Prevalence Of Methicillin-resistant Staphylococcus Aureus Research Articles

Prevalence and Characterization of Methicillin-Resistant Staphylococcus aureus from Meat Retail Shops and Meat Handlers in the Buea Municipality, Cameroon

Aim: Methicillin-resistant Staphylococcus aureus (MRSA) is a notorious multidrug-resistant biovar of S. aureus associated with infections that result in high morbidity and mortality in humans and animals. Its persistence in both host and non-host environments adds a major ecological dimension to the problem, thereby making it a one health challenge. This study determined the prevalence and antibiotic resistance patterns of MRSA from meat retail shops and meat handlers in the Buea municipality in addition to basic hygiene practices implemented in the meat retail shops.
 Study Design: In this cross-sectional study, a total of 260 samples (comprising 52 swabs each from weighing balances, butchering slabs, cutting knives, hands of meat handlers and meat samples) were randomly obtained and subjected to microbiological analysis. Data on sociodemographic characteristics of meat handlers and basic hygiene practices were captured in a questionnaire.
 Methodology: After enrichment, each sample was inoculated on mannitol salt agar and DNA extracted from presumptive S. aureus isolates for detection of the nuc gene. MRSA was identified by oxacillin disk diffusion and confirmed by amplification of the mecA gene. All MRSA isolates were challenged with 10 commonly used antibiotics using the Kirby-Bauer disk diffusion method.
 Results: A total of 27 MRSA isolates were recovered from hand swabs (5.8%), meat (15.4%), knives swabs (21.2%) and butchering slabs (9.6%). All (100%) MRSA were resistant to ampicillin and cefepime followed by ofloxacin (92.6%), ciprofloxacin (81.5%) and vancomycin (37%). High susceptibility was observed for gentamicin (100%) and amikacin (100%). All isolates were multidrug-resistant and comprised 11 antibiotypes. Most meat handlers (71.2%) did not have basic meat safety training, while 90.4% of the meat retail shops did not have a nearby water source.
 Conclusion: Our results indicate that meat retail shops could be a potential reservoir of MRSA in the environment and meat handlers need more basic meat safety training.

Prevalence of MRSA and Antimicrobial Susceptibility Staphylococcus aureus in Clinical Samples in National Capital Region, India

Background: Infections caused by Staphylococci are frequently linked to indwelling medical equipment. These are extremely difficult to treat with antibiotics. In India, the prevalence of Methicillin-Resistant Staphylococcus aureus (MRSA) varies from 30 to 70%, resulting in high mortality, increased economic burden, and high treatment failure in tertiary care hospitals. Rapid and reliable identification of MRSA is critical for infection management and avoiding the needless use of antibiotics.
 Materials and Methods: This prospective study was carried out in the Department of Microbiology, Santosh Medical College, Ghaziabad, from the 1st of August 2020 to the 31st of January 2021. MRSA isolates were screened and confirmed using standard methods recommended by the Clinical and Laboratory Standards Institute (CLSI). Methicillin resistance, in Staphylococcus aureus strains, was evaluated using oxacillin/cefoxitin. The Kirby-Bauer disc diffusion technique was used to assess the antibiotic susceptibility pattern of all MRSA strains.
 Results: In this investigation, MRSA was identified in 29.4% of the 384 Staphylococcus aureus strains. When compared to females, men outnumbered females. Cefoxitin detects a greater amount of MRSA than oxacillin. In this investigation, the majority of MRSA was found in pus samples.
 Conclusion: MRSA prevalence is known to vary depending on geographical region, hospital type, investigated population, and technique of detection used. Given the clinical implications of MRSA infection and its fast transmission capability, MRSA strains must be monitored on a regular basis.

1277. Colonization Rates for Antimicrobial-resistant Bacteria in Kenya: An Antibiotic Resistance in Communities and Hospitals (ARCH) Study

BackgroundCharacterization of antimicrobial-resistant organism (ARO) colonization is critical to understand transmission dynamics and infection risk, however data in resource-limited settings are scare. We estimated the prevalence of Enterobacterales colonization with extended-spectrum cephalosporin-resistance (ESCrE), carbapenem-resistance (CRE) and methicillin-resistant Staphylococcus aureus (MRSA) among community residents and hospitalized patients in rural (Siaya County) and urban (Kibera) Kenya.MethodsCommunity-dwelling adults and children were enrolled via cluster randomized sampling. Inpatients of all ages were enrolled by simple random sampling. Stool/rectal and nasal swabs were collected and screened for ESCrE, CRE and MRSA, respectively, using HardyChrom™ media. Vitek2® was used for isolate confirmation and antibiotic susceptibility testing. Fisher’s exact tests were used to compare prevalence of AROs.ResultsThe prevalence of ESCrE was higher for the urban hospital (69.8%, 263/377) compared to rural hospitals (62.7%, 298/475, P=0.04); a similar pattern was evident for CRE (16.7%, 63/377 and 6.5%, 31/475, respectively, P< 0.01). The prevalence of MRSA was 3.2% for both urban and rural hospitals (P=0.99). For adults, the prevalence of ESCrE was higher in Kibera households (51.4%, 346/673) compared to Siaya (44.6%, 283/634, P=0.02) while the prevalence of both CRE and MRSA was < 3% for both areas and did not differ significantly (CRE, P=0.13, MRSA, P=0.14). There was no significant difference between urban and rural children for ESCrE (47.7%, 74/155 and 53.4%, 135/253, P=0.31); both CRE and MRSA were rarely detected (< 2%) with no difference across settings (CRE, P=1.0, MRSA, P=0.42). Among Enterobacteriaceae recovered, Escherichia coli and Klebsiella spp. predominated.ConclusionColonization with AROs were widespread in households and hospitals in urban and rural areas. Hospitals with elevated prevalence of highly transmissible AROs should consider whether implementation of colonization screening can be incorporated as part of their infection prevention and control programs. Risk factors for ARO colonization should be elucidated to identify novel prevention strategies.Disclosures All Authors: No reported disclosures

247. The Predictive Value of Methicillin-Resistant Staphylococcus aureus Surveillance Swabs in Septic Arthritis

BackgroundSeptic arthritis is a destructive form of acute arthritis secondary to infection. With an annual incidence of 2 to 5 cases per 100 000 individuals, it is associated with significant morbidity and mortality. Prompt source control and antimicrobial therapy remain the mainstays of management. Epidemiology, microbiology studies, and local resistance patterns are important in guiding therapeutic decisions. Staphylococcal and streptococcal species are the most common pathogens with Methicillin-resistant Staphylococcus aureus (MRSA) becoming an increasingly important pathogen. The increasing incidence of MRSA provides clinicians with the challenge of deciding which patients require empiric coverage for MRSA. MRSA nasal screening has been shown to have a high negative predictive value in pneumonia, bloodstream infections, and nosocomial infections in critically ill patients. However, little is known about the diagnostic utility of MRSA surveillance swabs for predicting MRSA infections in septic arthritis. MethodsA retrospective cohort study was performed in 3 tertiary hospitals from September 1, 2010 to December 31, 2020. All adult patients with confirmed septic arthritis of the ankle, wrist, knee, or hip and an MRSA surveillance swab performed within 72 hours of admission were included in the study. These data were used to calculate the sensitivity, specificity, positive predictive value and negative predictive value for MRSA surveillance swabs. ResultsOne hundred seventy-two patients met inclusion criteria. Thirty patients had positive MRSA surveillance swabs. The prevalence of MRSA in joint cultures was 11.04%. The positive predictive value of MRSA surveillance swabs was 42.3% and the negative predictive value was 93.5% in all participants. The MRSA surveillance swab had a negative predictive value of 100% in participants with no risk factors for MRSA colonization. ConclusionThe negative predictive value of MRSA surveillance swabs used independently is insufficient to confidently rule out MRSA as the causative pathogen in septic arthritis. When used in combination with MRSA risk factors, the absence of MRSA risk factors may help clinicians rule out MRSA as a causative pathogen. Disclosures All Authors: No reported disclosures

666. Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in Chile between 1999-2018

BackgroundThe global spread of methicillin-resistant Staphylococcus aureus (MRSA) is associated with distinct genetic lineages that predominate in specific geographical regions. Available evidence suggests the Chilean-Cordobes clone (ChC), an ST5-SCCmecI lineage, has largely predominated in Chilean hospitals since its first description in the late 1990’s. Although the circulation of other MRSA lineages, including community-associated clones, has been well documented, the dynamics of clonal replacement over time has not been explored. Therefore, we aimed to study the molecular epidemiology and dynamics of clonal replacement using a large collection of clinical MRSA strains recovered from Chile during the last two decades.MethodsWe used whole-genome sequencing (WGS) and core-based phylogenomic analysis to identify genetic lineages and explore their relationship in 798 MRSA isolates obtained between 1999-2018 from two tertiary-care Chilean hospitals. ResultsOverall, the most frequently identified clones were the ST5-SCCmecI ChC (n=476, 60%), followed by ST105-SCCmecII (n=119, 15%), ST72-SCCmecIV (n=74, 9%), and ST8-SCCmecII (n=26, 3%). Phylogenomic reconstruction demonstrated 7 major clades: Clade I (CC30); Clade II (CC22); Clade III (CC97); Clade IV (CC8); Clade V (ST72); Clade VI (CC5/ST225 and ST105) and Clade VII (CC5/ST5-SCCmecI) (Fig. 1). The ChC clone remained the most frequent MRSA lineage throughout the study period (Fig. 2). However, its relative abundance decreased from >90% of isolates in 1999 to ca. 40% in 2018. This decrease began around 2005 and was associated with a progressive expansion of the ST105-SCCmecII and ST72-SCCmecIV lineages (Fig. 2). A Bayesian molecular clock analysis established the most recent common ancestor in 1964 (95% HPD interval=1961.975-1966.218) and corroborated a CC5 expansion event starting in Chile in 1999 (Fig. 3). Interestingly, our analyses revealed two branches within the ST5-SCCmecI lineage: one predominating in 1999-2006, and a more recent branch (related to the ST105-SCCmecII clone) that emerged around 2008. Figure 1. Core genome phylogenomic reconstruction of the 798 MRSA isolates. The seven major clades are represented by colored sections. The Clade I (purple section) was composed of isolates belonging to the CC30. Clade II (cyan section) includes four isolates of CC22. Clade III (red section) is composed of isolates of CC97. Clade IV (blue section) grouped isolates of different ST239 and ST8, belonging to the CC8. Clade V (orange section) includes isolates of ST72. Clade VI (yellow section) includes isolates of ST225 and ST105, both belonging to CC5. Clade VII (green section) is mostly composed of isolates of ST5-SCCmecI. The inner ring shows the ST of the isolates; the external ring shows the staphylococcal chromosomal cassette mec (SCCmec) type.Figure 2. Relative frequency of MRSA clones from 1999 to 2018. The genomes were grouped according to their isolation dates. Most frequent MRSA clones are represented by colored sections.Figure 3. Maximum clade credibility tree from the molecular clock analysis of the 798 MRSA genomes. A Bayesian molecular clock analysis was performed with BEAST using the isolation date of each genome as a calibrator. The colored strip showed the most frequent clones. The red dot shows a major event of divergence in 2008.ConclusionThe ChC clone remains the most prevalent MRSA in Chile. However, our data is consistent with the evolution of this clone and a progressive replacement of with ST105 and ST72 genetic lineages. Disclosures Lorena Diaz, PhD , Nothing to disclose Cesar A. Arias, M.D., MSc, Ph.D., FIDSA, Entasis Therapeutics (Grant/Research Support)MeMed Diagnostics (Grant/Research Support)Merk (Grant/Research Support)

Prevalence of methicillin-resistant Staphylococcus aureus in a tertiary hospital in Nepal.

SETTING:Patan Hospital, Lalitpur, Nepal.OBJECTIVES:To describe 1) the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and its antibiotic sensitivity pattern; 2) the demographic and clinical characteristics associated with MRSA infections; and 3) the treatment outcomes of in-patients with MRSA infection among patients with S. aureus infection between January 2018 and December 2020.DESIGN:This was a cross-sectional study using electronic and paper-based hospital records of patients with S. aureus infection.RESULTS:Of the 1,804 patients with S. aureus infection, 1,027 patients (57%, 95% CI 55–59) had MRSA. The MRSA were susceptible to vancomycin (100%), linezolid (96%), doxycycline (96%), chloramphenicol (86%) and cotrimoxazole (70%), and resistant to erythromycin (68%), clindamycin (56%), gentamycin (58%), ciprofloxacin (92%) and ofloxacin (91%). The prevalence of MRSA was higher in 2019, among out-patients, and in respiratory samples, and lower in blood samples. Of the 142 in-patients with MRSA, 93% had a successful clinical outcome (cured/improved).CONCLUSION:More than 50% of patients with S. aureus infection had MRSA that were resistant to commonly available antibiotics. This calls for strengthening surveil-lance and good infection control practices in this hospital.

Genotypic and Phenotypic Characterizations of Methicillin-Resistant Staphylococcus aureus (MRSA) on Frequently Touched Sites from Public Hospitals in South Africa.

The hospital environment acts as a reservoir in the transmission of pathogens, such as MRSA, which may cause hospital-acquired infections. This study aimed to ascertain the prevalence, genetic relatedness, antibiotic resistance, and virulence profile of MRSA on some frequently touched hospital sites in South Africa. A total of 777 swabs were randomly collected from 11 frequently touched sites in the hospital environment of three wards of four public hospitals in the KwaZulu-Natal province of South Africa. Isolation of S. aureus and confirmation were done using genotypic and phenotypic methods. Antibiotic susceptibility testing was performed using the Kirby–Bauer disk-diffusion method. MRSA isolates were determined by the presence of the mecA gene. Virulence and resistance genes were detected using a standard monoplex PCR assay. ERIC-PCR was conducted to evaluate the genetic relatedness. An overall prevalence of 12.7% for S. aureus isolates was obtained. Out of these, 89.9% (89/99) were confirmed to be MRSA. The sites with the highest prevalence were the occupied beds (16.2% (16/99)), unoccupied beds (16.2% (16/99)), patient files (14.1% (14/99)), ward phones (13.1% (13/99)), and nurses' tables (14.1% (14/99)). The virulence genes with the highest observed frequency were hld (87 (87.9%)) and LukS/F-PV (53 (53.5%)). The resistance genes with the highest frequency were the tetM and tetK genes detected in 60 (60.6%) and 57 (57.6%) isolates, respectively. The ERIC-PCR results obtained indicated a high level of genetic diversity; however, intraclonal (within a hospital) and interclonal (between hospitals) clusters of MRSA were observed. The study showed that MRSA can contaminate various surfaces, and this persistence allows for the dissemination of bacteria within the hospital environment. This highlights the need for improved infection prevention and control (IPC) strategies in public hospitals in the country to curb their potential transmission risks.

Evolution and Population Structures of Prevalent Methicillin-Resistant Staphylococcus aureus in Taiwan.

Global methicillin-resistant Staphylococcus aureus (MRSA) strains were dominated by few genetic lineages, suggesting their inherent advantage of competitive fitness. The information of genome evolution and population structures of prevalent MRSA strains can help gain a better understanding of the success of the pandemic clones. Whole-genome sequencing was performed in 340 MRSA isolates belonging to three prevalent lineages, including ST59 (129 isolates), ST239/241 (140 isolates), and ST5 (71 isolates), collected from 1996 to 2016 in Taiwan. The time-scaled phylogeny and evolutionary pathways were estimated by Bayesian analysis using Markov chain Monte Carlo. The toxome, resistome, and plasmids were characterized by screening the raw reads with a public database. ST59, ST239/241, and ST5 MRSA were estimated to emerge in 1974, 1979, and 1995, respectively, in Taiwan. ST59 evolved through two major pathways, generating two subclones in 1980 and 1984. Both ST59 subclones remained prevalent in the healthcare and community environments in late 2010s. ST239/241 diverged into three subclones, respectively, in 1989, 1993, and 1995. The 1995-emerging ST239 subclone predominated after 2000 by replacing two previous early subclones. ST5 could be subdivided into two clades within 3 years of introduction, but no substantial difference of genomic profiles was identified in the strains of distinct clades. Each of the three pandemic MRSA lineages harbored its own specific toxome, resistome, and plasmids. The frequently identified genetic diversities between the subclones of the same lineage were genes mediating immune evasion, leukocidins, enterotoxins, and resistance to aminoglycosides. In conclusion, MRSA ST59 and ST239/241 emerged in the 1970s and evolved drastically during 1980 and 1995, resulting in three successful subclones prevailing in Taiwan. ST5 was introduced late in 1995 without a significant genetic drift during 20 years of evolution.

Prevalence of Staphylococcus aureus, Methicillin-Resistant Staphylococcus aureus and Potential Risk Factors in Selected Dairy Farms at the Interface of Animal and Human in Bishoftu, Ethiopia

BackgroundStaphylococcus aureus (S. aureus) has been reported as the most commonly isolated highly contagious pathogen from human, animals and animal products. Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant pathogen with zoonotic potential that could have devastating consequence for the health and well-being of animals and human.MethodsA cross-sectional study was conducted from July 2020 to January 2021. A total of 233 samples from cow milk, udder swabs and milkers’ hand swabs were collected for culture and identification based on the standard protocol. Antimicrobial susceptibility tests were performed for all isolates by using Kirby Bauer’s disk diffusion test. MRSA was detected by cefoxitin disk diffusion test.ResultsS. aureus was isolated from 50 (21.46%) of 233 samples and the prevalence of MRSA was 4%. The highest prevalence was found in cow milk 36 (25.53%) followed by hand swabs 10 (19.23%) and udder swabs 4 (10%). S. aureus prevalence was 58.33%, 30.0%, 21.43%, 17.92%, 15.79% in farm D, C, E, A, B respectively. A large percentage (58.33% and 30%) were from farm D and C. S. aureus isolation rate showed statistically significant association with farm types (p = 0.011) and with previous mastitis exposure (p = 0.001). High level of resistance was observed to penicillin (94%) and ampicillin (92%), but low level resistance to gentamicin (0%), amikacin (0%), ceftriaxone (0%), chloramphenicol (4%), ciprofloxacin and cefoxitin (4%). The overall prevalence of multidrug resistance (MDR) was 10.42%.ConclusionPrevalence of S. aureus in milk showed statistically significant association with respect to previous mastitis exposure and farm types (p = 0.011). High level of resistant to penicillin and ampicillin was observed. Therefore, effective mastitis control programs, best veterinary practice among all farms and use of antibiotics in the farm should be strictly controlled.

PREVALENCE OF TSST PRODUCING COAGULASE-NEGATIVE STAPHYLOCOCCUS AUREUS IN WOUND SAMPLES AND CHARACTERIZATION OF MRSA AGAINST TEA EXTRACT

Objective: Methicillin-resistant Staphylococcus aureus (MRSA) is a potential pathogen for hospital-acquired infections. This study was conducted to determine the prevalence of MRSA using tea extract. Methods: All S. aureus isolates obtained from wound samples were studied for antibiotic resistance pattern using 23 different antibiotics. Based on coagulase negative, S. aureus isolates were identified for toxic shock syndrome toxin (TSST) gene and analyzed using PCR method. The antibacterial activities of tea extract were tested against MRSA using agar well-diffusion method. Results: A total of 100 wound samples were collected from hospital, where 75% of samples showed presence of S. aureus. About 100% resistance to cefoperazone, ampicillin, penicillin, rifampicin, novobiocin, and vancomycin antibiotics was observed. The isolates showed less resistance &lt;50% toward chloramphenicol (30%), ciprofloxacin (25%), gentamycin (52%), amikacin (38%), and imipenem (33%). Twenty-five isolates were selected for MRSA characterization based on multiple drug resistance pattern. Coagulase-negative S. aureus isolates showed presence of TSST gene. Tea extract (2%) showed effective antibacterial activity against MRSA strains. Conclusion: The study showed the presence of MRSA at higher level and suggesting to out further epidemiological study on such infections. However, cost-effective and easily available tea extract was found to be the best antimicrobial agent for preventing such bacterial infection and to reduce the risk of emerging resistance.

Epidemiology of Methicillin-Resistant Staphylococcus Aureus in Arab Countries of the Middle East and North African (MENA) Region.

Available data suggest a high burden of methicillin-resistant staphylococcus aureus (MRSA) in Arab countries of the Middle East and North Africa (MENA). To review the MRSA rates and molecular epidemiology in this region, we used PubMed search engine to identify relative articles published from January 2005 to December 2019. Great heterogeneity in reported rates was expectedly seen. Nasal MRSA colonization ranged from 2%–16% in Gulf Cooperation Council (GCC), 1–9% in the Levant, and 0.2%–9% in North African Arab states. Infective MRSA rates ranged from 9%–38% in GCC, 28%–67% in the Levant, and 28%–57% in North African states. Studies demonstrated a wide clonal diversity in the MENA. The most common molecular types belonged to 5 clonal complexes (CC) known to spread worldwide: CC5, CC8, CC22, CC30, and CC80. The most prevalent strains had genotypes related to the European community-acquired MRSA (CA-MRSA), Brazilian/Hungarian hospital-acquired MRSA (HA-MRSA), UK-EMRSA-15 HA-MRSA, and USA300 CA-MRSA. Finally, significant antimicrobial resistance was seen in the region with variation in patterns depending on location and clonal type. For a more accurate assessment of MRSA epidemiology and burden, the Arab countries need to implement national surveillance systems.

Vertical transmission of methicillin-resistant Staphylococcus aureus at delivery and its clinical impact: An observational, prospective cohort study.

Methicillin-resistant Staphylococcus aureus (MRSA) infection has a significant clinical impact on both pregnant women and neonates. The aim of this study was to assess accurately the vertical transmission rate of MRSA and its clinical impacts on both pregnant mothers and neonates. We conducted a prospective observational cohort study of 898 pregnant women who were admitted to our department and 905 neonates from August 2016 to December 2017. MRSA was cultured from nasal and vaginal samples taken from the mothers at enrollment and from nasal and umbilical surface swabs taken from neonates at the time of delivery. We examined the vertical transmission rate of MRSA in mother-neonate pairs. We used multivariable logistic regression to identify risk factors for maternal MRSA colonization and maternal/neonatal adverse outcomes associated with maternal MRSA colonization. The prevalence of maternal MRSA colonization was 6.1% (55 of 898) at enrollment. The independent risk factors were multiparity and occupation (healthcare provider) (odds ratio [OR] 2.35, 95% confidence interval [CI] 1.25-4.42 and OR 2.58, 95% CI 1.39-4.79, respectively). The prevalence of neonatal MRSA colonization at birth was 12.7% (7 of 55mother-neonate pairs) in the maternal MRSA-positive group, whereas it was only 0.12% (one of 843 pairs) in the maternal MRSA-negative group (OR 121, 95% CI 14.6-1000). When maternal vaginal samples were MRSA-positive, vertical transmission was observed in four of nine cases (44.4%) in this study. Skin and soft tissue infections developed more frequently in neonates in the maternal MRSA-positive group than in the MRSA-negative group (OR 7.47, 95% CI 2.50-22.3). The prevalence of MRSA in pregnant women was approximately 6%. Vertical transmission caused by maternal vaginal MRSA colonization was observed in four of nine cases (44.4%). Although our study includes a limited number of maternal MRSA positive cases, the vertical transmission of MRSA may occur in up to 44% of neonates of mothers with vaginal MRSA colonization. Maternal MRSA colonization may be associated with increased development of skin and soft tissue infections in neonates via vertical transmission.

Prevalence and clinical relevance of colonization with methicillin-resistant Staphylococcus aureus in the obstetric population

Background and aims Routine screening for Methicillin-Resistant Staphylococcus aureus (MRSA) in pregnant women is common practice in many hospitals. However, little is known on its prevalence and clinical relevance in this population. In this prospective longitudinal study, we aimed to investigate the MRSA prevalence in our obstetric population, the rate of vertical transmission of MRSA and the potential clinical relevance of MRSA colonization for both mother and child. A possible correlation between GBS and MRSA colonization was also investigated. Materials and methods MRSA screening samples were collected at 35–37 weeks of gestation (from mother), at delivery and at discharge (from mother and newborn). All samples were analyzed by conventional microbiological methods and MRSA strains were subjected to spa-typing to investigate genetic similarity. The medical records of all positive mother-child pairs were analyzed to detect the occurrence of clinical infection in the postpartum period. Results 679 mother-child pairs were included between June 2014 and July 2016. Maternal MRSA positivity rate was 1.3% at 35–37 weeks (vaginal/anorectal), 3.1% at delivery (nose/throat) and 3.6% at discharge (nose/throat). MRSA positivity in neonates was 0.3% at delivery and increased to 3% at discharge (nose/umbilicus). Almost all MRSA positive children were born to MRSA positive mothers (OR 120.40, 95% CI: 38.42–377.32). Genetic similarity of the MRSA strains found in mother and child was illustrated for all but one case. 57.7% of the cases of MRSA colonization in our cohort were associated with livestock exposure. 31% of the MRSA positive mothers developed an infectious complication in the postpartum period. No neonatal infectious complications were observed. GBS positivity was not a predictive factor for MRSA colonization in our cohort. Conclusion The rate of MRSA colonization (overall 4.3%) in our obstetric population is similar to that described in the literature and that of the general population admitted to our hospital in the same period. Maternal MRSA colonization appeared to be an important risk factor for neonatal colonization. Whereas mothers were at higher risk of developing infectious morbidity in the postpartum period, no neonatal infectious complications were observed. We observed no correlation between GBS and MRSA colonization.

Modeling Interventions to Reduce the Spread of Multidrug-Resistant Organisms Between Health Care Facilities in a Region

Multidrug-resistant organisms (MDROs) can spread across health care facilities in a region. Because of limited resources, certain interventions can be implemented in only some facilities; thus, decision-makers need to evaluate which interventions may be best to implement. To identify a group of target facilities and assess which MDRO intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. An agent-based model of health care facilities was developed in 2016 to simulate the spread of methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) for 10 years starting in 2010 and to simulate the use of various MDRO interventions for 3 years starting in 2017. All health care facilities (23 hospitals, 5 long-term acute care hospitals, and 74 nursing homes) serving adult inpatients in Orange County, California, were included, and 42 target facilities were identified via network analyses. Increasing contact precaution effectiveness, increasing interfacility communication about patients' MDRO status, and performing decolonization using antiseptic bathing soap and a nasal product in a specific group of target facilities. MRSA and CRE prevalence and number of new carriers (ie, transmission events). Compared with continuing infection control measures used in Orange County as of 2017, increasing contact precaution effectiveness from 40% to 64% in 42 target facilities yielded relative reductions of 0.8% (range, 0.5%-1.1%) in MRSA prevalence and 2.4% (range, 0.8%-4.6%) in CRE prevalence in health care facilities countywide after 3 years, averting 761 new MRSA transmission events (95% CI, 756-765 events) and 166 new CRE transmission events (95% CI, 158-174 events). Increasing interfacility communication of patients' MDRO status to 80% in these target facilities produced no changes in the prevalence or transmission of MRDOs. Implementing decolonization procedures (clearance probability: 39% in hospitals, 27% in long-term acute care facilities, and 3% in nursing homes) yielded a relative reduction of 23.7% (range, 23.5%-23.9%) in MRSA prevalence, averting 3515 new transmission events (95% CI, 3509-3521 events). Increasing the effectiveness of antiseptic bathing soap to 48% yielded a relative reduction of 39.9% (range, 38.5%-41.5%) in CRE prevalence, averting 1435 new transmission events (95% CI, 1427-1442 events). The findings of this study highlight the ways in which modeling can inform design of regional interventions and suggested that decolonization would be the best strategy for the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County.

Prevalence and Molecular Characterization of Enterotoxin- and Antibiotic Resistance-Encoding Genes in the Methicillin-resistant Staphylococcus aureus Recovered From Poultry Meat

Enterotoxigenic methicillin-resistant Staphylococcus aureus (MRSA) is considered as one of the common foodborne pathogens. The existing research was performed to investigate the distribution of enterotoxigenic and antibiotic resistance genes of MRSA bacteria that are isolated from raw poultry meat samples. Two-hundred and sixty poultry meat samples were cultured and MRSA bacteria were recognized using cefoxitin and oxacillin susceptibility test. Antibiotic resistance and enterotoxigenic gene profiles were studied using PCR test. Prevalence of MRSA amongst poultry samples was 5%. Chicken (12%) had the highest prevalence rate, while ostrich (1.66%) had the lowest. Total distribution of sea, seb, sec, sed and see enterotoxin encoding genes were 50%, 25%, 8.33%, 75% and 8.33%, respectively. BlaZ (100%), aacA-D (58.33%), tetK (58.33%), msrA (58.33%) and dfrA1 (50%) were the most regularly detected antibiotic resistance-encoding genes. Concurrent presence of enterotoxins and antibiotic resistance-encoding genes in MRSA bacteria stipulates important public health matters regarding the consumption of contaminated chicken, turkey, quail and ostrich meat.

Ward-level factors associated with methicillin-resistant Staphylococcus aureus acquisition-an electronic medical records study in Singapore.

Methicillin-Resistant Staphylococcus aureus (MRSA) is endemic in hospitals worldwide. Intrahospital transfers may impact MRSA acquisition risk experienced by patients. In this study, we investigated ward characteristics and connectivity that are associated with MRSA acquisition. We analysed electronic medical records on patient transfers and MRSA screening of in-patients at an acute-care tertiary hospital in Singapore to investigate whether ward characteristics and connectivity within a network of in-patient wards were associated with MRSA acquisition rates over a period of four years. Most patient transfers concentrated in a stable core network of wards. Factors associated with increased rate of MRSA acquisition were MRSA prevalence among patients transferred from other wards (rate ratio (RR): 7.74 [95% confidence interval (CI): 3.88, 15.44], additional 5 percentage point), critical care ward (RR: 1.72 [95% CI: 1.09, 2.70]) and presence of MRSA cohorting beds (RR: 1.39 [95% CI: 1.03, 1.90]. Oncology ward (RR: 0.66 [95% CI: 0.46, 0.94]) (compared to medical ward), and median length of stay (RR: 0.70 [95% CI: 0.55, 0.90], additional 1.5 days) were associated with lower acquisition rates. In addition, we found evidence of interaction between MRSA prevalence among patients transferred from other wards and weighted in-degree although the latter was not associated with MRSA acquisition after controlling for confounders. Wards with higher MRSA prevalence among patients transferred from other wards were more likely to have higher MRSA acquisition rate. Its effect further increased in wards receiving greater number of patients. In addition, critical care ward, presence of MRSA cohorting beds, ward specialty, and median length of stay were associated with MRSA acquisition.

Risk of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) acquisition during ambulance transport: A retrospective propensity-score-matched cohort analysis.

To estimate the relative risk (RR) of developing methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE) colonization or infection within 30 days of ambulance transport. We performed a retrospective cohort study of patients with a principal diagnosis of chest pain presenting to our emergency department (ED) over a 4-year period. Patients were included if they presented from and were discharged to nonhealthcare locations without being admitted. Encounters were stratified by arrival mechanism: ambulance versus private vehicle. We performed propensity score matching and multivariable logistic regression to estimate the RR for the primary outcome. In total, 321,229 patients had ED encounters during the study period. After applying inclusion criteria and propensity score matching, there were 11,324 patients: 3,903 in the ambulance group and 7,421 in the unexposed group. Among them, 12 patients (0.11%) had the outcome of interest, including 9 (0.08%) with MRSA and 3 (0.03%) with VRE. The 30-day prevalence of MRSA or VRE was larger in the ambulance group than in the unexposed group: 8 (0.20%) and 4 (0.05%), respectively (P = .02). Patients who presented to the ED via ambulance were almost 4 times more likely to have MRSA or VRE within 30 days of their encounter (RR, 3.72; 95% CI, 1.09-12.71; P = .04). Our cohort study is the first to demonstrate an association between ambulance exposure and pathogen incidence, representing the first step in evaluating medical-transport-associated infection burden to eventually develop interventions to address it.

Differential Analysis of Longitudinal Methicillin-Resistant Staphylococcus aureus Colonization in Relation to Microbial Shifts in the Nasal Microbiome of Neonatal Piglets.

ABSTRACTMethicillin-resistant Staphylococcus aureus (MRSA) is an important human pathogen and often colonizes pigs. To lower the risk of MRSA transmission to humans, a reduction of MRSA prevalence and/or load in pig farms is needed. The nasal microbiome contains commensal species that may protect against MRSA colonization and may be used to develop competitive exclusion strategies. To obtain a comprehensive understanding of the species that compete with MRSA in the developing porcine nasal microbiome, and the moment of MRSA colonization, we analyzed nasal swabs from piglets in two litters. The swabs were taken longitudinally, starting directly after birth until 6 weeks. Both 16S rRNA and tuf gene sequencing data with different phylogenetic resolutions and complementary culture-based and quantitative real-time PCR (qPCR)-based MRSA quantification data were collected. We employed a compositionally aware bioinformatics approach (CoDaSeq + rmcorr) for analysis of longitudinal measurements of the nasal microbiota. The richness and diversity in the developing nasal microbiota increased over time, albeit with a reduction of Firmicutes and Actinobacteria, and an increase of Proteobacteria. Coabundant groups (CAGs) of species showing strong positive and negative correlation with colonization of MRSA and S. aureus were identified. Combining 16S rRNA and tuf gene sequencing provided greater Staphylococcus species resolution, which is necessary to inform strategies with potential protective effects against MRSA colonization in pigs.IMPORTANCE The large reservoir of methicillin-resistant Staphylococcus aureus (MRSA) in pig farms imposes a significant zoonotic risk. An effective strategy to reduce MRSA colonization in pig farms is competitive exclusion whereby MRSA colonization can be reduced by the action of competing bacterial species. We complemented 16S rRNA gene sequencing with Staphylococcus-specific tuf gene sequencing to identify species anticorrelating with MRSA colonization. This approach allowed us to elucidate microbiome dynamics and identify species that are negatively and positively associated with MRSA, potentially suggesting a route for its competitive exclusion.

Staphylococcus aureus nasal colonization among dental health care workers in Northern Germany (StaphDent study)

Methicillin-resistant Staphylococcus aureus (MRSA) can colonize dental patients and students, however, studies on the prevalence of MRSA and methicillin-susceptible S. aureus (MSSA) among dental health care workers (DHCW) including use of personal protective equipment (PPE) are scarce. We conducted an observational study (StaphDent study) to (I) determine the prevalence of MRSA and MSSA colonization in DHCW in the region of Mecklenburg Western-Pomerania, Germany, (II) resolve the S. aureus population structure to gain hints on possible transmission events between co-workers, and (III) clarify use of PPE. Nasal swabs were obtained from dentists (n = 149), dental assistants (n = 297) and other dental practice staff (n = 38). Clonal relatedness of MSSA isolates was investigated using spa typing and, in some cases, whole genome sequencing (WGS). PPE use was assessed by questionnaire. While 22.3% (108/485) of the participants were colonized with MSSA, MRSA was not detected. MSSA prevalence was not associated with size of dental practices, gender, age, or duration of employment. The identified 61 spa types grouped into 17 clonal complexes and four sequence types. Most spa types (n = 47) were identified only once. In ten dental practices one spa type occurred twice. WGS data analysis confirmed a close clonal relationship for 4/10 isolate pairs. PPE was regularly used by most dentists and assistants. To conclude, the failure to recover MRSA from DHCW reflects the low MRSA prevalence in this region. Widespread PPE use suggests adherence to routine hygiene protocols. Compared to other regional HCW MRSA rates the consequent usage of PPE seems to be protective.

A meta-analysis of the global prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolated from clinical and subclinical bovine mastitis.

This meta-analysis aims to assess the point prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolated from bovine mastitis cases at the global level. Several electronic databases were searched for relevant publications (PubMed, EMBASE, Web of Knowledge and Cochrane Library). Heterogeneity between studies was assessed using the Cochrane Q test and I2 test statistics based on the random-effect model. The potential sources of between-study heterogeneity were evaluated using subgroup analysis and meta-regression. Sensitivity and publication bias analyses were performed. Sixty-six studies with a total of 77,644 mastitis cases were eligible and included in the analysis. The overall pooled prevalence of MRSA was 4·30% (95% CI: 3·24-5·50) with a significant heterogeneity (I2 =97·48%, p<0·001). In the subgroup analysis by region, the highest prevalence was found in Asia (6·47%, 95% CI: 4·33-8·97), and the lowest prevalence was reported in Europe (1·18%, 95% CI: 0·18-2·83). The pooled prevalence was significantly higher in clinical mastitis and cases published during 2016-2020. The results of this study suggest that there is a lower prevalence of MRSA in bovine mastitis. However, its prevalence increased in the past 4years. Therefore, continuous surveillance is urgently required for monitoring the dissemination of these clinically important bacteria. To our knowledge, this is the first meta-analysis to estimate the global prevalence of MRSA isolated from bovine mastitis cases.