MRSA Rate Research Articles

Staphylococcus Aureus Carriage among Healthcare Workers in Burn and Surgical Critical Care Units in Menoufia University Hospital, Egypt

Objectives: This study aimed to investigate Staphylococcal aureus (S. aureus) carriage among healthcare workers (HCWs) in Burn and Surgical Critical Care Units in Menoufia University Hospital, Egypt, following an outbreak of S. aureus wound infection in patients. Methods: The study involved 60 HCWs. They were 9 Doctors (15.0%) and 51 nurses and workers (85.0%). Each participant completed a questionnaire that covered demographic data, smoking habits, risk factors of S. aureus colonization and general infection control procedures. To detect S. aureus colonization, both nasal and hand swabs were collected from HCWs. Testing for sensitivity to methicillin was performed by cefoxitin disc diffusion method (30μg). Results: S. aureus was isolated from 53.3% of HCWs and 68.8% of them were colonized with MRSA strains. The overall MRSA carriage rate was 36.7%. MRSA was confined only in Surgical intensive care units (ICUs). MRSA isolates were sensitive to amikacin, chloramphenicol, vancomycin and ceftriaxone. There was no correlation between infection control training, antibiotic intake in the preceding month, duration of work, diabetes mellitus and smoking of HCWs and carriage rate of MRSA (P >0.5). Conclusion: HCWs who had contact with patients were at risk of acquisition and colonization with S. aureus and antimicrobial resistant bacteria especially MRSA . Training of HCWs on hygienic measures especially proper hand hygiene is the key to overcome S. aureus infection in Surgical ICUs and Burn Units. Key wards: S. aureus , MRSA , HCWs, Surgical ICU, Burn, Egypt

Prophylactic Effect of Vancomycin on Infection after Cranioplasty in Methicillin-Resistant Staphylococcus Aureus Carriers with Traumatic Brain Injury.

ObjectiveMethicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase negative staphylococci (MRCNS) are major causes of neurosurgical infection. Nasal colonization of MRSA is the most important risk factor and MRSA screening can be a screening method to identify MRSA and MRCNS colonization. We retrospectively evaluated prophylactic effect of vancomycin on MRSA or MRCNS surgical site infection (SSI) after cranioplasty following decompressive craniectomy (DC) after traumatic brain injury (TBI) in MRSA carriers.MethodsThe study included 21 patients who were positive in MRSA screening before cranioplasty. These patients underwent DC after TBI and subsequent cranioplasty with autologous bone. The patients were separated into SSI group and no SSI group according to the development of SSI due to MRSA or MRCNS after cranioplasty. Mean follow-up period after cranioplasty was 23.5±22.8 months (range, 3 to 73 months). The rate of MRSA or MRCNS SSI and factors including the prophylactic preoperative antibiotics were compared between groups.ResultsThe rate of MRSA or MRCNS SSI was 23.8% (5/21 patients). Mean time from cranioplasty to confirm the SSI was 19.6±10.9 days (6 to 63 days). The rate of MRSA or MRCNS SSI was significantly different from the use of preoperative prophylactic antibiotics (p=0.047). MRSA or MRCNS SSI developed in 1 of 13 patients (7.6%) who received vancomycin and in 4 of 8 patients (50%) who received 3rd generation cephalosporin.ConclusionPreoperative MRSA screening and administration of vancomycin as a preoperative prophylactic antibiotic should be considered in MRSA carriers who are scheduled to cranioplasty to reduce MRSA or MRCNS SSI.

Detection and antibiotic resistance pattern of Staphylococcus aureusand (MRSA) isolated from healthcare workers Nares at three Gaza hospitals, Palestine

Background: Staphylococcus aureus is a significant cause of nosocomial morbidity and mortality and has been identified as an emerging problem in the community. Here we detect the carriage rate and antibiotic resistance pattern of S. aureus and MRSA isolated from 140 healthcare workers (HCWs) nares at Gaza hospitals.Methods: A cross sectional study was conducted on a total of 140 HCWs. S. aureus were recovered and identified from nasal swabs by conventional and molecular laboratory techniques. Susceptibility to 13 commonly used antibiotics against S. aureus infections was determined by disk diffusion test according to the CLSI guidelines. Testing by PCR for the presence of nuc, mecA, cap5 and cap8 genes was performed on all isolates.Results: The nasal carriage rate of S. aureus was 42.1% (59/140), of MRSA was 22.6% (32/140) and of MSSA was 19.3% (27/140), with the highest carriage rate of MRSA among HCWs from surgery wards. There was no significant difference between the gender or hospitals with regard to S. aureus and MRSA carriage rate. However, a statistically significant difference was found for ward type and work experience. All 59 strains of S. aureus were sensitive to vancomycin and doxycycline, while nearly all were resistant to penicillin and ampicillin. The antibiotic resistance among MRSA was much higher than that among MSSA with a statistically significant difference for most antibiotics tested. Nearly 61% of isolates were noted to be multidrug resistant with higher percentage in MRSA (24/32; 75%) in comparison to MSSA (12/27; 44,44%). All isolates were successfully genotyped for capsular polymorphism type 5 (55.9%) and type 8 (44.1%).Conclusion: This is the first study in Gaza Strip investigating the nasal carriage of S. aureus among HCWs. High number of MRSA isolates were shown to be MDR. These results highlight the critical need for screening and tracking MRSA among HCWs and to monitor and manage the usage of antibiotics in the hospitals and community.Â

A correlation between reduced susceptibilities to vancomycin and daptomycin among the MRSA isolates selected in mutant selection window of both vancomycin and daptomycin.

Guidelines for the treatment of MRSA infection, recently published by the IDSA and JSC, recommend daptomycin for sepsis and skin and soft tissue infections comparably to or more strongly than vancomycin. Meanwhile MIC creeping with an increased isolation frequency of MRSA isolates with vancomycin MIC of 2 μg/mL has become a problem. In the present study, the MIC creeping rate of MRSA strains in the Tohoku district, Japan in 2012 was 13%, a significantly higher value than 3.3% in 2008 (P < 0.01). Of these isolates, the MIC and mutant prevention concentration (MPC) values of daptomycin and vancomycin were determined for 30 clinical isolates of MRSA in 2012. The MIC50/MIC80 values of daptomycin and vancomycin were 0.125/0.5 μg/mL and 0.125/1 μg/mL, respectively. The MPC50/MPC80 values of daptomycin and vancomycin were both 32/64 μg/mL. In the present study, the mutant selection window (MSW) of daptomycin and vancomycin was ≥64 MIC. Of strains that selected in the MSW, daptomycin non-susceptible isolates accounted for 70.0%, while MRSA with vancomycin MIC of 2 μg/mL accounted for 26.7%. On the other hand, 50% of the strains that selected in the vancomycin MSW were daptomycin non-susceptible strain. The detection rate of MRSA with vancomycin MIC of 2 μg/mL that selected in the daptomycin MSW was 36.7%. These results showed that MRSA with vancomycin MIC of 2 μg/mL and daptomycin non-susceptible isolates were selected by exposure to both antibiotics. Therefore, though vancomycin is frequently used for treatment of MRSA infection, both antibiotics should be selected as a first-line drug appropriately.

Appropriateness of antibiotics prescribed in patients with bacteremia

Background: Prescribing of appropriate antibiotics is particularly important in patients with bacteremia. The purpose of this work was to evaluate the appropriateness of antibiotic therapy prescribed to patients with bacteremia in our tertiary 300-bed hospital for the period 2010-2012. Methods & Materials: Blood-culture diagnostic was performed in Bactec 9050, BD, USA; positive bottles were investigated through Gram stain (immediately reported to the clinicians) and routinely cultured on blood-, MacConkey-, Sabouraux- agar; for anaerobes – on Schaedler-, for fastidious organisms – on chocolate- agar. Biochemical identification of pathogens was with API, BioMerieux, France, and Crystal, BD. Antimicrobial susceptibility tests were performed by disk diffusion method according to the CLSI, 2010. Empirical antibiotic prescription should be upon the institutional guidelines. An audit was performed to evaluate the appropriateness of antibiotic therapy. Results: Blood-cultures varied from 1700 to 1100 sets/year. Patients with bacteremia accounted for 200/100000 bed-days. The ratio ambulatory-: hospital- cases was 52%: 48%. Secondary bacteremia was more frequent than primary. The most common isolates were S. aureus, E. coli and other Enterobacteriaceae. The rate of MRSA varied from 14% to 40% and of Enterobacteriaceae - ESBL-producers – from 28 to 43%. Analysis of antibiotic prescriptions revealed that for almost half of patients with problematic antibiotic resistant pathogens the prescribed antibiotics were not appropriate. Conclusion: More precisely the risk factors for resistant pathogens should be evaluated to prescribe early appropriate antibiotics; introduction of fast diagnostic and susceptibility testing methods will further improve the prognosis of patients with bacteremia.

Carbapenem Resistant Acinetobacter Baumanii Versus MRSA Isolates in ICU in Clinical Center Skopje

Backgorund: Acinetobacter baumannii is often referred to as the “Gram-negative methicillin-resistant Staphylococcus aureus”, because it is frequently resistant to antibiotics. Clonal outbreaks of carbapenem-resistant and OXA-23–producing A. baumannii have been reported worldwide. Aim: The goal of this study was to promote the phenomenon of disbalance in endemic hospital ECO system which included increase of carbapenemase-resistant Acinetobacter baumanii on account of reduction of MRSA rate in surgical ICU and it’s clonal relatedness as well as the specific precautions. Material nad Methods: Computer database from 1994 – 2012 from surgical ICU patients in the Clinical Center Skopje was used as basic material for this study. Comparative study indicated 2007/8 as a break point period in which almost a twofold decrease of MRSA rates (from over 80% to 45%) versus increased rates of Acinetobacter baumanii (from 29% to 40%) was observed. In 2011 the very first eight strains of carbapenem resistant (resistant to imipenem and meropenem) A. baumannii, were observed. Disc diffusion and VITEK were used for antibiotic susceptibility testing. Resultes: Three distinct strains were detected by PFEGE and were designated as UKIM01AC-1 (5 strains), UKIM01AC-2 (two strains) and 642/2 (one strain). UKIM01AC-1 representatives were PCR positive for bla (OXA-23-like), in addition to the bla (OXA- 51-like) gene which is intrinsic in Acinetobacter baumannii. All isolated strains belonged to European clone II lineage. Conclusion: This clone dispersed very fast in 2012 and achieved the rate of 61.9%. This implicated changes in infection control precautions.

Ceftaroline activity against organisms isolated from respiratory tract infections in USA hospitals: results from the AWARE program, 2009–2011

The Assessing Worldwide Antimicrobial Resistance Evaluation Program monitors the activity of ceftaroline and comparator agents tested against pathogens causing either respiratory or skin and soft tissue infections. A total of 7733 isolates from patients in 80 medical centers across the United States (USA) identified as respiratory tract pathogens by the infection type and/or specimen site recorded by the submitting laboratory during 2009–2011 were evaluated. There were 3360 isolates of Streptococcus pneumoniae, 1799 Haemophilus influenzae, 1087 Staphylococcus aureus, 678 Moraxella catarrhalis, 459 Klebsiella pneumoniae, 223 Escherichia coli, and 127 Klebsiella oxytoca. Annual penicillin resistance among S. pneumoniae ranged from 21.9 to 24.3%. All S. pneumoniae strains were inhibited at a ceftaroline MIC of ≤0.5 μg/mL with 100.0% of isolates categorized as susceptible. Ceftaroline was 16-fold more active than ceftriaxone and 32-fold more active than amoxicillin-clavulanate against penicillin-resistant pneumococci. Only 49.8% of the penicillin-resistant isolates were susceptible to ceftriaxone. There were a total of 1087 S. aureus (48.9% methicillin-resistant S. aureus [MRSA]) isolates, and the yearly MRSA rate ranged from 47.9 to 49.7%. The ceftaroline MIC50/90 for S. aureus was at 0.25/1 μg/mL; 98.2% susceptible and no resistant strains (≥4 μg/mL). Ceftaroline activity against methicillin-susceptible S. aureus (MSSA) isolates (MIC50 and MIC90, 0.25 and 0.25 μg/mL, respectively; 100% susceptible) was 2- to 4-fold greater than for MRSA (MIC50/90, 0.5/1 μg/mL; 96.2% susceptible). The ceftriaxone MIC90 for MSSA was 4 μg/mL. Ceftaroline was active against H. influenzae (MIC50/90 ≤0.015/0.03 μg/mL; 100.0% susceptible) and against M. catarrhalis (MIC50/90, 0.06/0.12 μg/mL). Ceftaroline was active against non–extended spectrum β-lactamase (ESBL) phenotype strains of Enterobacteriaceae but not against ESBL-positive phenotype strains. In summary, ceftaroline was highly active against a large collection of bacterial pathogens isolated from patients with respiratory tract infections in the USA during 2009 through 2011.

Preventing Infections in the ICU

role. Although this is a matter of speculation, errors with the ascertainment of baseline VRE colonization are one possibility. Given the established relationship between antimicrobial exposure and the density of VRE colonization in the gastrointestinal tract, some patients with low levels of VRE may have been misclassified due to a false-negative baseline culture. 7 Compared with rates of MRSA, rates of VRE acquisition were approximately 2-fold higher in both groups, lending additional support to the possibility that some of the VRE “acquisitions” simply reflect false-negative screening tests. The investigators did not measure the effect of gloves and gowns on

Molecular epidemiology of community-associated meticillin-resistant Staphylococcus aureus in Asia

In Asia, most reports on the epidemiology of community-associated meticillin-resistant Staphylococcus aureus (CA-MRSA) are from developed countries, with few data from resource-limited countries, not because of low actual prevalence, but probably because of scarce diagnostic facilities. The rate of MRSA in all community-associated S. aureus infections in Asian countries ranges from 2·5% to 39%. Unlike the predominance of USA300-sequence type (ST) 8 staphylococcal cassette chromosome mec (SCCmec) type IV in the USA, the molecular epidemiology of CA-MRSA in Asia is characterised by clonal heterogeneity, similar to that in Europe. The emergence of CA-MRSA is a threat in both community and hospital settings because such strains are now more prevalent than are health-care-associated MRSA (HA-MRSA) strains. Many epidemic clones are in circulation in Asia and with scarce data available, concern has arisen that CA-MRSA could have devastating results if it becomes epidemic in resource-poor regions. The epidemiology of CA-MRSA in Asia is closely linked with the health of both developing and developed countries. The present situation of CA-MRSA in Asia is important not only for local public health, but also to provide a better understanding of the successful epidemic clones of this global pathogen.

Reduction in community-onset methicillin-resistant Staphylococcus aureus rates in an urban Canadian hospital setting

Community-onset methicillin resistant Staphylococcus aureus (CO-MRSA) became a prominent cause of infection in North America in 2003, with a peak in the epidemic noted by multiple groups in the USA between 2005 and 2007. We reviewed rates of MRSA in two hospitals in Vancouver, Canada, to observe changes in epidemiology from 2003 to 2011. Episodes of emergency department (ED) MRSA bacteraemia and wounds were extracted from the laboratory database, with rates calculated per 10,000 ED visits. All cases were assumed to be community onset, as they were diagnosed in the ED. A peak in ED MRSA bacteraemias occurred in 2005, at 7·8/10,000 ED visits. By 2011, rates of ED bacteraemia declined significantly to 3·3/10,000 ED visits (P<or=0·03). MRSA wound rates peaked at 82·2 cases/10,000 ED visits in 2007 with a subsequent significant decline to 34·3 cases in 2011 (P=0·04). We have demonstrated a significant decline in CO-MRSA within our population, consistent with reports from the USA, suggesting a substantial change in the epidemiology of CO-MRSA in certain North American cities.

Antibiotic prophylaxis for preventing burn wound infection

Infection of burn wounds is a serious problem because it can delay healing, increase scarring and invasive infection may result in the death of the patient. Antibiotic prophylaxis is one of several interventions that may prevent burn wound infection and protect the burned patient from invasive infections. To assess the effects of antibiotic prophylaxis on rates of burn wound infection. In January 2013 we searched the Wounds Group Specialised Register; The Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid MEDLINE - In-Process & Other Non-Indexed Citations (2013); Ovid EMBASE; EBSCO CINAHL and reference lists of relevant articles. There were no restrictions with respect to language, date of publication or study setting. All randomised controlled trials (RCTs) that evaluated the efficacy and safety of antibiotic prophylaxis for the prevention of BWI. Quasi-randomised studies were excluded. Two review authors independently selected studies, assessed the risk of bias, and extracted relevant data. Risk ratio (RR) and mean difference (MD) were estimated for dichotomous data and continuous data, respectively. When sufficient numbers of comparable RCTs were available, trials were pooled in a meta-analysis to estimate the combined effect. This review includes 36 RCTs (2117 participants); twenty six (72%) evaluated topical antibiotics, seven evaluated systemic antibiotics (four of these administered the antibiotic perioperatively and three administered upon hospital admission or during routine treatment), two evaluated prophylaxis with non absorbable antibiotics, and one evaluated local antibiotics administered via the airway.The 11 trials (645 participants) that evaluated topical prophylaxis with silver sulfadiazine were pooled in a meta analysis. There was a statistically significant increase in burn wound infection associated with silver sulfadiazine compared with dressings/skin substitute (OR = 1.87; 95% CI: 1.09 to 3.19, I(2) = 0%). These trials were at high, or unclear, risk of bias. Silver sulfadiazine was also associated with significantly longer length of hospital stay compared with dressings/skin substitute (MD = 2.11 days; 95% CI: 1.93 to 2.28).Systemic antibiotic prophylaxis in non-surgical patients was evaluated in three trials (119 participants) and there was no evidence of an effect on rates of burn wound infection. Systemic antibiotics (trimethoprim-sulfamethoxazole) were associated with a significant reduction in pneumonia (only one trial, 40 participants) (RR = 0.18; 95% CI: 0.05 to 0.72) but not sepsis (two trials 59 participants) (RR = 0.43; 95% CI: 0.12 to 1.61).Perioperative systemic antibiotic prophylaxis had no effect on any of the outcomes of this review.Selective decontamination of the digestive tract with non-absorbable antibiotics had no significant effect on rates of all types of infection (2 trials, 140 participants). Moreover, there was a statistically significant increase in rates of MRSA associated with use of non-absorbable antibiotics plus cefotaxime compared with placebo (RR = 2.22; 95% CI: 1.21 to 4.07).There was no evidence of a difference in mortality or rates of sepsis with local airway antibiotic prophylaxis compared with placebo (only one trial, 30 participants). The conclusions we are able to draw regarding the effects of prophylactic antibiotics in people with burns are limited by the volume and quality of the existing research (largely small numbers of small studies at unclear or high risk of bias for each comparison). The largest volume of evidence suggests that topical silver sulfadiazine is associated with a significant increase in rates of burn wound infection and increased length of hospital stay compared with dressings or skin substitutes; this evidence is at unclear or high risk of bias. Currently the effects of other forms of antibiotic prophylaxis on burn wound infection are unclear. One small study reported a reduction in incidence of pneumonia associated with a specific systematic antibiotic regimen.

Analysis of resistance tendency of bloodstream-infecting pathogens in China

To investigate the resistance profiles and the trend of bloodstream-infecting pathogens isolated from hospitalized patients during 2004-2010. The bloodstream isolates were collected from 18 hospitals in 17 cities. Minimum inhibition concentrations (MIC) were determined using the agar dilution method recommended by CLSI (Clinical and Laboratory Standards Institute), and susceptibility results were analyzed according to the 2011 CLSI guideline. Among the 2004-2005, 2007-2008 and 2009-2010 periods, the proportions of clinical isolates were similar; 43.1% (149 isolates), 34.0% (151 isolates) and 47.5% (776 isolates) for Gram positive strains, 56.9% (197 isolates), 66.0% (293 isolates) and 52.5% (858 isolates) for Gram negative strains, respectively. The isolating rate of MRSA was 54.1% (20/37) in 2007-2008, which was the highest among the 3 periods during 2004 to 2010, while it decreased in 2009-2010 (36.5%, 62/170). The MRCNS proportions were similar across the 3 periods. One (1.8%) vancomycin-resistant Enterococcus faecium and 1 linezolid-resistant Enterococcus faecalis were found. Although the isolating rates of penicillin non-sensitive strains (oral) were similar between 2009-2010 and 2007-2008 [54.5% (6/11) and 53.9% (7/13), respectively], the resistant rates increased from 0% in 2007-2008 to 30.8% (4/13) in 2009-2010. The results were similar according to the non-meningitis criterion (IV), and the susceptibility rates decreased from 100.0% (11 isolates) in 2007-2008 to 84.6% (11/13) in 2009-2010. ESBL-harboring strains in E. coli were similar among the 3 periods during 2004 to 2010 [66.7% (30/45), 73.2% (71/97) and 67.9% (233/343), respectively]. ESBL-producing strains in Klebsilla pnuemoniae decreased year after year, 72.4% (21/29), 50.0% (18/36) and 41.1% (65/158) in 2004-2005, 2007-2008 and 2009-2010, respectively. Except that the sensitive rate of Enterobacter cloacae to ertapenem was 80% (32/40), the sensitive rates of other strains to carbapenems were still above 90% and the resistance rates were less than 5%. Acinetobacter baumannii had the highest multi-drug resistance rate (81.8%, 81/99). One strain (1.0%, 1/99) of Acinetobacter baumannii isolated in 2009-2010 was reported to be pan-resistant. We are facing a more serious situation of bacterial resistance. Acinetobacter baumannii resistance was most serious, usually with the characteristics of multiple drug resistance, and even pan-resistance. Carbapenems remain to be the most effective against enterobacteriaceae. Strains resistant to novel antibiotics (linezolid and tigecycline) have emerged.

Anti-MRSA drug use and antibiotic susceptibilities of MRSA at a university hospital in Japan from 2007 to 2011

The purpose of this study is to examine the use of anti-methicillin-resistant Staphylococcus aureus (MRSA) drugs, such as vancomycin (VCM), teicoplanin (TEIC), arbekasin (ABK) and linezolid (LZD), and the antibiotic susceptibilities of MRSAs in Kobe University Hospital. We investigated MRSA isolation and use of anti-MRSA drugs and susceptibilities of MRSA, using linear regression analysis, from 2007 to 2011, and checked for correlation between the use of these drug and the antibiotic susceptibilities of MRSA. The overall monthly isolation rates of MRSA decreased from a mean of 84.8% in 2007 to 70.0% in 2011 (r=0.946, P=0.015, b=-0.220), and the monthly isolation rate of MRSA in inpatients decreased from a mean of 78.6% in 2007 to 57.7% in 2011 (r=0.952, P=0.012, b=-0.160). From 2007 to 2011, VCM consumption significantly increased (r=0.916, P=0.029, b=0.055), whereas TEIC and LZD use remained stable during the study period. In addition, ABK use significantly decreased from 23.8 defined daily dose (DDD) per 1000 patient-days in 2007 to 5.2 DDD per 1000 in 2011 (r=0.902, P=0.036, b=-0.216). Susceptibility rates of MRSA were almost 100% to TEIC and VCM. The rates of MRSA to ABK and LZD significantly increased (r=0.959, P=0.010, b=2.137 for ABK and r=0.933, P=0.020, b=3.111 for LZD). In conclusion, our findings indicated a decreased MRSA isolation rate and the effective use of anti-MRSA drugs (VCM, TEIC, ABK and LZD), and improved susceptibility rates to anti-MRSA drugs, suggesting the possibilities that appropriate and early use of anti-MRSA drugs may cause the decrease of MRSA isolation.

Cost comparison of MRSA screening and management – a decision tree analysis

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) infections represent a serious challenge for health-care institutions. Rapid and precise identification of MRSA carriers can help to reduce both nosocomial transmissions and unnecessary isolations and associated costs. The practical details of MRSA screenings (who, how, when and where to screen) remain a controversial issue.MethodsAim of this study was to determine which MRSA screening and management strategy causes the lowest expected cost for a hospital. For this cost analysis a decision analytic cost model was developed, primary based on data from peer-reviewed literature. Single and multiplex sensitivity analyses of the parameters “costs per MRSA case per day”, “costs for pre-emptive isolation per day”, “MRSA rate of transmission not in isolation per day” and “MRSA prevalence” were conducted.ResultsThe omission of MRSA screening was identified as the alternative with the highest risk for the hospital. Universal MRSA screening strategies are by far more cost-intensive than targeted screening approaches. Culture confirmation of positive PCR results in combination with pre-emptive isolation generates the lowest costs for a hospital. This strategy minimizes the chance of false-positive results as well as the possibility of MRSA cross transmissions and therefore contains the costs for the hospital. These results were confirmed by multiplex and single sensitivity analyses. Single sensitivity analyses have shown that the parameters “MRSA prevalence” and the “rate of MRSA of transmission per day of non-isolated patients” exert the greatest influence on the choice of the favorite screening strategy.ConclusionsIt was shown that universal MRSA screening strategies are far more cost-intensive than the targeted screening approaches. In addition, it was demonstrated that all targeted screening strategies produce lower costs than not performing a screening at all.

War on mrsa

Progress in reducing rates of MRSA and healthcare-acquired infections is being put at risk by the lack of a centrally funded campaign promoting hand hygiene, according to patient champion Ashley Brooks. However, healthcare professionals emphasise the need for a multifactorial approach to infection control and the Department of Health denies momentum is being lost.

Cost-analysis of PCR-guided pre-emptive antibiotic treatment of Staphylococcus aureus infections: an analytic decision model

The aim of this study is to examine whether rapid polymerase chain reaction (PCR)-based screening is a cost-efficient tool to optimize pre-emptive antibiotic therapy of methicillin-resistant and methicillin-sensitive Staphylococcus aureus (MRSA and MSSA, respectively) infections. A decision analytic cost model was developed, based on data from the peer-reviewed literature. Sensitivity analyses were undertaken to investigate the impact of variation in the MRSA rate, cost ratio of the cost of inappropriate antibiotic therapy to the cost of appropriate antibiotic therapy, PCR test cost, and total hospital costs per case. At a current MRSA rate of 24.5% in Germany, PCR-guided treatment regimens are cost-efficient compared to empirical strategies. The costs of alternative treatment strategies differ, on average, up to 1,780 <euro> per case. An empirical MRSA treatment strategy is least costly when the cost ratio is less than 1.06. When the total hospital cost per MRSA case is increased, pre-emptive MSSA treatment with PCR tests achieves the lowest average cost. Early verification and adaptation of an initial pre-emptive antibiotic treatment of S. aureus infections using PCR-based tests are advantageous in Germany and other European countries. PCR tests, accordingly, should be considered as elements in antimicrobial stewardship programs.

Clindamycin resistance among Staphylococcus aureus causing skin and ear infections from Chennai, South India

Background Antibiotic resistance in S. aureus is one of the major concerns and the rate of MRSA has dramatically increased in recent years. Clindamycin belongs to the MLS group and is used to treat skin and soft tissue infections. Resistance to clindamycin may be inducible (iMLSB) or constitutive (cMLSB) and it is present both in MRSA and MSSA. Treatment failure has been reported both in iMLSB and cMLSB cases. Knowledge on clindamycin resistance is important for its proper use. Hence, the present study was done to detect clindamycin resistance among S. aureus causing skin and ear infections.

Susceptibility to Tigecycline and Linezolid Among Gram-Positive Isolates Collected in the United States as Part of the Tigecycline Evaluation and Surveillance Trial (TEST) Between 2004 and 2009

Background The Tigecycline Evaluation and Surveillance Trial (TEST) was initiated in 2004 to chart the activity of tigecycline and comparator antimicrobial agents against gram-positive and gram-negative organisms globally. Objectives This study aimed to provide an analysis of the antimicrobial susceptibility of gram-positive organisms collected from the 9 census regions of the United States between 2004 and 2009. Methods The MICs and antimicrobial susceptibility were determined using Clinical and Laboratory Standards Institute methodology. For tigecycline, US Food and Drug Administration susceptibility criteria were used. Results A total of 8782 Staphylococcus aureus isolates (54.5% methicillin-resistant S aureus) were collected, with the highest percentage of MRSA isolates collected from the South Central region (67.9%). All S aureus isolates were susceptible to tigecycline, linezolid, and vancomycin. Overall, 4.6% of Enterococcus faecalis (n = 3753) and 69.1% of Enterococcus faecium (n = 1417) isolates were vancomycin resistant, with the highest rates in the East North Central region for E faecalis (7.1%) and the South Atlantic region for E faecium (79.5%). Small numbers of linezolid nonsusceptible E faecalis (n = 13) were identified. MIC 90 values for tigecycline were ≤0.25 mg/L against E faecalis and 0.12 mg/L against E faecium. Of the Streptococcus pneumoniae isolates collected (n = 4541), 1.1% were penicillin resistant. All S pneumoniae isolates were susceptible to linezolid and vancomycin; susceptibility to tigecycline varied between 80.9% (Pacific region) and 95.2% (West North Central region). Conclusions The rates of MRSA and vancomycin-resistant Enterococcus spp varied among the 9 census regions; however, susceptibility to linezolid, vancomycin, and tigecycline remained consistent, with low MIC 90 values and high rates of antimicrobial susceptibility.

MRSA admission screening in a low prevalence setting - much ado about nothing?

To prospectively evaluate new guidelines for MRSA admission screening and pre-emptive isolation implemented in response to a doubling of newly diagnosed MRSA patients in 2007. One-year surveillance (04/2008-03/2009). Patients admitted to the tertiary-care hospital in St. Gallen (700 beds) and 10 affiliated public hospitals (890 beds) in Eastern Switzerland (MRSA rate 2.5% in isolates). Except for known MRSA carriers, all patients who underwent admission screening in accordance with the guidelines and all MRSA patients newly detected by a clinical sample were included. Depending on epidemiological factors (stay in a foreign hospital, a Swiss hospital with known high MRSA prevalence, or a chronic care facility) and personal risk factors (wound, tracheostoma, urinary catheter, IVDU), patients were risk stratified into screening and isolation, only screening or no screening at all. MRSA admission screening included nasal, throat and axillary/inguinal swabs, supplemented by wound swabs, urine and respiratory secretion whenever appropriate (conventional culture). A total of 6/161 (3.7%) MRSA admission screenings yielded positive results (number needed to screen: 27). 2/32 (6.3%) pre-emptively isolated patients were positive (number needed to isolate: 16). Only 6/27 (22.2%) newly diagnosed MRSA patients were detected by admission screening, and the remaining patients were detected by clinical sample during hospitalisation. A total of 80% of the MRSA positive patients had wounds. Swabs of axilla/inguina did not increase the sensitivity of the admission screening. In the setting of low MRSA prevalence, admission screening of patients at high risk for MRSA carriage detected only one out of five newly diagnosed MRSA patients, emphasising the importance of standard precautions for the prevention of MRSA transmission.

Trends in the occurrence of MRSA strains in Upper Austria from 2006 to 2009

Between 2006 and 2009, all MRSA isolates recovered from human patients in Upper Austria were subjected to molecular biological analysis. Whereas the isolate number decreased from year to year, the proportion of the most common sequence types (ST5, ST8 and ST22) as well as the frequency of associated PFGE subtypes and spa-types remained similar. The rate of PVL-positive MRSA increased, whereupon the most common sequence types were ST152, ST8 including clone USA300, ST5, ST777 and ST88. The frequency of ST398 was high (25%) in relation to the PVL-positive clones. Thus, we consider a special focus on community-associated MRSA to be necessary.