faster dwell time, which promoted compliance with the required drying time. It also offered an improved safety rating which instilled confidence in our staff. RESULTS: Surveillance data showed thatMDR-Abwas eliminated at our facility. The number of cases of MDR-Ab dropped to zero as of November 2012 (figure 1). Only one new case was identified since then (September 2013). Not surprisingly, the rate of methicillin resistant Staphylococcus aureus (MRSA) dropped significantly. As shown in figure 2, the rate of hospital admissions with MRSA Nosocomial Infection Marker (NIM) dropped from 0.67% in the third quarter 2012 to 0.25% in the 3rd quarter 2013.

The reduction of nosocomial MRSA infection in Germany: an analysis of data from the Hospital Infection Surveillance System (KISS) between 2007 and 2012.

Infections with multiresistant Gram negative pathogens are rising around the world, but many European countries have recently seen a decline in infections due to methicillin resistant Staphylococcus aureus (MRSA). We determined the percentage of nosocomial Staphylococcus aureus infections in Germany that were accounted for by MRSA in the past six years and looked for regional differences in the overall downward trend. Data from the German Hospital Infection Surveillance System (Krankenhaus-Infektions-Surveillance-System, KISS) from the years 2007-2012 were analyzed. In intensive care units, data on the following nosocomial infections were registered: primary sepsis, lower respiratory tract infections, and urinary tract infections; in surgical wards, data on postoperative wound infections were collected. The number of participating intensive care units varied from 465 to 645, while the number of participating surgical wards varied from 432 to 681. Over the period 2007-2012, the percentage of nosocomial Staphylococcus aureus infections that were due to MRSA dropped significantly, from 33% to 27%. More specifically, the percentage of infections due to MRSA dropped from 36% to 31% for primary sepsis and from 36% to 30% for lower respiratory tract infections. Regression analysis revealed significantly lower MRSA fractions in the German states of Brandenburg (odds ratio [OR] 0.41), Bavaria (OR 0.73), and Saxony-Anhalt (OR 0.53), with higher fractions in Berlin (OR 1.59), Mecklenburg-West Pomerania (OR 1.91), Lower Saxony (OR 1.85), and North Rhine-Westphalia (OR 1.55). There were no significant differences in the remaining German states. In Germany, the percentage of nosocomial Staphylococcus aureus infections due to MRSA dropped significantly over the period 2007-2012. The causes of this decline are unclear; it may have resulted from human intervention, pathogen biology, or both.

Continued Emergence of USA300 Methicillin-ResistantStaphylococcus aureusin the United States: Results from a Nationwide Surveillance Study

The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) is changing, with USA300 emerging first in community and then in healthcare settings. We performed nationwide surveillance to assess recent trends in the molecular epidemiology of MRSA. One hundred consecutive unique clinically significant S. aureus isolates were recovered from patients at each of 43 US centers between July 1, 2011, and December 31, 2011. Susceptibility testing, pulsed-field gel electrophoresis (PFGE), staphylococcal protein A gene (spa) and staphylococcal cassette chromosome mec typing, and Panton-Valentine leukocidin detection were performed on all MRSA isolates. Of 4,131 isolates collected, 2,093 (51%) were MRSA. Specimen sources of MRSA isolates included wound or abscess (54%), blood (24%), lower respiratory tract (11%), and other sterile site (10%). Thirty percent were isolated more than 48 hours after hospital admission (ie, were associated with nosocomial acquisition of infection). USA300 was the most common PFGE type (1,269 isolates; 61%), overall and in all regions, followed by USA100 (368 isolates; 18%). Among 173 spa types found, the most common were t008 (51%) and t002 (18%); no other spa type accounted for more than 2% of isolates. One strain type (USA300/t008/IV) constituted almost half of all MRSA isolates (1,005 isolates; 48%) and was the most common at all body sites, causing 37% of MRSA bloodstream infections (BSIs) and 38% of nosocomial MRSA infections. Multidrug-resistant phenotypes were found among 34 USA300 isolates (3%) from 18 states. The USA300 PFGE type continues to advance nationwide. A single strain type (USA300/t008/IV) predominates in all regions and infection sites and is now more common than USA100 as a cause of MRSA BSI and nosocomial infections. Although most USA300 retain typical susceptibility profiles, multidrug-resistant phenotypes are emerging.