Methicillin-resistant Staphylococcus Aureus Patients Research Articles

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.

Prevalence of S. aureus and/or MRSA in hospitalized patients with diabetic foot and establishment of LAMP methods for rapid detection of the SCCmec gene

BackgroundPatients with diabetic feet are prone to be infected due to the impaired immune system. However, the prognostic outcome of different microbial infections remains controversial. Identification and rapid screening of the pathogenic microorganisms that pose the greatest threat to the prognosis of patients with diabetic foot infections (DFIs) is critical.MethodsClinical data were statistically analyzed, which were obtained from 522 patients with DFIs, including pathogenic bacterial culture results and treatment outcomes at the last return visit. In addition, a loop-mediated isothermal amplification (LAMP) detection method was developed to identify the prevalent subtype of methicillin-resistant Staphylococcus aureus (MRSA) in DFIs patients. This study was approved by the Ethics Committee of Nanfang Hospital (NFEC-202012-K6) and registered on ClinicalTrials.gov (NCT04916457) on June 1, 2021.ResultsWe found that the proportion of patients with infections of Staphylococcus aureus (S. aureus) and MRSA was 27.7% (145/522) and 33.7% (49/145), respectively. Additionally, the incidence of osteomyelitis was 46.9% (23/49) and amputation/disability was 40.8% (20/49) in patients with MRSA infection, which were significantly higher compared to patients with other types of bacterial infections such as methicillin-susceptible Staphylococcus aureus (MSSA). Notably, we demonstrated that the main prevalent subtype of MRSA in DFIs patients in our hospital was Staphylococcal chromosomal cassettes mec (SCCmec) type II. In addition, it only takes 1.5 h to complete the entire experimental procedure in this LAMP assay, providing high sensitivity (100%) and specificity (77.8%) in hospitalized patients with DFIs.ConclusionsWe demonstrated there is a very high rate of MRSA isolation in patients with DFIs and revealed that patients infected with MRSA are at a higher risk of developing osteomyelitis, and amputation or disability. Importantly, we have developed a method for quickly screening newly admitted patients for MRSA.

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.

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.

Community-Acquired Methicillin-Resistant Staphylococcus aureus in Hospitals: Age-Specificity and Potential Zoonotic-Zooanthroponotic Transmission Dynamics.

Methicillin-resistant Staphylococcus aureus (MRSA) lineages are a devastating clinical and public health issue. Data on local lineage profiles are limited. We report on the frequency of community-acquired and hospital-acquired cases (CA-MRSA, HA-MRSA). We studied 147 isolates from King Khalid tertiary care hospitals (KKH), each from a case in a patient and including 33 patients at the Maternity and Children's Hospital (MCH). Of the 147 isolates, 87 males (59%) and 60 females (41%) were in KKH. The overwhelming majority (80%; n = 119/147) were CA-MRSA in KKH. Intriguingly, despite significant differences between males (70%) and females (53%), lineage-acquisition remained age-specific around 58-60 years in both genders. However, while CA-MRSA dominated early in life (0-20, 70% MCH), it increased with age in KKH adults; 21-50 (28%), >50 (59%) until the overall 80% (n = 144/180). Major specimens included skin-wounds, surgeries (70.3%), blood (13.5%), sputum (8.8%), very rarely urine (4.1%), and nasal (3.4%), albeit most patients showed severe enteritis and necrotizing pneumonia. Antibiograms showed high beta lactam resistances, including amoxicillin-clavulanate (83%), oxacillin (84%), cefoxitin FOX (100%), penicillin and ampicillin (~100%), as well as high resistance (82%) to carbapenem. Fortunately, high susceptibility was seen to non-beta lactams and, to a lesser extent, gentamicin, erythromycin, and fusidic acid; 33%, 34%, and 38%, respectively, in KKH. A similar pattern was seen in MCH except for a low resistance pattern to gentamicin CN, clindamycin CD, erythromycin E, and tobramycin TOB; 34%, 31%, 39%, and 41%, respectively, except for fusidic acid. These findings have significant clinical implications for MRSA patient management strategies. Clinical- and lineage-profiles imply host-selection and zoonotic-zooanthroponotic transmission dynamics. Future molecular typing, sequencing, and characterization of dominant clone(s) is imperative.

Correlation Analysis of Staphylococcus aureus Drug Resistance and Virulence Factors with Blood Cell Counts and Coagulation Indexes.

The influence of different Staphylococcus aureus variants on blood cells and coagulation system was evaluated by investigating the carrying status of drug resistance genes and virulence genes of methicillin-resistantStaphylococcus aureus (MRSA) and methicillin-sensitiveStaphylococcus aureus (MSSA). A total of 105 blood culture-derivedStaphylococcus aureus strains were collected. The carrying status of drug resistance genes mecA and three virulence genes tst, pvl, and sasX was analyzed by polymerase chain reaction (PCR). The changes in routine blood routine counts and coagulation indexes of patients infected with different strains were analyzed. The results showed that the positive rate of mecA was consistent with that of MRSA. Virulence genes tst and sasX were detected only in MRSA. Compared with MSSA, patients infected with MRSA or MSSA patients infected with virulence factor, leukocyte count and neutrophil count in peripheral blood were significantly increased, and the platelet count decreased to a higher degree. Part thromboplastin time increased, D-dimer increased, but fibrinogen content decreased more. The changes of erythrocyte and hemoglobin had no significant correlation with whether Staphylococcus aureus carried virulence genes. The detection rate of MRSA in patients with positive Staphylococcus aureus in blood culture had exceeded 20%. The detected MRSA bacteria carried three virulence genes, tst, pvl, and sasX, which were more likely than MSSA. MRSA, which carries two virulence genes, is more likely to cause clotting disorders.

1326. Mupirocin Resistance in Staphylococcus aureus in Pediatric Patients for Ten Years

Abstract Background Mupirocin has been recommended for decolonization in methicillin-resistant Staphylococcus aureus (MRSA) carriers for recurrent skin and soft tissue infections and treatment for impetigo. However, the indiscriminate use of mupirocin causes mupirocin resistance, associated with decolonization failure. The aim of the study was to investigate the epidemiology of mupirocin resistance and to identify clinical characteristics among children in a single center. Methods From January 2011 to October 2020, we retrospectively analyzed the epidemiology of antibiotic resistance and clinical characteristics of pediatric patients under 19 years old in whom S. aureus was firstly isolated at any body site. Results Of the 3,414 S. aureus isolates, 46% (1569/3414) were methicillin-resistant, and 20.3% (692/3414) were mupirocin resistant. Among MRSA, Mupirocin-resistant (MupR) was 22.6% (354/1569), and among methicillin-sensitive S. aureus (MSSA), MupR was 18.3% (338/1845) (P< 0.001). The median age of MupR MRSA patients was 0.14 years (interquartile range 0.04-0.79), and the median age of MupR MSSA patients was 5.0 years (interquartile range 2.0-8.1) (P=0.000). Of 692 MupR S. aureus, 94.2% (652/692) were mainly detected in the skin. MupR MRSA was most frequently isolated in the neonatal intensive care unit (40.1%, 142/354), but MupR MSSA was most frequently isolated in the outpatient setting (81.4%, 275/338) (P< 0.001). Of these, 43% (119/275) patients were diagnosed with atopic dermatitis. By age, mupR MRSA was the more commonly isolated in infants younger than one year (77.4%, 274/354), and MupR MSSA was more commonly isolated in children older than three years old (65.4%, 221/338) (P< 0.001). The frequency of MupR MRSA and MSSA showed an increase in trend over time (P< 0.001). Among other topical agents, 6.5% (102/1569) of MRSA was resistant to fusidic acid. Conclusion As mupirocin resistance gradually increases, a test for mupirocin susceptibility should be performed before applying the skin lesions or decolonization for MRSA. In addition, clinicians should carefully prescribe mupirocin to prevent the development of MupR S. aureus. Disclosures Yae-Jean Kim, MD, PhD, Janssen: Grant/Research Support|Korean Society of Pediatric Infectious Diseases: Grant/Research Support|Ministry of Trade, Industry and Energy: Grant/Research Support|MSD: Grant/Research Support.

Molecular concordance of methicillin-resistant Staphylococcus aureus isolates from healthcare workers and patients.

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant nosocomial pathogen in the ICU. MRSA contamination of healthcare personnel (HCP) gloves and gowns after providing care to patients with MRSA occurs at a rate of 14%-16% in the ICU setting. Little is known about whether the MRSA isolates identified on HCP gown and gloves following patient care activities are the same as MRSA isolates identified as colonizing or infecting the patient. From a multisite cohort of 388 independent patient MRSA isolates and their corresponding HCP gown and glove isolates, we selected 91 isolates pairs using a probability to proportion size (PPS) sampling method. To determine whether the patient and HCP gown or gloves isolates were genetically similar, we used 5 comparative genomic typing methods: phylogenetic analysis, spa typing, multilocus sequence typing (MLST), large-scale BLAST score ratio (LSBSR), and single-nucleotide variant (SNV) analysis. We identified that 56 (61.5%) of isolate pairs were genetically similar at least by 4 of the methods. Comparably, the spa typing and the LSBSR analyses revealed that >75% of the examined isolate pairs were concordant, with the thresholds established for each analysis. Many of the patient MRSA isolates were genetically similar to those on the HCP gown or gloves following a patient care activity. This finding indicates that the patient is often the primary source of the MRSA isolates transmitted to the HCP, which can potentially be spread to other patients or hospital settings through HCP vectors. These results have important implications because they provide additional evidence for hospitals considering ending the use of contact precautions (gloves and gowns) for MRSA patients.

Epidemiology and infection control of Methicillin-resistant Staphylococcus aureus in a German tertiary neonatal intensive and intermediate care unit: A retrospective study (2013-2020).

In preterm and term infants who require intermediate or intensive care Methicillin-resistant Staphylococcus aureus (MRSA) infection can lead to significant morbidity. In this study MRSA colonization and infection were assessed in a mixed tertiary neonatal intensive and intermediate care unit in Germany over an 8-year period (2013–2020). We investigated patient-related factors, associated with nosocomial MRSA acquisition, and we discuss our infection control concept for MRSA. Of 3488 patients treated during the study period, 24 were MRSA positive patients, corresponding to 26 patient hospital stays. The incidence was 0.7 MRSA patients per 100 patients. The incidence density was 0.4 MRSA patient hospital stays per 1000 patient days. Twelve patients (50%) acquired MRSA in the hospital. One patient developed a hospital acquired MRSA bloodstream infection 9 days after birth (i.e., 0.03% of all patients on the ward during the study period). A total of 122 patients had to be screened to detect one MRSA positive patient. In a logistic regression model, the use of 3rd generation intravenous cephalosporin (cefotaxim) was associated with nosocomial MRSA acquisition compared with matched control patients who did not acquire MRSA. In sum, the burden of MRSA colonization and infection in the ward was low during the study period. A comprehensive infection control concept that included microbiologic colonization screening, prospective infection surveillance together with isolation and emphasis on basic hygiene measures is essential to handle MRSA in this specialized setting.

Estimated Roles of the Carrier and the Bacterial Strain When Methicillin-Resistant Staphylococcus aureus Decolonization Fails: a Case-Control Study.

ABSTRACTMethicillin-resistant Staphylococcus aureus (MRSA) is a common bacterial pathogen that frequently colonizes healthy individuals, with potential to cause invasive infection. In Denmark, to keep the prevalence low, MRSA carriers are recommended to undergo decolonization treatments, but achieving decolonization is challenging. Knowledge about the factors contributing to decolonization is scarce. We aimed to identify bacterial genome and clinical factors influencing MRSA decolonization. We identified all new MRSA patients above 2 years of age within the Hvidovre catchment area, Copenhagen, Denmark, in 2017 and 2018. Carriers were defined as chronic carriers (cases) if they were MRSA positive after two or more treatments and as nonchronic carriers (controls) if they were MRSA free after the first or second treatment. Using whole-genome sequencing (WGS), we constructed a pangenome of bacterial strains. With the incorporation of bacterial genome and clinical patient data, machine learning and multivariate analyses were performed to determine the factors associated with decolonization. A total of 477 MRSA carriers were included. An age of ≥13 years was significantly associated with nonchronic carriage. We identified 278 bacterial genetic features that were statistically significantly associated with chronic carriage (P < 0.05 by Fisher’s exact test). Chronic MRSA carriage was predicted with 68% accuracy using a combination of bacterial genome data and patient clinical data. Decolonization success is multifactorial. Apart from the 68% predicted accuracy found in this study, we estimate that the remaining 32% is a result of host factors and microbiome composition.IMPORTANCE Carriage of methicillin-resistant Staphylococcus aureus (MRSA) and other multiresistant bacteria is a prerequisite for infection and transmission. Successful decolonization treatment removes these risks. We aimed to identify bacterial genome and host clinical factors that influence MRSA decolonization to estimate the roles of the carrier and the bacterial strain, respectively, when decolonization fails. The long-term goal, beyond this study, is to optimize decolonization success, minimize MRSA transmission, and, ultimately, improve the quality of life of MRSA carriers.

Vancomycin Monotherapy vs Alternative Antibiotics for MRSA Patients: A Systematic Review

Background: MRSA (Methicillin-resistant Staphylococcus Aureus) has become a global epidemic at a high rate. MRSA is one of the most difficult infections to treat because of its resistance to several antibiotics. Nowadays, there are still many antibiotics for MRSA in the world. This study discusses antibiotic usage against MRSA infection. It expects to contribute to the third SDG in terms of infection therapy. Method: Seven studies used for this systematic review study were conducted through PubMed and ClinicalTrials.gov databases. Aims: This study compared MRSA patients treated with vancomycin monotherapy and alternative antibiotics. Result: The highest use alternative antibiotics besides vancomycin were linezolid with 27.8%, cotrimoxazole 8.1%, daptomycin was 6.7%, and combination vancomycin plus flucloxacillin was 3.2%. Treatment duration for MRSA, treated using vancomycin compared with alternative antibiotics, did not show a significant difference. Patients treated using vancomycin mostly had higher mortality than the alternative antibiotics. The most dominant age infected by MRSA is the elderly population. Gender dominated by males 59.4% (range from 32.5% to 71.4%). The main comorbidity of the patients was heart disease, diabetes mellitus, and lung disease. Conclusion: Alternative antibiotics mostly have lower mortality compared to vancomycin. Insignificant treatment duration appears between vancomycin and alternative antibiotics. Most patients with MRSA were elderly, male, and patients with comorbid heart disease, diabetes mellitus, and lung disease.

Understanding short-term transmission dynamics of methicillin-resistant Staphylococcus aureus in the patient room.

Little is known about the short-term dynamics of methicillin-resistant Staphylococcus aureus (MRSA) transmission between patients and their immediate environment. We conducted a real-life microbiological evaluation of environmental MRSA contamination in hospital rooms in relation to recent patient activity. Observational pilot study. Two hospitals, hospital 1 in Zurich, Switzerland, and hospital 2 in Ann Arbor, Michigan, United States. Inpatients with MRSA colonization or infection. At baseline, the groin, axilla, nares, dominant hands of 10 patients and 6 environmental high-touch surfaces in their rooms were sampled. Cultures were then taken of the patient hand and high-touch surfaces 3 more times at 90-minute intervals. After each swabbing, patients' hands and surfaces were disinfected. Patient activity was assessed by interviews at hospital 1 and analysis of video footage at hospital 2. A contamination pressure score was created by multiplying the number of colonized body sites with the activity level of the patient. In total, 10 patients colonized and/or infected with MRSA were enrolled; 40 hand samples and 240 environmental samples were collected. At baseline, 30% of hands and 20% of high-touch surfaces yielded MRSA. At follow-up intervals, 8 (27%) of 30 patient hands, and 10 (6%) of 180 of environmental sites were positive. Activity of the patient explained 7 of 10 environmental contaminations. Patients with higher contamination pressure score showed a trend toward higher environmental contamination. Environmental MRSA contamination in patient rooms was highly dynamic and was likely driven by the patient's MRSA body colonization pattern and the patient activity.

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.

Methicillin-resistant Staphylococcus aureus in hip fracture.

Infection after surgery increases treatment costs and is associated with increased mortality. Hip fracture patients have historically had high rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization and surgical site infection (SSI). This paper reports the impact of routine MRSA screening and the "cleanyourhands" campaign on rates of MRSA SSI and patient outcome. A total of 13,503 patients who presented with a hip fracture over 17 years formed the study population. Multivariable logistic regression was performed to determine risk factors for MRSA and SSI. Autoregressive integrated moving average (ARIMA) modelling adjusted for temporal trends in rates of MRSA. Kaplan-Meier estimators were generated to assess for changes in mortality. In all, 6,189 patients were identified before the introduction of screening and 7,314 in the post-screening cohort. MRSA infection fell from 69 cases to 15 in the post-screening cohort (p < 0.001). The ARIMA confirmed a significant reduction in MRSA SSI post-screening (p = 0.043) but no significant impact after hand hygiene alone (p = 0.121). Overall SSI fell (2.4% to 1.5%), however deep infection increased slightly (0.89% to 1.06%). ARIMA showed neither intervention affected overall SSI ("cleanyourhands" -0.172% (95% confidence interval (CI) -0.39% to 0.21); p = 0.122, screening -0.113% per year, (95% CI -0.34 to 0.12); p = 0.373). One-year mortality after deep SSI was unchanged after screening (50% vs 45%; p = 0.415). Only warfarinization (OR 3.616 (95% CI 1.366 to 9.569); p = 0.010) and screening (OR 0.189 (95% CI 0.086 to 0.414); p < 0.001) were significant covariables for developing MRSA SSI. While screening and decolonization may reduce MRSA-associated SSI, the benefit to patient outcome remains unclear. Overall deep SSI remains an unsolved problem that has seen little improvement over time. Preventing other hospital-associated infections should not be forgotten in the fight against MRSA. Cite this article: Bone Joint J 2021;103-B(1):170-177.

Does the removal of contact precautions for MRSA and VRE infected patients change health care-associated infection rate?: A systematic review and meta-analysis

Update existing meta-analysis to analyze if discontinuation of contact precautions (CPs) for Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin resistant Enterococcus (VRE) colonization or infection affects hospital-associated MRSA or VRE infection rates. We conducted a systematic review of 17 studies evaluating discontinuation of CPs for MRSA and VRE. Random-effects and fixed-effects models were used to determine the pooled risk ratios (RR) of preincidence hospital-associated infection rate to postincidence rate. Subgroup analysis was used to assess sources of heterogeneity. No significant difference between rates of hospital-associated MRSA infection before and after stopping the CPs was observed (RR, 0.84; 95% confidence internal [CI], 0.71-1.01; P = .06). An inverse association was observed between discontinuation of CPs and rates of hospital-associated VRE infection (RR, 0.82; 95% CI, 0.72-0.94; P = .005). A subgroup analysis of 6 studies that used chlorhexidine, showed no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 0.83; 95% CI, 0.69-1.00; P = .05). In 5 studies that did not use chlorhexidine, there was no difference between rates of hospital-associated MRSA infection with discontinuation of CPs (RR, 1.02; 95% CI, 0.55-1.88; P= .95). There was no significant difference in rates of hospital-associated MRSA infection before and after removing CPs. Additionally, there were decreased rates of hospital-associated VRE infection following stoppage of CPs.

Risk Factors Associated With Hospital-Onset MRSA Proportion—National Healthcare Safety Network, 2017–2018

Background:Staphylococcus aureus is frequently implicated in healthcare-associated infections in the United States, and a substantial proportion of these infections are attributed to methicillin-resistant Staphylococcus aureus (MRSA). Although MRSA infections have decreased in health care settings, accurate estimates of the rate of decline call for risk-adjusted methods for calculating the resistant proportion (%R), that is, the proportion of S. aureus resistant to cefoxitin or oxacillin. Risk-adjusted %R also enables more accurate interhospital comparisons and can serve as a quantitative guide and evaluation metric for prevention efforts. Methods: To develop a risk-adjusted %R for S. aureus, we analyzed the antimicrobial susceptibility test (AST) results for S. aureus isolates reported to the CDC NHSN Antimicrobial Resistance Option during 2017–2018. Isolates were reported for cerebrospinal fluid (CSF), blood, lower respiratory tract (LRT), and urine. Isolates without cefoxitin and oxacillin test results, or from the facilities that had &gt;10% missing test results were excluded. Test results were differentiated between those associated with community-onset and hospital-onset (HO) infections by defining the latter group as test results for isolates obtained 3 days or more after hospital admission. Logistic regression was used to evaluate the factors associated with oxacillin/cefoxitin resistance. Hospital, patient and isolate-level variables from NHSN annual survey and AR option were assessed as covariates. Variable entry into the models is based on significance level P &lt; .05. Results: Among 9,992 hospital-onset SA isolates from 9,019 patients in 315 facilities, 5,488 (54.9%) were MRSA. Logistic regression showed that a higher proportion of HO-MRSA was significantly associated with older age, female, particular sources of specimen (urine and LRT), and selected hospital characteristics: hospitals not serving as major teaching hospitals, hospitals with a higher proportion of MRSA among community-onset SA isolates, hospitals with lower percentage of beds in intensive care units, and hospitals outsourcing AST service (Table 1). Conclusions: HO-MRSA is independently associated with community burden of MRSA, older and female patient populations, and hospital teaching status and AST practices, which highlights the importance of public health engagement and regional collaborations to prevent MRSA. To provide a standardized MRSA proportion for public health surveillance, taking some of these factors into account in MRSA proportion standardization should be considered.Funding: NoneDisclosures: None

Epidemiology of Hospital Onset Staphylococcus aureus Bloodstream Infections (HO-SA-BSI) in the Era of MRSA LabID Reporting

Background: Acute-care hospitals began reporting methicillin-resistant Staphylococcus aureus (MRSA) LabID facility-wide inpatient events to the NHSN in 2013. Few data are available regarding the epidemiology of these patients. Methods: We conducted a retrospective cohort study of patients who developed hospital onset Staphylococcus aureus bloodstream infections (HO-SA-BSIs) to describe the epidemiology (characteristics and outcomes) from January 2014 through June 2019 and to compare MRSA LabID BSIs to HO-MSSA BSIs. Proportions were compared using 2 and continuous variables using the Kruskal-Wallis test (EpiInfo). Results: Overall, 264 HO-SA BSIs occurred over the study period (2.21 per 10,000 patient days), 160 HO-MSSA BSIs (1.34 per 10,000 patient days), and 104 MRSA LabID BSIs (0.869 per 10,000 patient days). These rates have not significantly changed over time (Fig. 1). Most of these patients were men (64%); 42.4% were African-American; mean age was 43.5 years; mean Charlson comorbidity index was 3.2; 67.8% were admitted for medical care (vs surgical); and 13.3% had a previous history of S. aureus infection. Of all HO-SA-BSIs, 49.2% were acquired in the ICU, 53.8% were primary BSIs, and 37.9% were catheter associated. Patients were hospitalized a mean of 19.9 days prior to HO-SA BSI, and the mean overall length of stay was 48.5 days. Compared to HO-MSSA BSIs, there were no significant differences in these characteristics among MRSA LabID BSIs except that a significantly greater proportion were catheter associated (46.2% vs 32.5%; OR, 1.78; 95% CI, 1.07–2.96; P = .04). Overall, 101 patients (38.3%) died: 41 with MRSA LabID BSI (39.4%) and 60 with HO-MSSA BSI (37.5%). Mortality rates have not changed significantly over time. The mean number of days to death was 154.2, and 59 patients (22.3%) died during incident hospitalization: 26.9% of MRSA patients and 19.4% of MSSA BSI patients. Moreover, 28.3% of patients were readmitted within 30 days of discharge from incident hospitalization, and compared to HO-MSSA BSI, this rate was significantly higher among MRSA LabID BSI patients (34.2% vs 24.8%; OR, 2.07; 95% CI, 1.09–3.93; P = .03). Among those who died, 58.4% died during hospitalization, 52.5% died within 30 days, 66.3% died within 60 days, and 74.3% had died within 90 days. Also, 47.5% died as a result of their HO-SA BSI, and compared to HO-MSSA BSI, this rate was significantly higher among those with MRSA LabID-BSI (63.4% vs 36.7%; OR, 2.99; 95% CI, 1.31–6.83; P = .02). Conclusions: Among patients with HO-SA BSI, methicillin-resistance continues to be associated with higher attributable mortality, and in our study, higher rates of 30-day readmission. There has been no significant change in HO-SA BSI rates (MSSA or MRSA) since reporting for MRSA LabID events began. Furthermore, mortality rates have not changed and remain high for both MRSA BSI and MSSA BSI patients. Given these findings, MSSA LabID event reporting should be considered.Funding: NoneDisclosures: None

Comprehensive Approach to Reduce Surgical Site Infections in Patients Undergoing Neurosurgical Procedures.

Background: Surgical site infections (SSIs) are recognized complications of surgical procedures. Methicillin-resistant Staphylococcus aureus (MRSA) colonization increases the likelihood of developing SSIs. Decolonization of MRSA has been shown to reduce post-operative SSIs, therefore, the aim of this project was to identify and decolonize MRSA carriers and to tailor perioperative antibiotic prophylaxis to protect those at high risk for SSIs better. Methods: In September 2013, a quality improvement process initiative was implemented for pre-operative screening of MRSA nasal carriage for patients undergoing elective neurosurgical procedures. Those identified as colonized received a 10-day decolonization protocol that consisted of: oral doxycycline 100 mg twice daily or oral trimethoprim-sulfamethoxazole (TMP-SMX) DS twice daily; oral rifampin 600 mg daily; daily bathing with chlorhexidine; and twice daily use of mupirocin ointment in each nostril and under the fingernails. In addition to cefazolin (weight-based dosing), vancomycin (weight-based dosing) was recommended for perioperative prophylaxis in known MRSA carriers and patients undergoing surgical procedures involving hardware implantation irrespective of colonization status. We compared the results with our previously documented neurosurgical site infection rates (2012 and 2013 were 3.0 and 2.2%, respectively) Results: From 2014 to 2015, MRSA screening was done for 1,197 patients, of whom 52 (4.3%) were found to be colonized. Surgical site infections occurred in 14 procedures (1.4%) in 2014 and eight (0.8%) procedures in 2015, respectively. Methicillin-resistant Staphylococcus aureus remained responsible for most of these infections. None of the patients who underwent decolonization developed an infection (MRSA or otherwise). Conclusions: The overall rate of neurosurgical site infections can be reduced through a bundled approach of MRSA decolonization and change in perioperative antibiotic prophylaxis to include vancomycin for procedures involving hardware implantation irrespective of MRSA carriage state.

Can we reduce contact precautions days for methicillin-resistant Staphylococcus aureus and vancomycin resistant Enterococcus infected patients?

BackgroundPatients with MRSA (methicillin-resistant Staphylococcus aureus) and VRE (vancomycin resistant Enterococcus) are placed under contact precautions according to the Center of Disease Control protocol. Contact precautions however increases patient isolation from Health Care Workers, increase overall hospital costs and may increase depression and anxiety. Our aim in this study was to observe the effects of shortening the number of days of contact precautions for patients infected with MRSA and VRE. MethodWe observed patients as two cohorts (Pre-Pilot and Pilot) in one Medical Intensive Care Unit, one Surgical Intensive Care Unit & two medical floors during 2014–2015. In the Pre-pilot period contact precautions were kept throughout admission. In the Pilot period contact precautions were initially placed followed by universal gloving. Comparisons were made for MRSA and VRE infection rates. Total costs were estimated assuming the average cost of 1 gown was $26 per patient per day. ResultsMean isolation days were reduced from 11.9 days to 6.8 days for MRSA and 12.8 days to 8.4 days for VRE. There were 86 MRSA infections in the Pre-Pilot period and 73 MRSA infections during the Pilot period (p=0.052). Incidence of hospital acquired MRSA in the wards decreased from 15 to 7 cases and 6 to 2 cases in the Intensive Care Unit in both the Pilot and Pre-Pilot periods respectively. Cost reduced by $2476 and $17,336 per month for VRE and MRSA patients. Number of readmissions also decreased by 39% for MRSA and 50% for VRE. ConclusionsA reduction in contact precautions has reduced patient costs without affecting the rate of MRSA and VRE infection within a one-year period.

Patient to healthcare personnel transmission of MRSA in the non-intensive care unit setting.

The transmission rate of methicillin-resistant Staphylococcus aureus (MRSA) to gloves or gowns of healthcare personnel (HCP) caring for MRSA patients in a non-intensive care unit setting was 5.4%. Contamination rates were higher among HCP performing direct patient care and when patients had detectable MRSA on their body. These findings may inform risk-based contact precautions.