Staphylococcus Aureus Carriage Research Articles

(163) VIABILITY OF TARGETED SCREENING FOR STAPHYLOCOCCUS AUREUS AND MRSA AS A SUBSTITUTE FOR UNIVERSAL PREOPERATIVE INFLATABLE PENILE PROSTHESIS NASAL SCREENING

Abstract Introduction Staphylococcus aureus (SA) and Methicillin-resistant Staphylococcus aureus (MRSA) are significant and preventable sources of inflatable penile prosthesis (IPP) infection. SA and MRSA nasal carriers have increased risk of healthcare-related infections. Screening and prompt decolonization for nasal carriers of SA in the hospital setting has been shown to reduce postoperative SA hospital-associated surgical-site infections. Objective We determined if known epidemiologic risk factors for SA and MRSA were prevalent in our IPP patients who tested positive for SA or MRSA at their preoperative visit. Our hypothesis was that these determinants would help identify at-risk patients to better target preoperative SA and MRSA screening in the future. Methods This is a retrospective IRB-approved analysis of 62 asymptomatic patients who screened positive for either SA (n = 56) or MRSA (n = 6) via nasal culture prior to undergoing IPP placement at two hospitals in our practice. These two groups were evaluated separately to compare the presence of risk factors present for SA and MRSA prior to nasal screening. Known risk factors for SA include: intravenous drug use, diabetes, recent hospitalization within 30 days, immunocompromised status, healthcare employment, hemodialysis, HIV positive status, and prior prosthetic implant placement. Known risk factors for MRSA patients include: intravenous drug use, living in a correctional facility, residential home, or shelter, occupation as a veterinarian, recent influenza-like illness and/or severe pneumonia, concurrent skin/soft tissue infection, and history of MRSA. We examined the presence of these risk factors in patients who screened positive for nasal colonization to determine if they could have undergone targeted nasal screening. Results Our data are shown in Table 1. We found that the most common indicator for SA colonization in our population was diabetes in 16 of 56 patients (28.6%). We found the most common MRSA-specific risk factor was a history of MRSA in 1 of 6 patients (16.7%). No patient in this prescreened and pretreated cohort subsequently had IPP infection. Conclusions No known risk factor for SA and MRSA colonization was found to be widely prevalent in our SA and MRSA patient cohorts. Targeting screening based on known epidemiologic risk factors for SA and MRSA would not have been a useful substitute for universal preoperative nasal screening in our population. Universal preoperative nasal SA and MRSA screening and treatment may be a useful tool to potentially diminish postoperative IPP surgical-site infections. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, MenMD.

Association of Staphylococcus aureus Bacterial Load and Colonization Sites With the Risk of Postoperative S. aureus Infection.

The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study. Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery. SA carriers and noncarriers were enrolled in a prospective cohort study in a 2:1 ratio. Weighted multivariable Cox proportional hazard models were used to assess the independent associations between different measures of SA carriage and occurrence of SA SSI/BSI within 90 days after surgery. We enrolled 5004 patients in the study cohort; 3369 (67.3%) were SA carriers. 100 SA SSI/BSI events occurred during follow-up, and 86 (86%) of these events occurred in SA carriers. The number of colonized bodily sites (adjusted hazard ratio [aHR], 3.5-8.5) and an increasing SA bacterial load in the nose (aHR, 1.8-3.4) were associated with increased SA SSI/BSI risk. However, extranasal-only carriage was not independently associated with SA SSI/BSI (aHR, 1.5; 95% CI, 0.9-2.5). Nasal SA carriage was associated with an increased risk of SA SSI/BSI and accounted for the majority of SA infections. Higher bacterial load, as well as SA colonization at multiple bodily sites, further increased this risk.

Heterogeneity in Pre-operative Staphylococcus aureus Screening and Decolonization Strategies among Healthcare Institutions

Background: Staphylococcus aureus (SA) is the most common pathogen causing surgical site infections (SSIs). In the past decade, strategies incorporating new SA decolonization products have been implemented to prevent SSIs in surgical patients. The objective of this cross-sectional study was to determine which pre-operative screening and decolonization strategies are currently utilized in healthcare institutions. Methods: A survey was programmed in REDCap and emailed to members of the Society for Healthcare Epidemiology of America Research Network, the Minnesota chapter of the Association of Practitioners in Infection Control and Epidemiology, and the Minnesota Hospital Association between May-August 2023. We report the prevalence of institutional screening and decolonization strategies and decolonization products used for the prevention of SA SSIs. Results: A total of 153 unique institutions initiated the survey and 111 provided complete data on their institutional screening and decolonization strategies. The most commonly reported strategies included universal decolonization (decolonization of pre-operative patients without screening for carrier status) (n=31, 27.9%), no screening or decolonization (n=24, 21.6%), targeted screening for methicillin-sensitive Staphylococcus aureus (MSSA) or methicillin-resistant Staphylococcus aureus (MRSA) and decolonization based on carrier status (n=24, 21.6%), or MRSA only screening and decolonization (n=11, 9.9%) (Figure 1). Institutions that utilized targeted screening and decolonization strategies frequently reported using nasal mupirocin (n=18, 66.7%MSSA, n=29, 60.4%MRSA), chlorhexidine gluconate (CHG) bathing (n=16, 59.3%MSSA, n=28, 58.3%MRSA), and CHG cloths (n=7, 25.9%MSSA, n=14, 29.2%MRSA) (Figure 2). Among the 31 institutions that reported implementing the universal decolonization strategy, CHG bathing (n=18, 58.1%), CHG cloths (n=15, 48.4%), and nasal povidone iodine (n=14, 45.2%) were the most prevalent decolonization products. Additionally, a smaller percentage of institutions used nasal alcohol gel (n=5, 16.1%) for universal decolonization. Conclusion: Compared to the survey we conducted in 2012, we report a new shift towards universal decolonization and a small increase in targeted SA screening and decolonization.1 In the 2012 survey we reported 37% of respondents’ institutions screened pre-operative patients for SA carriage and the majority of those institutions decolonized carriers.1 Universal decolonization was not reported in the 2012 survey.1 We highlight the continued heterogeneity in practice at this time, which may reflect the ongoing uncertainty in optimal decolonization practices and emphasizes the need for future research.

Nasal MRSA carriage is a risk factor for development of antibiotic resistance in diabetic foot ulcers and is significantly higher than diabetic and non-diabetic individuals without foot ulcer

BackgroundDiabetic foot ulcer (DFU) is a major complication of diabetes often impacted by polymicrobial infection in the wound site. Diabetic patients are immunocompromised in nature and hence vulnerable to infection once the skin barrier is breached. Microbiological culture-based methods show that Staphylococcus aureus (SA) is the most frequently isolated bacteria from the DFU wounds. SA and its most clinically important antibiotic resistant variant methicillin-resistant S. aureus (MRSA) are commonly found in the nasal vestibule and colonization of SA as well as MRSA in any wound site can aggravate the condition. We hypothesize that the presence of nasal MRSA carriage can serve as a potential risk factor contributing to the emergence of antibiotic resistance in diabetic foot ulcer wounds.MethodsIn the present study, we have compared the carriage of SA and MRSA in nasal cavity and foot skin among DFU patients (D+F+, n = 50), diabetic patients without any ulcer (D+F-, n = 50), and healthy controls (D-F-, n = 40) by using bacterial culture and PCR based methods. The D+F+, D+F- and D-F-individuals were further categorized based on the presence or absence of MRSA and clinical parameters were compared between MRSA+ ve and MRSA-ve individuals in each of the three groups mentioned above.ResultsOur results show that, (a) nasal MRSA carriage is significantly higher (p < 0.05) in D+F+ group than the D+F- and D-F- and significantly associated with wound MRSA carriage in D+ F+ individuals (O.R. = 4.09; 95% C.I. = 1.12–15.05) and (b) the HbA1C level is significantly higher (p < 0.02) in wound MRSA positive, compared to MRSA negative D+F+ patients. Interestingly more than half of the MRSA (64%) isolated from DFU wound were identified to be multidrug resistant.ConclusionThese findings strongly suggest that nasal MRSA carriage can act as a risk factor for development of antibiotic resistance in diabetic foot ulcers and it is therefore important to screen nasal and wound sites of these patients regularly. We have also developed a rapid multiplex PCR assay to detect MRSA from clinical isolates or microbial DNA isolated from clinical samples in the hospital settings.

Tunneled hemodialysis central venous catheters prevalence and bloodstream infection rates in Northern Italy: A survey of the "East Lombardy Nephrological Network".

Tunneled central venous catheter (tCVCs) is a vascular access frequently employed in hemodialysis patients. Catheter-related bloodstream infections (CRBSI) are potentially life-threatening complications. We performed a retrospective survey regarding tCVCs prevalence as well as the CRBSI incidence and management within five hospitals in the Brescia province belonging to the "East Lombardy Nephrological Network"; this study was based upon 18 queries regarding the years 2020 and 2021. The data collected refer to an overall hemodialysis population of 736 patients in 2020 and 745 patients in 2021. The prevalence of tCVCs was respectively 22.1% and 24.2% with the initial placement being performed with fluoroscopy support in 80% of the centers. CRBSI incidence was respectively 0.88 and 0.77 episodes per 1000 days of tCVC use. When the CRBI was caused by Staphylococcus Aureus (SA) or Pseudomonas, differently from the recommendation of the KDOQI guidelines, the removal or the substitution of the tCVC did not occur immediately at the time of the diagnosis of the infection but only when the specific antibiotic therapy failed. A nose swab aimed at identifying SA carriers was performed in 60% of centers. The policy regarding the referral to other specialists (infectious disease specialist and microbiologist) was heterogenous across the centers according to their specific logistics. This retrospective survey performed by the "East Lombardy Nephrological Network" within the Brescia province describes the prevalence of tCVCs use as well as the incidence and management of CRBSIs in the hemodialysis patients of this area. The clinical impact of the differences in terms of clinical approach detected compared to the KDOQI guidelines will need to be clarified ideally in prospective studies.

Impact of Long-Term Azithromycin Therapy on Carriage and Resistance of Respiratory Bacteria Among Children with HIV-Associated Chronic Lung Disease: A Randomised Controlled Trial

Background: Long-term azithromycin (AZM) therapy is increasingly used to prevent acute exacerbations of chronic lung diseases (CLD). However, selection for resistance to macrolides and other antibiotics remains a concern. We investigated the impact of 48 weeks of AZM therapy on the carriage and antibiotic resistance of common respiratory bacteria in children and adolescents with HIV-associated CLD. Methods: Nasopharyngeal (NP) swabs and sputa were collected at baseline, 48 and 72 weeks from children and adolescents with HIV-associated CLD randomised to receive weekly AZM or placebo for 48 weeks and followed post-intervention up to 72 weeks. The primary outcomes were the prevalence of Streptococcus pneumoniae (SP), Staphylococcus aureus (SA), Haemophilus influenzae (HI), and Moraxella catarrhalis (MC) and their antibiotic resistance between the trial arms at 48 and 72 weeks. Mixed-effects logistic regression and Fisher's exact test were used to compare carriage and resistance, respectively. Findings: Between June 2016, and September 2018, 347 participants (174 AZM, 173 placebo arm) were enrolled (median age, 15 years [IQR = 13–18], females, 49%). NP carriage was significantly lower in the AZM compared to placebo arm at 48 weeks for SP (18% [29/159] vs 41% [64/153], adjusted odds ratio (aOR) 0·2 [95% CI 0·1–0·4]), HI (7% [11/159] vs 16% [24/153], aOR 0·3 [0·1–0·8]), or MC (4% [7/159] vs 11% [17/153], aOR 0·3 [0·1–0·8]). SP resistance to AZM (62% [18/29] vs 13% [8/63], p <0·0001) or tetracycline (60% [18/29] vs 21% [13/63], p <0·0001) were higher in the AZM arm at 48 weeks. Although, carriage of SA did not differ between the two arms, carriage of SA resistant to AZM (NP= 91% [31/34] vs 3% [1/31], p <0·0001), tetracycline (NP= 35% [12/34] vs 13% [4/31], p = 0·05) or clindamycin (NP= 79% [27/34] vs 3% [1/31], p <0·0001) was significantly higher in the AZM arm at 48 weeks and persisted at 72 weeks. The above observations were mirrored in sputum samples. Interpretation: Long-term AZM reduced carriage of SP, HI and MC but promoted antibiotic resistance in SP and SA; antibiotic-resistant SA persisted at 72 weeks from randomisation. This risk of drug resistance should be taken into account when long-term AZM therapy is being considered. Trial Registration: The trial registration number is ClinicalTrials.gov Identifier: NCT02426112 Funding: The Global Health and Vaccination Research (GLOBVAC) Programme of the Medical Research Council of Norway Declaration of Interest: None declared. Ethical Approval: Approval for the main trial was obtained from local regulatory bodies at the study sites and the research ethics committees of the London School of Hygiene and Tropical Medicine, the University of Cape Town, and the Medical and Health Research in Norway. This sub-study was approved by the Human Research Ethics Committee of the University of Cape Town (HREC/REF: 092/2019).

Exposure to Environmental Chemical Mixtures is Associated with Nasal Colonization by Staphylococcus aureus: NHANES 2001-2004

Background: Understanding the health effects of exposure to chemical mixtures is critical given the broad range of concurrent exposures throughout the life-course. While investigations of environmental chemicals and components of the human microbiome are becoming more common, few have examined associations with chemical mixtures. This study assesses the association between exposure to mixtures of 66 different environmental chemicals and nasal colonization of Staphylococcus aureus (SA) and methicillin resistant SA (MRSA).Methods: Data came from the National Health and Nutrition Examination Survey (NHANES) 2001-2004. The analytical sample consists of 10,312 participants, subdivided into 8 different chemical mixture groups. Within each of 6 chemical classes (metals, phthalates, polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), polyfluorochemicals (PFCs), and phenols), weighted quantile sum (WQS) regression was used to analyze the joint association of the component compounds and nasal SA colonization. WQS was also used to assess the joint association of 3 chemical mixtures (metals, metal and PAHs, and metal and triclosan) and nasal MRSA colonization. All regression models were adjusted for confounders.Results: The analytical sample was between ages 6-85, slightly more female, and predominantly non-smokers. Prevalence of SA carriage was 29.2%, and MRSA colonization prevalence was 1.2%. Within each chemical class, odds of SA colonization increased significantly with exposure to mixtures of metals (OR = 1.11, 95% CI = 1.02-1.20), phthalates (OR = 1.09, 95% CI = 1.04-1.14), and phenols (OR = 1.08, 95% CI = 1.01-1.15). Exposure to a mixture of metals combined with PAHs was also associated with increased odds of MRSA carriage (OR=1.38, 95% CI = 1.02-1.86).Conclusion: Results indicate an association between multiple environmental chemical mixtures and SA colonization, including MRSA. These findings support the need for further analysis of associations between chemical mixtures and SA colonization, as well as other components of the human microbiome.

Genetic diversity of Staphylococcus aureus influences disease phenotype of systemic lupus erythematosus.

We investigated the genetic diversity, molecular epidemiology and evolutionary dynamics of Staphylococcus aureus (SA) isolated from SLE patients by means of phylogenetic analysis. Consecutive SLE patients (ACR 1997 criteria) were enrolled: clinical/laboratory data were collected and nasal swab for SA identification was performed. On the basis of the translation elongation factor (tuf) gene, a phylogenetic analysis was performed to investigate relationships and to assess significant clades. Selective pressure analysis was used to investigate the evolution of the SA tuf gene. The gene sequences from non-SLE individuals, downloaded from the GenBank database, were compared through phylogenetic analysis with the tuf gene from SLE patients. We enrolled 118 patients [M/F 10/108; median (interquartile range (IQR)) age 45.5 (13.2) years; median (IQR) disease duration 120 (144) months]. Twenty-four patients (20.3%) were SA carriers (SA+), three of them MRSA. SA+ SLE showed significantly higher SLEDAI-2k values [SA+: median (IQR) 2 (3.75); SA-: 0 (2); P = 0.04]. The phylogenetic analysis, restricted to 21 non-MRSA SA+, revealed a statistically supported larger clade (A, n = 17) and a smaller one (B, n = 4). Patients located in clade A showed a significantly higher prevalence of joint involvement (88.2%) in comparison with clade B (50.0%, P < 0.0001) and SA- (62.7%, P < 0.0001). Haematological manifestations were significantly more frequent in clade A (64.7%) compared with B (50.0%, P = 0.004). We suggest a possible role of SA nasal carriage status in SLE disease activity. Moreover, our findings support the hypothesis that bacterial genetic variants may be associated with specific disease features.

Exposure to environmental chemical mixtures is associated with nasal colonization by Staphylococcus aureus: NHANES 2001–2004

BackgroundUnderstanding the health effects of exposure to chemical mixtures is critically important given the broad range of concurrent exposures throughout the life-course. While investigations of environmental chemicals and components of the human microbiome are becoming more common, few have examined associations with chemical mixtures. This study assesses the association between exposure to mixtures of 66 different environmental chemicals and nasal colonization of Staphylococcus aureus (SA) and methicillin resistant SA (MRSA). MethodsData came from the National Health and Nutrition Examination Survey (NHANES) 2001–2004. The analytical sample consists of 10,312 participants, age 6 years and older, subdivided into 8 groups with different chemical exposure mixtures. Within each of 6 chemical classes (metals, phthalates, polycyclic aromatic hydrocarbons (PAHs), polybrominated diphenyl ethers (PBDEs), polyfluorochemicals (PFCs), and phenols), weighted quantile sum (WQS) regression was used to analyze the joint association of the component compounds and nasal SA colonization. WQS was also used to assess the joint association of 3 chemical mixtures (metals, metal and PAHs, and metal and triclosan) and nasal MRSA colonization. All regression models were adjusted for confounders. ResultsThe analytical sample was between ages 6–85, slightly more female, and predominantly non-smokers. Prevalence of SA carriage was 29.2%, and MRSA colonization prevalence was 1.2%. Within each chemical class, odds of SA colonization increased statistically significantly with exposure to mixtures of metals (OR = 1.11, 95% CI = 1.02–1.20), phthalates (OR = 1.09, 95% CI = 1.04–1.14), and phenols (OR = 1.08, 95% CI = 1.01–1.15). Exposure to a mixture of metals combined with PAHs was also associated with increased odds of MRSA carriage (OR = 1.38, 95% CI = 1.02–1.86). ConclusionResults indicate an association between multiple environmental chemical mixtures and SA colonization, including MRSA. These findings support the need for further analysis of associations between chemical mixtures and SA colonization, as well as other components of the human microbiome.

Individual decontamination measures reduce by two the incidence of surgical site infections in spinal surgery

BackgroundIn spinal surgery, incidence of surgical site infections (SSI) is estimated between 1 and 10%. It results in increased morbidity, mortality and cost of management. Individual Staphylococcus aureus (SA) decolonization has already proved efficiency to prevent those events in various surgical domains. The aim of this study was to evaluate a strategy of prevention of SSI and in particular the decolonization of the nasal carriage of SA by a protocol with Mupirocin application. MethodsWe conducted a bicentric observational study on 5314 spinal surgery patients over a seven-year period. In both center, we compared periods before and after implementation of two measures: modification of antibioprophylaxis and staphylococcus decolonization. Homogeneity of the different samples of patients was assessed through measure of individual and surgical variables. We measured monthly incidence of SSI and evaluated its evolution in order to assess efficiency of these interventions. ResultsThe incidence of SSI decreased by half, from 7.3% to 3% at the Beaujon Hospital and from 8.3% to 3.9% at the Georges-Pompidou European Hospital (GPEH). We do not observe any significant decrease of SA rate in these SSI. ConclusionWe believe that Staphylococcus aureus decolonization should be recommended in spinal surgery, and should be combined with an overall improvement of the quality of care.

Nasal Colonization by Staphylococci and Severity of Atopic Dermatitis.

Skin colonization by Staphylococcus aureus (SA) correlates with increased severity of atopic dermatitis (AD). The role of nasal SA carriage and coagulase-negative staphylococci (CNSs) in AD is unclear. The aim of this study was to assess the influence of colonization of lesional/nonlesional skin and the anterior nares by SA and CNSs on AD severity in 63 adult patients. Disease severity was assessed with SCORAD index. The total immunoglobulin E (IgE) concentration was determined using the enzyme-linked immunosorbent assay method. The prevalence and abundance of staphylococci were assessed with the combination of bacterial culture and mass spectrometry. The prevalence values of SA within the skin (lesional/nonlesional) and anterior nares were 79.4%/61.9% and 69.8%, respectively (vs 5.6% and 13.9%, respectively in controls, P < 0.0001). The carriage of CNSs in all niches was associated with lower mean IgE concentration (1164.66 ± 1010.36 vs 1762.99 ± 1059.15, P < 0.0213; 1166.9 ± 1006.4 vs 2152.7 ± 759.2, P < 0.0063; 1022 ± 1100 vs 1925 ± 880.8, P < 0.0044, respectively). The abundance of SA correlated with the extent of skin lesions and total IgE (ρ = 0.42, P = 0.0007; ρ = 0.488, P < 0.0001; ρ = 0.312, P < 0.2; and ρ = 0.402, P = 0.0007; ρ = 0.403, P < 0.002; ρ = 0.287, P < 0.03, respectively). Atopic dermatitis severity correlates with both cutaneous and nasal colonization by SA. Staphylococcus aureus seems to promote TH2-type response, whereas CNS probably limits this process. Preventive measures within the anterior nares should be considered for AD patients.

A two-part phase 1 study to establish and compare the safety and local tolerability of two nasal formulations of XF-73 for decolonisation of Staphylococcus aureus: A previously investigated 0.5 mg/g viscosified gel formulation versus a modified formulation

ObjectivesSuccessful decolonisation of nasal Staphylococcus aureus (SA) carriage by mupirocin is limited by increasing drug resistance. This randomised, open-label, phase 1 study compared the safety and local tolerability of two nasal formulations of XF-73, a novel porphyrinic antibacterial with rapid intrinsic activity against SA. MethodsThe study was performed in 60 healthy adults. In Part 1, eight non-SA carriers were randomised to groups of four subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel or 2.0mg/g 2% gel. In Part 2, 52 persistent SA carriers were randomised to groups of 13 subjects each and were treated with XF-73 concentrations of 0.5mg/g 2% gel, 2.0mg/g 2% gel, 0.5mg/g 4% gel or 4% viscosified placebo gel. Plasma pharmacokinetic and pharmacodynamic studies were performed. Antistaphylococcal activity was assessed as the presence/absence of SA and by quantification of colonisation using a semiquantitative scale (SA score). Results56 subjects (8/8 from Part 1 and 48/52 from Part 2) completed the study, with 47/60 comprising the pharmacokinetic population and 48/60 the pharmacodynamic population. There was no measurable systemic absorption of XF-73. XF-73 treatment was associated with rapid reduction in SA score in all subjects. The most common treatment-emergent adverse events (TEAEs) were rhinorrhoea and nasal dryness (15.5% each in Parts 1 and 2). TEAEs were mild and resolved spontaneously. ConclusionXF-73 was well tolerated with minimal side effects at doses of 0.5mg/g 2% gel and 2.0mg/g 2% gel. These findings support further development of XF-73.

No evident association of nasal carriage of Staphylococcus aureus or its small-colony variants with cotrimoxazole use or ANCA-associated vasculitis relapses.

To identify the role of Staphylococcus aureus (SA) or its intracellular small-colony variant phenotype (SCV) with co-trimoxazole (CTX) or ANCA-associated vasculitis (AAV) activity. All consecutive AAV patients with granulomatosis with polyangiitis (GPA), eosinophilic GPA or microscopic polyangiitis, followed at the French National Vasculitis Referral Center (09/2012-05/2013), and hospitalized non-AAV controls, exclusively for SA/SCV carriage comparisons, were enrolled. All had bilateral anterior nasal swab cultures. Nasal SA or SCV carriage was determined and associations with relapse(s), BVAS, ANCA-positivity, anti-staphylococcal and immunosuppressant use, were analysed ⩾4 years post-inclusion. Nasal SA carriage rates did not differ among AAVs (P = 0.53): GPA (24/80; 30%), EGPA (7/28; 25%) and microscopic polyangiitis (3/11; 27.3%); and the rate was less frequent in controls than in GPA patients not taking CTX (P = 0.04). AAV patients taking CTX prophylaxis had less nasal SA carriage (8.7% vs 36.2%; P = 0.02). Nasal SA carriage or CTX use did not modify relapse rates, BVAS or ANCA-positivity at inclusion or during follow-up. Nasal SCV carriage, found in 15/207 (7.2%) patients, was similar for GPA (10/24; 41.7%), microscopic polyangiitis (2/7; 28.6%) and eosinophilic GPA (2/3; 66.7%), but higher (P = 0.02) than controls (1/14; 7.1%). SCV carriage by AAV groups did not modify relapse rates or ANCA positivity at inclusion or during follow-up; a trend towards higher BVAS was observed only for anti-PR3 ANCA patients. Nasal SA or SCV carriage was comparable among AAVs but more frequent than in controls. Nasal SA or SCV carriage and CTX use did not modify AAV relapse rates.

2004. Clinical Application of Xpert SA Nasal Complete for Direct Detection of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus in Nasal Swabs in Pediatric Care Setting

Background Staphylococcus aureus (SA) is a major human pathogen, causing a variety of nosocomial and community-acquired infections. Nasal carriers of SA are at increased risk for healthcare associated infections with this organism. Timely detection of SA and Methicillin-resistant Staphylococcus aureus (MRSA) and decolonization of pre-surgical patients carrying SA are of importance in infection prevention. We sought to evaluate the clinical performance of the Xpert SA Nasal Complete assay (Xpert SA) for detection of SA and MRSA in the nasal specimens from pediatric patients.MethodsA total of 504 nasal specimens were collected in the Copan dual swab systems from patients with ages between 0 to 61 years with 91.9% patients ≤21 year-old (n = 463). For each sample, one swab was tested with Xpert SA. The second swab was plated onto Blood agar, Mannitol salt agar and ChromID™ MRSA plate and incubated at 35°C in non-CO2 incubator. The identification of SA and MRSA was compared between Xpert SA and the culture results. Methicillin resistance was determined using conventional methods (susceptibility testing or detection of altered penicillin binding protein).ResultsWhen compared with culture for the identification of SA (n = 481), there was an agreement of 95.0% with sensitivity and specificity being 95.6% and 94.8%, respectively. Among those culture-confirmed and Xpert SA positive samples (n = 131), concordance between Xpert SA and conventional methods for detection of methicillin resistance was 97.0% with sensitivity and specificity being 100% and 96.3%, respectively. Four culture-confirmed methicillin-susceptible SA (MSSA) were identified as MRSA by Xpert SA. Among 504 nasal specimens, 23 (4.6%) samples had invalid or instrument failure results. Nasal swabs collected from pediatric patients (≤21-year-old) had a higher invalid/instrument failure rate (5.0%) than those from adults (0%) (P < 0.001).ConclusionXpert SA Nasal Complete assay provides a rapid and sensitive method to detect and differentiate between MSSA and MRSA colonization. The higher invalid rate in pediatric patients and misidentification of MSSA as MRSA by Xpert SA warrant the confirmation by bacterial culture and conventional susceptibility test.Disclosures A. Leber, Nationwide Children’s Hospital: Research Contractor, Research support.

Staphylococcus aureus colonization in Qazvin University hospitals healthcare workers

Background: Staphylococcus aureus (SA) colonization of hospital personnel is a source of hospital acquired infections. Objective: The aim of this study was to determine the prevalence of nasal carriage rate of SA and methicillin resistant Staphylococcus aureus (MRSA) among Health Care Workers (HCWs) at Qazvin university hospitals. Methods: A cross sectional study was conducted among 396 employees of five teaching hospitals from October 2016 to April 2017. After obtaining informed consent and completion of the questionnaire, a sample was taken from the anterior nasal cavity for microbiology. The isolation of SA and their antimicrobial sensitivity were carried out by standard bacteriological procedures (disk diffusion and E-Test method). MRSA were confirmed by cefoxitin disk diffusion test. Chi square and independent t test were used to analyze the collected data. Findings: From the 198 HCWs, 32 people (16.1%) carried SA that the most carriers were workers of intensive care units (20.3%). 3% of all HCWs were identified as MRSA carriers. Colonization with SA is significantly lower among nursing and higher education. All SA isolates were sensitive to vancomycin and rifampin. Conclusion: The rate of nasal SA (especially MRSA) carriage among HCWs of Qazvin university hospitals is low. Also, staff teaching appears to be a promising approach for reducing nasal carrier. Rifampin and mupirocin, for eradication of Staphylococcus colonization in health workers (even MRSA) are acceptable. Keywords: Methicillin resistant staphylococcus aureus, Healthcare workers, Nasal carriage, Antimicrobial sensitivity

Methicillin resistance in Staphylococcus aureus infections among patients colonized with methicillin-susceptible Staphylococcus aureus

ObjectivesWe have noticed that patients colonized with methicillin-susceptible Staphylococcus aureus (MSSA) rarely get methicillin-resistant S. aureus (MRSA) infections. The purpose of this study was to compare the odds of a Staphylococcus aureus (SA) infection being an MRSA infection in MSSA carriers, MRSA carriers and non-carriers of SA. MethodsHospitalizations of adult patients at the Cleveland Clinic Health System from 2008 to 2015 were screened to identify those where the patient was tested for SA colonization. The first such hospitalization was identified. Among these 90 891 patients, those who had an SA infection during the hospitalization were included. SA carrier status (MRSA, MSSA, or non-carrier), was defined based on the first nasal SA test result. The association of carrier status and MRSA infection was examined. ResultsThe mean (±standard deviation (SD)) age of the 1999 included patients was 61 (17) years, and 1160 (58%) were male. Thirty percent, 26%, and 44%, were MRSA carriers, MSSA carriers and non-carriers, respectively. Of the 601 SA infections in MRSA carriers (reference group), 552 (92%) were MRSA infections compared with 42 (8%) of 516 in MSSA carriers (odds ratio (OR) 0.008, 95% confidence interval (CI) 0.005–0.012, p <0.0001) and 430 (49%) of 882 in non-carriers (OR 0.072, 95% CI 0.051–0.100, p <0.0001), after controlling for age, sex, hospital length of stay and calendar year. ConclusionAmong patients with SA infection, the odds of the infection being an MRSA infection are 125-times lower in an MSSA carrier than in an MRSA carrier.

Nasal colonization and bacterial contamination of mobile phones carried by medical staff in the operating room.

BackgroundMobile phones (MPs) have been an essential part of the lives of healthcare professionals and have improved communication, collaboration, and sharing of information. Nonetheless, the widespread use of MPs in hospitals has raised concerns of nosocomial infections, especially in areas requiring the highest hygienic standards such as operating rooms (ORs). This study evaluated the incidence of bacterial contamination of the MPs carried by medical staff working in the OR and determined its association with bacterial colonization of this personnel.MethodsThis is an observational cohort study. Medical staffs working in the OR were asked to take bacterial cultures from their MPs, anterior nares, and dominant hands. To identify the relation between MP contamination and bacterial colonization of the medical staff, genotyping of Staphylococcus aureus (SA) was done via Staphylococcus protein A gene (spa) typing and pulsed-field gel electrophoresis (PFGE).ResultsA total of 216 swab samples taken from 72 medical-staff members were analyzed. The culture-positive rate was 98.1% (212/216). In 59 (27.3%) samples, the bacteria were possible clinical pathogens. The anterior nares were the most common site of colonization by clinical pathogens (58.3%, 42/72), followed by MPs (13.9%, 10/72) and the dominant hand (9.7%, 7/72). SA was the most commonly isolated clinical pathogen and was found in 43 (19.9%) samples. In 66 (94.3%) of the 70 staff members for whom bacteria were detected on their MPs, the same bacteria were detected in nares or hand. Among 31 medical staff who were carriers of SA in the anterior nares or dominant hand, 8 (25.8%) were found to have SA on their MPs, and genotyping confirmed the same SA strain in 7 (87.5%) of them.ConclusionA high rate of bacterial nasal colonization and MPs contamination were found among the OR medical staff. An MP may be a reservoir for pathogen contamination in the OR.

The epidemiology of Staphylococcus aureus carriage in patients attending inner city sexually transmitted infections and community clinics in Calgary, Canada.

BackgroundAlthough the nares represent the most common carriage site for traditional hospital-associated strains of Staphylococcus aureus (SA), the predominant site of carriage of SA in the community is less certain.MethodsWe conducted a cross-sectional study in 285 patients attending sexually transmitted diseases and inner-city clinics to evaluate the prevalence, body site colonisation and risk factors associated with carriage of methicillin susceptible SA (MSSA). All isolates were characterized by pulsed field gel electrophoresis, staphylococcal cassette chromosome mec, staphylococcal protein A and multilocus sequence typing.ResultsThe prevalence of colonisation with SA was 57.5% (164/285); 162 (56.8%) participants were colonized with MSSA, and 4 (1.4%) with methicillin-resistant SA (MRSA), 2 of them were co-colonised with both MRSA and MSSA. The most common sites of colonisation were the throat (73.1%), nares (65.2%) and interdigital web spaces of the hand (21.3%). Three out of 4 MRSA isolates were USA300-MRSA strains. Twelve MSSA isolates were closely related to the USA300 CA-MRSA. We identified sexual behaviours such as having more than 6 heterosexual sexual partners in the last 6 months and trimming pubic hair to be independently associated with MSSA colonisation, and more specifically practicing oral sex as a risk factor for throat colonisation.ConclusionThere is a high prevalence of MSSA carriage in this population, with a low prevalence of MRSA. The throat was the most common site of carriage and sexual behaviours were found to be risk factors for MSSA colonisation. Close strain relatedness of MSSA and USA300-MRSA isolates suggests either gain or loss of the SCCmec element, respectively.

Chronic nasal Staphylococcus aureus carriage identifies a subset of newly diagnosed granulomatosis with polyangiitis patients with high relapse rate.

The aim of this study was to evaluate whether chronic nasal carriage of Staphylococcus aureus (SA) is related to relapses in patients with newly diagnosed ANCA-associated vasculitis (AAV). In two clinical trials (n = 200), for early systemic (n = 83) and generalized (n = 117) AAV, nasal swabs were obtained monthly and at the time of a relapse. Chronic nasal SA carriage (CNSAC) was defined as ⩾ 75% of cultures being SA positive, with non-carriers being SA negative in all cultures and remaining patients being intermittent carriers. Fifty-five of 200 (27.5%) patients received prophylactic trimethoprim/sulfamethoxazole (T/S) against Pneumocystis jirovecii . Of the total AAV patients, 24/200 (12%) were chronic, 102/200 (51%) intermittent and 74/200 (37%) non-carriers. Of 65 relapsing patients, 10/24 (41.7%) were chronic, 32/102 (31.4%) intermittent and 23/74 (31.1%) non-carriers (P = 0.59). For all AAV patients, CNSAC was not associated with an increased relapse risk [odds ratio (OR) = 1.57, 95% CI: 0.66, 3.76; P = 0.31]. However, 23/24 chronic carriers had granulomatosis with polyangiitis (GPA). In the 73 patients with generalized GPA (hazard ratio = 4.10, 95% CI: 1.37, 12.25; P = 0.01) and the 78 patients with early systemic GPA during immunosuppression (hazard ratio = 2.73, 95% CI: 0.95, 7.87; P = 0.06), relapse rates were higher for chronic SA carriers. Prophylactic T/S was not associated with a reduced relapse risk (OR = 0.71, 95% CI: 0.36, 1.41; P = 0.33). Nevertheless, prophylactic T/S reduced CNSAC (OR = 0.19, 95% CI: 0.04, 0.91; P = 0.04). The frequency of CNSAC in newly diagnosed GPA paralleled that in the general population. This subset of GPA patients (23/151, 15.2%) has a high relapse rate despite immunosuppression and prophylactic T/S treatment, requiring further investigations on pathogenesis and therapy.

Hospital clones of methicillin-resistant Staphylococcus aureus are carried by medical students even before healthcare exposure

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) strains are prevalent in healthcare and the community. Few studies have examined MRSA carriage among medical students.The aim of this study is to examine Staphylococcus aureus (SA) carriage, and particular MRSA, over time in cohort medical studentsMethodsProspective collection of nasal swabs from medical students in Israel and assessment of SA carriage. Three samples were taken per student in preclinical and clinical parts of studies. Antibiotic susceptibilities were recorded and MRSA typing was performed by staphylococcal cassette chromosome mec (SCCmec) types, Panton Valentine Leukocidin (PVL) encoding genes, and spa types. Clonality was assessed by pulsed-field gel electrophoresis.ResultsAmong 58 students, SA carriage rates increased from 33% to 38% to 41% at baseline (preclinical studies), 13 and 19 months (clinical studies), respectively (p = 0.07). Methicillin-susceptible SA (MSSA) carriage increased in the clinical studies period (22 to 41%, p = 0.01). Overall, seven students (12%) carried 13 MRSA isolates. MRSA isolates were PVL negative and were characterized as SCCmecII-t002, SCCmecIV-t032, or t12435 with untypable SCCmec. MRSA carriage during the pre-clinical studies was evident in 4/7 students. Two students carried different MRSA clones at various times and persistent MRSA carriage was noted in one student. Simultaneous carriage of MRSA and MSSA was not detected.ConclusionsMSSA carriage increased during the clinical part of studies in Israeli medical students. Compared with previous reports, higher rates of MRSA carriage were evident. MRSA strains were genotypically similar to Israeli healthcare-associated clones; however, carriage occurred largely before healthcare exposure, implying community-acquisition of hospital strains.