Methicillin-resistant Staphylococcus Aureus Rates Research Articles

Implications of deduplication on the detection rates of multidrug-resistant organism (MDRO) in various specimens: insights from the hospital infection surveillance program

BackgroundCurrently, different guidelines recommend using different methods to determine whether deduplication is necessary when determining the detection rates of multidrug-resistant organisms (MDROs). However, few studies have investigated the effect of deduplication on MDRO monitoring data. In this study, we aimed to investigate the influence of deduplication on the detection rates of MDROs in different specimens to assess its impact on infection surveillance outcomes.MethodsSamples were collected from hospitalized patients admitted between January 2022 and December 2022; four types of specimens were collected from key monitored MDROs, including sputum samples, urine samples, blood samples, and bronchoalveolar lavage fluid (BALF) samples. In this study, we compared and analysed the detection rates of carbapenem-resistant Klebsiella pneumoniae (CRKP), carbapenem-resistant Escherichia coli (CRECO), carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and methicillin-resistant Staphylococcus aureus (MRSA) under two conditions: with and without deduplication.ResultsWhen all specimens were included, the detection rates of CRKP, CRAB, CRPA, and MRSA without deduplication (33.52%, 77.24%, 44.56%, and 56.58%, respectively) were significantly greater than those with deduplication (24.78%, 66.25%, 36.24%, and 50.83%, respectively) (all P < 0.05). The detection rates in sputum samples were significantly different between samples without duplication (28.39%, 76.19%, 46.95%, and 70.43%) and those with deduplication (19.99%, 63.00%, 38.05%, and 64.50%) (all P < 0.05). When deduplication was not performed, the rate of detection of CRKP in urine samples reached 30.05%, surpassing the rate observed with deduplication (21.56%) (P < 0.05). In BALF specimens, the detection rates of CRKP and CRPA without deduplication (39.78% and 53.23%, respectively) were greater than those with deduplication (31.62% and 42.20%, respectively) (P < 0.05). In blood samples, deduplication did not have a significant impact on the detection rates of MDROs.ConclusionDeduplication had a significant effect on the detection rates of MDROs in sputum, urine, and BALF samples. Based on these data, we call for the Infection Prevention and Control Organization to align its analysis rules with those of the Bacterial Resistance Surveillance Organization when monitoring MDRO detection rates.

Impact of COVID-19 on antimicrobial stewardship activities in Italy: a region-wide assessment

BackgroundIn the region of Piedmont, in Northern Italy, formal monitoring of antimicrobial stewardship (AMS) programs has been in place since 2012. The objective of our study was to provide an updated assessment of AMS programs operating in our region, and to assess the impact of the COVID-19 pandemic on stewardship activities.MethodsA retrospective observational study was conducted to investigate AMS programs implemented in acute-care trusts participating in a broader healthcare-associated infections and antimicrobial resistance (AMR) prevention and control program, promoted by the regional health department. Within this program, structure, process, and outcome indicators of AMS programs were investigated, using a previously developed scoring system. Differences between scores prior to (2019) and during the pandemic (2021) were assessed. Linear regression was used to assess whether the 5-year trends (2017–2021) in outcome measures in relation to structure and process scores were statistically significant. Compound annual growth rates (CAGR) for each outcome were calculated to illustrate changes in outcome rates over time.ResultsAll public trusts in the Region (20) and a small number of private institutions (3) provided data for this study. A modest, non-significant improvement was found for 2021 structure, process, and total scores compared to respective 2019 scores. A significant improvement was found concerning the definition of a formal mission statement, whereas significantly less trusts included monitoring adherence to antimicrobial policy or treatment guidelines in their programs. Overall consumption of antibiotics for systemic use saw an increase in 2021, with 2021 recording the highest median overall consumption compared to all previous years considered in this study. Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant enterobacteria (CRE) rates decreased over the 5-year period. Significant downwards trends in MRSA rates were identified for high-outlier structure and process groups.ConclusionsResults of this study suggest AMS programs in Piedmont were not set back following the pandemic. This outcome was possible thanks to well-established programs, coordinated within a regional framework. Continued efforts should be dedicated to supporting AMS programs and contrasting AMR, even when the focus is shifted towards other public health emergencies.

The Prevalence and Antimicrobial Susceptibility of Methicillin-Resistant Staphylococcus aureus Before and After the COVID-19 Pandemic in a Tertiary Saudi Hospital.

Methicillin-resistant Staphylococcusaureus (MRSA) has become a major public health problem all over the world. After the 2019 coronavirus illness (COVID-19), the pandemic may have influenced research priorities and resource allocation, potentially affecting the ability to monitor MRSA trends. The study aimed to evaluate the prevalence of S. aureus, including MRSA infections, and their antimicrobial susceptibilities over the years 2019 and 2020 in a tertiary hospital in Makkah City, KSA. A total of 2128 and 1515 laboratory (lab) samples were collected during the years 2019 and 2020, respectively. From these samples, the prevalence of S. aureus, including MRSA, and their antibiotic susceptibility were identified using standard, automated, and molecular microbiological methods. The present study shows that the lab prevalence ofall S. aureus during 2019 was found to be 35.5%, of which MRSA was 44.8%. During 2020, the frequency of S. aureus strains was 16%, of which MRSA was 41.2%. The most common MRSA isolated during both years were colonizing pus swabs and urine samples. The results showed that MRSA susceptibility against antimicrobial agents in 2019 was as follows: vancomycin (100%), linezolid (100%), trimethoprim-sulfamethoxazole (88%), and doxycycline (34.2%). The MRSA strains isolated during 2020 were as follows: vancomycin (100%), linezolid (96%), trimethoprim-sulfamethoxazole (100%), and doxycycline (24.3%). There was no significant difference in the incidence and antimicrobial resistance rates of MRSA over the two years. It was concluded that the prevalence rates of MRSA have not increased in 2020 when compared to 2019. Vancomycin, linezolid, trimethoprim-sulfamethoxazole, and doxycycline remain susceptible to the positive collected MRSA strains. There was no significant difference between the prevalence and antimicrobial resistance rates of MRSA between 2019 and 2020. Continued research efforts are needed to address this persistent public health threat. Strategies to control the spread of MRSA should include early detection of MRSA and surveillance, even during pandemics.

Antibiotic resistance’s of Staphylococcus aureus strains isolated at Hue University Hospital of Medicine and Pharmacy (3/2022 - 3/2023)

Background: Staphylococcus aureus is one of the major causes of infections in hospitals. Many studies have pointed out the fact that Staphylococcus aureus is resistant to many antibiotics, especially Methicillin-Resistant Staphylococcus aureus (MRSA). Objectives: To determine the frequency of Staphylococcus aureus and the frequency of the antibiotic resistance of S. aureus strains isolated at Hue University Hospital of Medicine and Pharmacy in 2022. Materials and methods: A cross-sectional descriptive study on S. aureus strains isolated at Hue University Hospital of Medicine and Pharmacy from March 2022 to March 2023, determining antibiotic resistance by Kirby-Bauer technique. Results: The frequency of S. aureus infections is 18.0%. The frequency of MRSA infections was 61.7%, the antibiotic resistance rates of S. aureus strains were the highest in the beta-lactam antibiotic group (61.7%-95.8%), followed by erythromycin 65.1%, clindamycin (59.9%). The rates of resistance of MRSA to penicillin, erythromycin, clindamycin, trimethoprim-sulfa antibiotics were higher than that of MSSA and this difference was statistically significant (p &lt; 0.05). The rate of multi-resistance to over 6 antibiotics of MRSA accounted for 9.3%. Conclusion: The frequency of S. aureus infections was 18.0%. The rate of MRSA accounts for 61.7%, the rate of multi-antibiotic resistant MRSA (over 6 antibiotics) was low, with 9.3%. Key words: Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus, Atibiotic Resistance.

Assessment of Knowledge and Compliance with Hand Hygiene among Health Personnel to Reduce Methicillin Resistant Staphylococcus aureus Nosocomial Infections: A Prospective Observational Study from a Tertiary Care Hospital in Southern India

Introduction: Following a significant recovery from Coronavirus Disease-2019 (COVID-19) pandemic, the world has recognised that Hand Hygiene (HH) and facial masks are key preventive measures against various cross infections, particularly in hospital settings. Studying the incidence of Methicillin Resistant Staphylococcus aureus (MRSA) as a part of Healthcare Associated Infections (HAI) surveillance is crucial, as MRSA transmission can be effectively prevented through HH. Aim: To assess the knowledge and compliance of HH among health personnel using the World Health Organisation (WHO) HH questionnaire. Materials and Methods: A prospective observational study was conducted at Bhaarath Medical College and Hospital, Chennai, Tamil Nadu, India, over one year, from December 2020 to November 2021. The Hospital Infection Control Committee (HICC) team carried out an HH survey using the WHO HH questionnaire to evaluate knowledge and attitudes among 115 Healthcare Workers (HCWs), including doctors and nursing staff, in a tertiary care hospital in Kanchipuram, Southern India. The study also involved monitoring monthly MRSA incidence density rates in Intensive Care Unit (ICU) settings as part of HAI surveillance, followed by regular HH audits. MRSA infectivity rates were statistically analysed using paired t-tests with Statistical Package for Social Sciences (SPSS) software version 21.0 to determine p-values and address standard deviations. Results: In this study, 26 (65%) of doctors had undergone training, while 57 (76%) of nurses reported recent formal HH training. Only 16 (40%) of doctors and 21 (28%) of nurses used alcohol-based handrub. Doctors exhibited knowledge ranging from 60-77.5% on germ transmission and hand rub-related questions, while nurses demonstrated better knowledge ranging from 72-93.3%. HH adherence was 30% among doctors and 72% among nurses. The MRSA infectivity rate varied over the year, starting at 1.33 per 1000 resident days before HH audits and decreasing to 0.3. Each HH audit led to a significant improvement in MRSA rates, with a p-value &lt;0.0001, indicating statistical significance. Conclusion: Present study evaluated HCWs knowledge and attitudes toward HH, along with the impact of HH audits on reducing MRSA rates, has proven to be beneficial for hospital infection control practices, particularly during the COVID-19 pandemic and its aftermath, when vigilance tends to decrease over time.

Clinical and etiological characteristics of infectious vulvovaginitis in children in Zhejiang province from 2009 to 2019

Objective: To explore the clinical characteristics, common pathogens in children with vulvovaginitis. Methods: This was a retrospective cases study. A total of 3 268 children with vulvovaginitis were enrolled, who visited the Department of Pediatric and Adolescent Gynecology, Children's Hospital, Zhejiang University School of Medicine from January 2009 to December 2019. Patients were divided into 3 groups according to the age of <7, 7-<10 and 10-18 years. Patients were also divided in to 4 groups according to the season of first visit. The pathogen distribution characteristics of infective vulvovaginitis were compared between the groups. Their clinical data were collected and then analyzed by χ2 test. Results: The were 3 268 girls aged (6.2±2.5) years. There were 1 728 cases (52.9%) aged <7 years, 875 cases (26.8%) aged 7-<10 years, and 665 cases (20.3%) aged 10-18 years. Of these cases, 2 253 cases (68.9%) were bacterial vulvovaginitis, 715 cases (21.9%) were fungal vulvovaginitis and 300 cases (9.2%) were vulvovaginitis infected with other pathogens. Bacterial culture of vaginal secretions was performed in 2 287 cases, and 2 287 strains (70.0%) of pathogens were detected, of which the top 5 pathogens were Streptococcus pyogenes (745 strains, 32.6%), Haemophilus influenzae (717 strains, 31.4%), Escherichia coli (292 strains, 12.8%), Staphylococcus aureus (222 strains, 9.7%) and Klebsiella pneumoniae (67 strains, 2.9%). Regarding different age groups, H.influenzae was the most common in children under 7 years of age (40.3%, 509/1 263), S.pyogenes (41.9%, 356/849) was predominantly in children aged 7 to 10 years, and E.coli was predominant in children aged 10 to 18 years (26.3%, 46/175). Susceptibility results showed that S.pyogenes was susceptible to penicillin G (610/610, 100.0%), ceftriaxone (525/525, 100.0%), and vancomycin (610/610, 100.0%); the resistance rates to erythromycin and clindamycin were 91.9% (501/545)and 90.7% (495/546), respectively. For H.influenzae, 32.5% (161/496) produced β-elactamase, and all strains were sensitive to meropenem (489/489, 100.0%) and levofloxacin (388/388, 100.0%), while 40.5% (202/499) were resistant to ampicillin. Among E.coli, all strains were sensitive to imipenem(100%, 175/175). The resistance rates of E.coli to levofloxacin and ceftriaxone were 29.1% (43/148) and 35.1% (59/168), respectively. A total of 48 strains of methicillin-resistant Staphylococcus aureus (MRSA) were isolated with a proportion of 28.3% (45/159) in 3 268 patients. The results of drug susceptibility test showed that all MRSA strains were sensitive to linezolid 100.0% (40/40), vancomycin (45/45, 100.0%), and tigecycline (36/36, 100.0%); the resistance rates of MRSA to penicillin G, erythromycin and clindamycin were 100% (45/45), 95.6% (43/45) and 88.9% (40/45), respectively. All methicillin-sensitive Staphylococcus aureus (MSSA) strains were sensitive to oxacillin (114/114, 100.0%), linezolid (94/94, 100.0%), vancomycin (114/114, 100.0%), and tigecycline (84/84, 100.0%); it's resistance rates to penicillin G, erythromycin and clindamycin were 78.1% (89/114), 59.7% (68/114) and 46.5% (53/114), respectively. The drug resistance rate of MSSA to penicillin G, erythromycin and clindamycin were lower than those of MRSA (χ²=11.71,19.74,23.95, respectively, all P<0.001). Conclusions: The age of consultation for pediatric infectious vulvovaginitis is mainly around 6 years. The most common pathogens are S.pyogenes, H.influenzae and Escherichia coli. Third generation cephalosporins can be used as the first choice of empirical anti-infection drugs. However, the results of drug susceptibility should be considered for targeted treatment.

No Changes in the Occurrence of Methicillin-Resistant Staphylococcus aureus (MRSA) in South-East Austria during the COVID-19 Pandemic.

Methicillin-resistant Staphylococcus aureus (MRSA) is a universal threat. Once being well established in the healthcare setting, MRSA has undergone various epidemiological changes. This includes the emergence of more aggressive community-acquired MRSA (CA-MRSA) and the occurrence of MRSA which have their origin in animal breeding, called livestock-associated MRSA (LA-MRSA). Emergence of new clones as well as changes in the occurrence of some clonal lineages also describes the fluctuating dynamic within the MRSA family. There is paucity of data describing the possible impact of the COVID-19 pandemic on the MRSA dynamics. The aim of the study was the analysis of MRSA isolates in a three-year time period, including the pre-COVID-19 years 2018 and 2019 and the first year of the pandemic 2020. The analysis includes prevalence determination, antibiotic susceptibility testing, spa typing, and detection of genes encoding the PVL toxin. The MRSA rate remained constant throughout the study period. In terms of a dynamic within the MRSA family, only a few significant changes could be observed, but all except one occurred before the start of the COVID-19 pandemic. In summary, there was no significant impact of the COVID-19 pandemic on MRSA in Austria.

One-tube RPA-CRISPR Cas12a/Cas13a rapid detection of methicillin-resistant Staphylococcus aureus

At present, methicillin-resistant Staphylococcus aureus (MRSA) has caused a serious impact on a global scale. The infection and carrier rate of MRSA in the community is increasing year by year, but there is still no convenient detection system for on-site rapid detection. It is very important to select a rapid detection system to accurately and quickly detect patients infected with MRSA. We have developed a high-efficient single-tube detection platform based on RPA and CRISPR reaction system to detect the genes of mecA and clfA of MRSA. Using this detection platform, visual MRSA detection could be achieved in 30 min. It was observed that this detection platform was capable to successfully detect the target genomic as low as 5 copies μL−1, and the reaction was completed in one step without opening the lid. This detection platform could only detect MRSA, but not other common clinical pathogenic bacteria, such as Salmonella, Pseudomonas aeruginosa, Staphylococcus xylosus, Aeromonas hydrophila, Escherichia coli and Staphylococcus warneri, indicated its satisfactory selectivity for MRSA without interference from other bacteria. The results of clinical samples show that the platform has outstanding advantages in sensitivity, specificity and identification of methicillin resistance. The entire reaction can be completed in one step in the handheld instrument without opening the cover, avoiding aerosol pollution during the reaction. The detection platform combined with handheld instruments will have great application potential in point-of-care testing.

Bacteriology and trends of antimicrobial resistance of Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus in otitis media: A retrospective data analysis.

Otitis media (OM) has a high prevalence worldwide and the treatment is crucial because hearing loss in children can lead to growth disorders such as language development disorders. The aim of this study is to analyse the changes in bacterial strains and the trends of antibiotic susceptibility in otitis media with effusion (OME), chronic otitis media (COM) and cholesteatomatous otitis media (Chole OM). This retrospective study involved 2926 patients diagnosed with OME, COM, or Chole OM between January 2000 and December 2020. The clinical data were collected and analysed through chart review from May 2021 to July 2021. Two tertiary medical centres. The 2926 OM patients. An otorrhea sample was collected on the first day of their hospital visit. Middle ear fluid samples for bacterial culture and antibiotics susceptibility test were collected from patients during middle ear surgery, including ventilation tube insertion. In each type of OM, the distribution of bacterial strains in the 2000s and the 2010s was compared. In addition, changes in the detection rate of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PA) and trends in their antibiotic susceptibility over the last 10 years were analysed. The most frequently detected bacterial strains in OME, COM and Chole OM over the study period were coagulase-negative Staphylococcus (CNS) (29.6%), MRSA (24.1%), and PA (20.1%). Compared to the 2000s, the proportion of non-typable Haemophilus influenzae in OME and MRSA in COM increased in the 2010s (27.4%-31.6% and 1.5%-29.5%, respectively). In total three types of OM, although there was no significant trend of change in detection rates of MRSA, PA, and multidrug resistant-P. aeruginosa (MDR-PA) during the last 10 years, resistance to the Quinolone class of MRSA and PA tended to increase (P < .05). The composition of bacterial strains in each types of OM has changed over the past 20 years. Additionally, the antibiotic resistance of MRSA and PA has increased in the last decade. Therefore, when using empirical antibiotics in necessary situations, it is necessary to change to an appropriate antibiotic through a bacterial culture test and antimicrobial susceptibility test.

Design, synthesis, and evaluation of novel pleuromutilin aryl acrylate derivatives as promising broad-spectrum antibiotics especially for combatting multi-drug resistant gram-negative bacteria

The emergence of drug-resistant strains presents a grave challenge for traditional antibiotics, underscoring the exigency of exploring novel antibacterial drugs. To address this, the present study endeavors to design and synthesize a collection of pleuromutilin aromatic acrylate derivatives, guided by combination principles. The antibacterial activity and structure-activity relationship of these derivatives were evaluated, and most of the derivatives displayed moderate to excellent antibacterial activity against both Gram-positive bacteria and Gram-negative bacteria. Among these derivatives, 5g exhibited the strongest antibacterial activity, with MIC (minimum inhibitory concentration) values ranging from 1–32 μg/mL, and a MIC value against clinically isolated drug-resistant strains of 4–64 μg/mL. Additionally, 5g exhibited negligible cytotoxicity, superior anti-mycoplasma activity, and a greater propensity to perturb bacterial cell membranes. Notably, the administration of 5g resulted in an increased survival rate of MRSA (Methicillin-resistant Staphylococcus aureus)-infected mice, with an ED50 (median effective dose) value of 9.04 mg/kg. These results indicated the potential of 5g to be further developed as an antibacterial drug for the clinical treatment of drug-resistant bacterial infections.

Evaluation of surgical site infections along with the study of antibiogram and drug-resistant isolates from exudate samples in a tertiary care hospital

Abstract Background: Infections of the skin and soft tissue caused by pyogenic bacteria, are a major cause of morbidity, prolonged hospital stay and post-surgical complications. Present study was designed to determine the rate of surgical site infection (SSI), burden of multi drug resistant (MDR) isolates in exudate samples and to study the antimicrobial resistance and susceptibility pattern among these isolates. Methods: One thousand five hundred and seven pus samples from pyogenic infections and SSI received over 1 year in a microbiology laboratory, which yielded aerobic growth, were identified by standard culture methods and biochemical reactions. Antibiotic susceptibility test and determination of extended-spectrum beta-lactamase (ESBL) and methicillin-resistant staphylococci [methicillin-resistant Staphylococcus aureus (MRSA), methicillin-resistant coagulase-negative Staphylococci (MRCoNS)] rates was done according to the Clinical and Laboratory Standards Institute guidelines. SSI rates of the hospital were determined. Results: Staphylococcus aureus, Klebsiella, Pseudomonas and methicillin-resistant coagulase-negative staphylococci were the most common organisms isolated from pyogenic lesions. SSI rate was 5.9%. Susceptibility of Gram-negative bacteria to imipenem was 88%, amikacin 86%, gentamicin 83% and piperacillin/tazobactam 80%. Susceptibility was least for cephalosporins 54%, ciprofloxacin 39% and ampicillin 28%. ESBL rate was 33% and MRSA was 38%. In SSI, ESBL and MRSA rates were 35% and 43%, respectively. Among Gram positives, susceptibility to linezolid was 100% and clindamycin 71% susceptible. It was least to ciprofloxacin 19% and co-trimoxazole 24.6%. Conclusions: Developing antibiogram helps in framing local antibiotic policy and adhering to this contributes to controlling drug-resistant strains and also aids in reducing SSI rates.

Screening for Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) has become less common in Germany in recent years. In this paper, we report data from the MRSA module of the Hospital Infection Surveillance System (Krankenhaus-Infektionen- Surveillance-System, KISS) for the years 2006-2021. We also describe the association of MRSA rates with the frequency of patient screening for MRSA and discuss the findings. Participation in the MRSA KISS module is voluntary. Once a year, the participating hospitals submit structural data, information on cases in which MRSA was detected (both colonizations and infections; both detected on admission and nosocomially acquired), and the number of nasal swabs taken for the detection of MRSA to the German National Reference Center for the Surveillance of Nosocomial Infections. Statistical analyses were performed with R software. The number of hospitals participating in the MRSA module rose from 110 in 2006 to 525 in 2021. From 2006 onward, the overall MRSA prevalence in German hospitals increased, reaching a maximum of 1.04 cases per 100 patients in 2012. The prevalence on admission fell by 44% from 0.96 in 2016 to 0.54 in 2021. The incidence density of nosocomial MRSA fell by an average of 12% per year, from 0.27 per 1000 patient-days in 2006 to 0.06 in 2021, while MRSA screening frequency increased sevenfold by 2021. The nosocomial incidence density was stable, independently of the screening frequency. MRSA rates in German hospitals fell markedly from 2006 to 2021, reflecting a general trend. The incidence density was no higher in hospitals with a low or moderate screening frequency than in those with a high one. Thus, a targeted, riskadapted MRSA screening strategy on hospital admission can be recommended.

#5871 PERITONEAL DIALYSIS INFECTIONS IN MALTA: AN OVERVIEW OF THIRTEEN YEARS

Abstract Background and Aims Peritoneal dialysis (PD)-related infections are still associated with an increased risk of morbidity and mortality. We describe an overview of PD peritonitis and catheter-related infection (CRI) rates in Malta over a period of thirteen years. Method All patients undergoing PD in Malta from 2008 to 2020 were included. Data from 2008 to 2012 was retrospective (shown as mean), whilst data from 2013 to 2020 was prospective. ISPD guidelines and definitions were followed. Results Study population sizes from 2008 to 2020 were as follows: 137 (2008-2012), 91, 80, 126, 117, 102, 103, 101, and 101 respectively. PD peritonitis rates from 2008 to 2020 were 0.38, 0.31, 0.35, 0.46, 0.43, 0.57, 0.54, 0.43, 0.39, 0.40, 0.46, 0.37, and 0.29 episodes/patient/year respectively. Gram-positive peritonitis episodes predominated, the majority of which were Staphylococcal infections. Methicillin-resistant Staphylococcus aureus (MRSA) rates have overall decreased from 0.03 episodes/patient in 2008–2012 to 0.01 episodes/patient in 2020, to no cases in 2016, 2017 and 2019. Coagulase-negative Staphylococcal (CNS) rates also decreased from 0.26 episodes/patient in 2013 to 0.03 in 2017, 0.11 in 2018, 0.04 in 2019, and 0.08 in 2020. With regards to Gram-negative peritonitis, Pseudomonas rates declined from 0.06 episodes/patient in 2008–2012 to 0.03 in 2018. No cases were recorded in 2016, 2019 and 2020. The rate of Escherichia coli-associated peritonitis was 0.03 episodes/patient/year in 2020, and no cases were found in 2016, 2017, 2018, and 2019. Fungal peritonitis rates varied from 0.03 in 2008–2012 to 0.01 episodes/patient/year in 2013, 2018, 2019 and 2020 with no cases being recorded in 2016 and 2017. CRI rates were as follows: 0.39 (2008-2012), 0.35, 0.91, 0.37, 0.38, 0.25, 0.50, 0.29, and 0.22 episodes/patient/year respectively. The incidence of Gram-negative infections from 2013 to 2020 was 49, 51, 52, 65, 58, 66, 48, 41% respectively, with an average rate of 54%. Gram-positive CRIs were mostly Staphylococcal, peaking in 2014 at 0.38 episodes/patient, down to 0.14 in 2019, and 0.10 in 2020. MRSA rates decreased from 0.15 episodes/patient/year in 2014 to 0.01 in 2018, no cases in 2019, and 0.04 in 2020. CRI Pseudomonas rates have overall improved from 0.12 (2008-2012), to 0.06, 0.09, 0.09, 0.14, 0.03, 0.17, 0.06, 0.04 episodes/patient/year from 2013 to 2020. Conclusion The Maltese PD cohort has been achieving ISPD target requirements. Both PD peritonitis and catheter-related infection rates declined over the last thirteen years. There was no MRSA peritonitis in 2016, 2017 and 2019, no Pseudomonas peritonitis in 2016, 2019 and 2020, no E. coli in 2016,2017, 2018 and 2019 and no fungal PD peritonitis in 2016 and 2017. Overall CRIs were predominantly Gram-negative, but not in 2019 and 2020.

Community-acquired and healthcare-associated Staphylococcus aureus infections in a pediatric hospital in southern Brazil over 8 years: how common is MRSA?

Both healthcare-associated and community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections are relevant in children. The objective of our study was to evaluate their impact in a pediatric hospital in southern Brazil. Data from patients under 18 years of age with S. aureus infections between January 2013 and December 2020 were retrospectively analyzed. Data were collected regarding infection site, infection type (community-acquired or healthcare-associated), susceptibility to oxacillin [methicillin-susceptible S. aureus (MSSA) or MRSA] and other antimicrobials. We analyzed the evolution of the susceptibility rates for the isolates over this period. A total of 563 patients were included, among whom the prevalences of community- and hospital-acquired MRSA infections were 46.1% and 8.1%, respectively. No significant change occurred in these prevalences over the study period. In community-acquired infections, MSSA was significantly more associated with osteoarticular infections and MRSA was more associated with respiratory and intra-abdominal infections. In healthcare-associated infections, there was an association between MSSA and primary bloodstream infections and between MRSA, skin/soft tissue infections, and respiratory infections. Community-acquired MRSA were highly susceptible to trimethoprim-sulfamethoxazole (96.1%), clindamycin (88.4%), and doxycycline (99.0%). Our study draws attention to the high rates of MRSA in community-acquired staphylococcal infections in this population, indicating a need to review initial protocols for severe staphylococcal infections according to local epidemiology.

Methicillin Resistant Staphylococcus Aureus Isolates From Bed Surface Contacts And Bed Sheets Of Surgical Wards In A Secondary Healthcare Facility In Gombe, Nigeria

Background: Methicillin resistant Staphylococcus aureus (MRSA) has become one of the most important human pathogens associated with hospital infections globally. It is responsible for a considerable number of infections but has received inadequate attention in our local communities. Objective: To determine the occurrence of Methicillin Resistance Staphylococcus aureus (MRSA) isolates from bed contact surfaces and bed sheets in the male and female surgical wards of State Specialist Hospital Gombe, Nigeria. Results: A total of 100 samples were collected purposively for the study. Overall, 79/100 (79%) were positive for S. aureus, and out of these, 42/50(84%) were from the male surgical ward and 37/50 (74%) from the female surgical wards (χ2=1.5, p=0.22). The Male surgical ward bed contact surfaces had the highest S. aureus colonization (92%), and the least affected was the female surgical ward bed contact surfaces (72%), and the difference was not statistically significant (χ2=3.388, p= 0.07). Out of the 79 samples that yielded S. aureus, 56(56%) were positive for MSRA while the remaining 23(23%) were MSSA. Comparing the two wards, we found that the rate of MRSA in the FSW (60%) was higher than that of the MSW (56%), but the difference was not statistically significant (χ2=0.65, p=0.42). The antibiotic sensitivity of the S. aureus isolated from the bed sheet of the MSW was higher (78.3%) compared to those isolated from the bed sheets of the FSW (38.9%) with χ2=6.58 and p value=0.01. However, there was no significant difference in the antibiotic sensitivity to (cefoxitin and ampicillin) of S. aureus isolated from the bed surface contacts of the MSW and FSW. Conclusion: This study reports a high occurrence rate of both S. aureus and the MRSA variant among the two wards studied. Regular fumigation and disinfection may help control the transmission via contact surfaces. Staff training on hospital sanitation and occupational safety will serve as an additional effort to ensure patients and visitors safety.

Risk factors for the transmission of Clostridioides difficile or methicillin-resistant Staphylococcus aureus in acute care

Background: Some hospitals continue to struggle with nosocomial transmission of Clostridioides difficile infection (CDI) and methicillin-resistant Staphylococcus aureus (MRSA) despite years of infection control efforts. We investigated the relationship between unit infrastructural–organizational risk factors and nosocomial transmission of CDI and MRSA. Methods: This retrospective observational study included 100 eligible acute-care inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020, to September 16, 2021. The outcome variables included whether a unit was on the CDI or MRSA vulnerable unit list (ie, defined as having ≥5 CDI cases or ≥6 MRSA cases being attributed to the unit in the last 6 fiscal periods), the average CDI/MRSA rate, as well as the average CDI/MRSA standardized infection ratio (SIR). Independent variables included, but were not limited to, infection control factors (eg hand hygiene rate), infrastructural factors (eg, unit age, total beds on unit), and organizational factors (eg, hallway bed utilization, nursing overtime). Multivariable regression was performed to identify statistically significant risk factors using SAS, R Studio, and Stata software. Results: For CDI, older units were associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.086; 95% CI, 1.024–1.175), higher CDI rate (adjusted relative risk [aRR], 0.012; 95% CI, 0.004–0.020), and higher CDI SIR (aRR, 0.011; 95% CI, 0.003–0.020). Larger unit size was associated with higher odds of being on the CDI vulnerable unit list (aOR, 1.210; 95% CI, 1.095–1.400) and higher CDI SIR (aRR, 0.013; 95% CI, 0.001–0.026). For MRSA, an increase in hand hygiene rate was associated with lower odds of being on the MRSA vulnerable unit list (aOR, 0.71; 95% CI, 0.53–0.897), lower MRSA rate (aRR, −0.035; 95% CI, −0.063 to −0.008), and lower MRSA SIR (aRR, −0.039; 95% CI, −0.069 to −0.008). Higher MRSA bioburden was associated with higher odds of being on the MRSA vulnerable unit list (aOR, &gt;999; 95% CI, &gt;999 to &gt;999), higher MRSA rate (aRR, 9.008; 95% CI, 5.586–12.429), and higher MRSA SIR (aRR, 4.964; 95% CI, 1.971–7.958). Additionally, higher MRSA rates were associated increased utilization of hallway beds (aRR, 0.680; 95% CI, 0.094–1.267), increased nursing overtime rate (aRR, 5.018; 95% CI, 1.210–8.826), and not having a clean supply room with the door consistently closed (aRR, −0.283; 95% CI, −0.536 to −0.03). Conclusions: Several infrastructural and organizational factors were associated with nosocomial transmissions of CDI and MRSA. Further research is needed to investigate the mechanisms by which these factors are associated.Disclosures: None

Methicillin resistant Staphylococcus aureus isolated from surgical patients in Cambodia over a 10-year period.

Methicillin-resistant Staphylococcus aureus (MRSA) related surgical infections are a global challenge. The burden of antimicrobial resistance is high throughout South-East Asia, and this is reflected in our local institution in Cambodia. Between 2011 and 2013, we analysed 251 wound swab samples at the Children's Surgical Centre, Phnom Penh; 52.5% of the Staphylococcus aureus isolates (n = 52/99) were MRSA positive. Ten years on, we have sought to investigate whether there is a difference in MRSA rates within our adult and paediatric patient population. Between 2020 and 2022, MRSA rates in our patient population have remained similar at 53.8% (n = 42/78). Resistance profiles of MRSA isolates have also remained similar with a significant proportion of MRSA still showing sensitivity to trimethoprim-sulfamethoxazole and tetracycline. We also find that patients presenting with wound infection secondary to trauma or orthopaedic implants had greater propensity to yield MRSA.

Prevalence, antimicrobial susceptibility pattern and multidrug resistance of methicillin-resistant Staphylococcus aureus isolated from clinical samples at a tertiary care teaching hospital: an observational, cross-sectional study from the Himalayan country, Nepal

ObjectiveWe sought to determine the prevalence and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA) isolated from the clinical samples at a tertiary care hospital in Nepal.MethodsCross-sectional, observational study design.Study...

Health Care–Associated Infections Among Hospitalized Patients With COVID-19, March 2020-March 2022

The reported incidence of many health care-associated infections (HAIs) increased during the COVID-19 pandemic; however, it is unclear whether this is due to increased patient risk or to increased pressure on the health care system. To assess HAI occurrence among patients admitted to hospitals with and without COVID-19. A cross-sectional retrospective analysis of inpatients discharged both with and without laboratory-confirmed COVID-19 infection was conducted. Data were obtained between January 1, 2019, and March 31, 2022, from community hospitals affiliated with a large health care system in the US. COVID-19 infection. Occurrence of central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, and Clostridioides difficile infection as reported to the National Healthcare Safety Network. Among nearly 5 million hospitalizations in 182 hospitals between 2020 and 2022, the occurrence of health care-associated infections (HAIs) was high among the 313 200 COVID-19 inpatients (median [SD] age, 57 [27.3] years; 56.0% women). Incidence per 100 000 patient-days showed higher HAIs among those with COVID-19 compared with those without. For CLABSI, the incidence for the full 9 quarters of the study was nearly 4-fold higher among the COVID-19 population than the non-COVID-19 population (25.4 vs 6.9). For CAUTI, the incidence in the COVID-19 population was 2.7-fold higher in the COVID-19 population (16.5 vs 6.1), and for MRSA, 3.0-fold higher (11.2 vs 3.7). Quarterly trends were compared with the same quarter in 2019. The greatest increase in the incidence of HAI in comparison with the same quarter in 2019 for the entire population occurred in quarter 3 of 2020 for CLABSI (11.0 vs 7.3), quarter 4 of 2021 for CAUTI (7.8 vs 6.8), and quarter 3 of 2021 for MRSA (5.2 vs 3.9). When limited to the non-COVID-19 population, the increase in CLABSI incidence vs the 2019 incidence was eliminated, and the quarterly rates of MRSA and CAUTI were lower vs the prepandemic 2019 comparator quarter. In this cross-sectional study of hospitals during the pandemic, HAI occurrence among inpatients without COVID-19 was similar to that during 2019 despite additional pressures for infection control and health care professionals. The findings suggest that patients with COVID-19 may be more susceptible to HAIs and may require additional prevention measures.

Epidemiology of Methicillin-resistant and Methicillin-sensitive Staphylococcus aureus infections in Lebanon

Background. Methicillin-resistant Staphylococcus aureus (MRSA) is a prevalent pathogen associated with significant morbidity and mortality. In Lebanon, MRSA rates have recently started to rise. We aimed to determine risk factors for acquiring MRSA and Methicillin-sensitive Staphylococcus aureus (MSSA) infections and identify independent risk factors for in-hospital mortality among patients with S. aureus infection. Methods. We used a case-case-control study design that included patients with infections and compared them to uninfected controls. Two multivariable regression models were constructed to determine variables associated with acquiring MRSA and MSSA infections. We explored independent predictors of mortality in the overall population compared with the MRSA subgroup. Results. 356 patients with S. aureus infections were identified and compared to 208 uninfected controls. A recent history of surgery and underlying diabetes were independent risk factors for acquiring both infections. Having a urinary catheter for more than 6 days and steroid therapy were unique risk factors for MRSA infection (aOR 28.1, 95% CI 3.5-223.6 and 3.7, 95% CI 1.6-8.7, respectively). Risk factors exclusively associated with MRSA infection included ICU admission, acute renal failure, and malignancy. Conclusions. Risk factors associated with MRSA infection are distinct from those associated with MSSA infection. This can be used to risk stratify patients and will aid in choosing empirical antibiotic therapy.