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Latest Results for BMC Infectious Diseases, 3.12.2019
Tilføjet 03.12.2019 21:55
Effects of the proportion of high-risk patients and control strategies on the prevalence of methicillin-resistant Staphylococcus aureus in an intensive care unit
The presence of nosocomial pathogens in many intensive care units poses a threat to patients and public health worldwide. Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen endemic in many hospital settings. Patients who are colonized with MRSA may develop an infection that can complicate their prior illness.
A mathematical model to describe transmission dynamics of MRSA among high-risk and low-risk patients in an intensive care unit (ICU) via hands of health care workers is developed. We aim to explore the effects of the proportion of high-risk patients, the admission proportions of colonized and infected patients, the probability of developing an MRSA infection, and control strategies on MRSA prevalence among patients.
The increasing proportion of colonized and infected patients at admission, along with the higher proportion of high-risk patients in an ICU, may significantly increase MRSA prevalence. In addition, the prevalence becomes higher if patients in the high-risk group are more likely to develop an MRSA infection. Our results also suggest that additional infection prevention and control measures targeting high-risk patients may considerably help reduce MRSA prevalence as compared to those targeting low-risk patients.
The proportion of high-risk patients and the proportion of colonized and infected patients in the high-risk group at admission may play an important role on MRSA prevalence. Control strategies targeting high-risk patients may help reduce MRSA prevalence.
Latest Results for BMC Infectious Diseases, 2.12.2019
Tilføjet 03.12.2019 02:28
Nasopharyngeal carriage, spa types and antibiotic susceptibility profiles of Staphylococcus aureus from healthy children less than 5 years in Eastern Uganda
Staphylococcus aureus carriage is a known risk factor for staphylococcal disease. However, the carriage rates vary by country, demographic group and profession. This study aimed to determine the S. aureus carriage rate in children in Eastern Uganda, and identify S. aureus lineages that cause infection in Uganda.
Nasopharyngeal samples from 742 healthy children less than 5 years residing in the Iganga/Mayuge Health and Demographic Surveillance Site in Eastern Uganda were processed for isolation of S. aureus. Antibiotic susceptibility testing based on minimum inhibitory concentrations (MICs) was determined by the BD Phoenix™ system. Genotyping was performed by spa and SCCmec typing.
The processed samples yielded 144 S. aureus isolates (one per child) therefore, the S. aureus carriage rate in children was 19.4% (144/742). Thirty one percent (45/144) of the isolates were methicillin resistant (MRSA) yielding a carriage rate of 6.1% (45/742). All isolates were susceptible to rifampicin, vancomycin and linezolid. Moreover, all MRSA were susceptible to vancomycin, linezolid and clindamycin. Compared to methicillin susceptible S. aureus (MSSA) isolates (68.8%, 99/144), MRSA isolates were more resistant to non-beta-lactam antimicrobials –trimethoprim/sulfamethoxazole 73.3% (33/45) vs. 27.3% (27/99) [p
Clinical Infectious Diseases Advance Access, 1.11.2019
Tilføjet 01.11.2019 11:45
Decreases in antimicrobial use associated with multihospital implementation of electronic antimicrobial stewardship tools
AbstractBackgroundAntimicrobial stewards may benefit from comparative data to inform interventions that promote optimal antimicrobial use in the inpatient setting.MethodsAntimicrobial stewards from eight geographically dispersed Veterans Affairs (VA) inpatient facilities participated in the development of iterative antimicrobial use visualization tools that allowed for comparison to facilities of similar complexity. The visualization tools consisted of an interactive web-based antimicrobial dashboard and, later, a standardized antimicrobial usage report updated at user-selected intervals. Following tool implementation, stewards participated in monthly learning collaboratives. The percent change in average monthly antimicrobial use [all antimicrobial agents, anti-methicillin-resistant Staphylococcus aureus agents (anti-MRSA), and anti-pseudomonal agents] was analyzed using a pre-post (1/2014-1/2016 versus 7/2016-1/2018) design with segmented regression and external comparison with uninvolved control facilities (n=118).ResultsIntervention sites demonstrated a 2.1% decrease (95% confidence interval (CI) [-5.7%, 1.6%]) in total antimicrobial use pre-post intervention, versus a 2.5% increase (95% CI [0.8%, 4.1%]) in non-intervention sites (absolute difference 4.6%, P=0.025). Anti-MRSA antimicrobial use decreased 11.3% (95% CI [-16.0%, -6.3%]) at intervention sites versus a 6.6% decrease (95% CI [-9.1%, -3.9%]) at non-intervention sites (absolute difference 4.7%, P=0.092). Anti-pseudomonal antimicrobial use decreased 3.4% (95% CI [-8.2%, 1.7%]) at intervention sites versus a 3.4% increase (95% CI [0.8%, 6.5%]) at non-intervention sites (absolute difference 7.0%, P=0.018).ConclusionsComparative data visualization tool use by stewards in a pilot implementation project at eight VA facilities was associated with significant reductions in overall antimicrobial and anti-pseudomonal use relative to uninvolved facilities.
Latest Results for BMC Infectious Diseases, 28.10.2019
Tilføjet 28.10.2019 17:54
Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus nasal carriage in the West of Iran: a population-based cross-sectional study
Several reports designate the recent increase in community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal carriage. Because of the scanty information regarding the nasal carriage sate of MRSA in the west of Iran, the purpose of the present study was to determine the frequency of CA-MRSA in Sanandaj city.
Swabs collected from anterior nares of 600 volunteers were analyzed for the presence of S. aureus. The isolates were further investigated for methicillin resistance by using the cefoxitin disk diffusion test, followed by PCR-amplification of the mecA gene. SCCmec types and the presence of the Panton-Valentine Leukocidin (pvl) encoding genes were determined through PCR. Finally, the antimicrobial susceptibility of the isolates was determined by the agar diffusion method.
Nasal screening identified 181 S. aureus, of which 55 isolates were MRSA. SCCmec types IV and V were detected in MRSA at frequencies of 80 and 20%, respectively. The overall frequency of pvl genes among the MRSA isolates was 14.54%. MRSA isolates were highly susceptible (98.18%) to mupirocin, gentamicin, and fusidic acid.
The high prevalence of CA-MRSA carriage in the population could pose a serious public health concern for the region. Additionally, advent of drug-resistant pvl-positive strains demands continuous surveillance on the colonization state of CA-MRSA in order to prevent dissemination of the bacterium in the community.
Clinical Infectious Diseases Advance Access, 22.10.2019
Tilføjet 23.10.2019 10:59
The effectiveness of Contact Precautions on methicillin-resistant Staphylococcus aureus (MRSA) in long-term care across the United States
AbstractBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections in long-term care facilities (LTCF). The Centers for Disease Control and Prevention (CDC) recommends Contact Precautions for prevention of MRSA within acute care facilities and are being used within the United States Department of Veterans Affairs (VA) for LTCF in a modified fashion. The impact of Contact Precautions in long-term care is unknown.MethodsTo evaluate if Contact Precautions decreased MRSA acquisition in LTCF compared to Standard Precautions we performed a retrospective effectiveness study (pre-post with concurrent controls) using data from the VA healthcare system from 1/1/2011 until 12/31/2015, two years before and after a 2013 policy recommending a more aggressive form of Contact Precautions.ResultsAcross 75,414 patient admissions from 74 long-term care facilities in the United States, the overall unadjusted rate of MRSA acquisition was 2.6/1000 patient days. Patients were no more likely to acquire MRSA if they were cared for using Standard Precautions vs. Contact Precautions in multivariable discrete-time survival analysis, controlling for patient demographics, risk factors, and year of admission (Odds Ratio (OR) 0.97, 95% confidence interval (CI), 0.85-1.12, p=0.71).ConclusionsMRSA acquisition and infections were not impacted by use of active surveillance and Contact Precautions in LTCF in the VA.
Latest Results for BMC Infectious Diseases, 22.10.2019
Tilføjet 22.10.2019 13:23
Molecular characteristics and virulence gene profiles of Staphylococcus aureus isolates in Hainan, China
There have been no reports regarding the molecular characteristics, virulence features, and antibiotic resistance profiles of Staphylococcus aureus (S. aureus) from Hainan, the southernmost province of China.
Two hundred twenty-seven S. aureus isolates, consisting of 76 methicillin-resistant S. aureus (MRSA) and 151 methicillin-susceptible S. aureus (MSSA), were collected in 2013–2014 and 2018–2019 in Hainan, and investigated for their molecular characteristics, virulence genes, antibiotic resistance profiles and main antibiotic resistance genes.
Forty sequence types (STs) including three new STs (ST5489, ST5492 and ST5493), and 79 Staphylococcal protein A (spa) types were identified based on multilocus sequence typing (MLST) and spa typing, respectively. ST398 (14.1%, 32/227) was found to be the most prevalent, and the prevalence of ST398-MSSA increased significantly from 2013 to 2014 (5.5%, 5/91) to 2018–2019 (18.4%, 25/136). Seventy-six MRSA isolates were subject to staphylococcus chromosomal cassette mec (SCCmec) typing. SCCmec-IVa was the predominant SCCmec type, and specifically, ST45-SCCmec IVa, an infrequent type in mainland China, was predominant in S. aureus from Hainan. The antibiotic resistance profiles and antibiotic resistance genes of S. aureus show distinctive features in Hainan. The resistant rates of the MRSA isolates to a variety of antibiotics were significantly higher than those of the MSSA isolates. The predominant erythromycin and tetracycline resistance genes were ermC (90.1%, 100/111) and tetK (91.8%, 78/85), respectively. Eleven virulence genes, including the Panton-Valentine leukocidin (pvl) and eta, were determined, and the frequency of eta and pvl were found to be 57.3 and 47.6%. Such high prevalence has never been seen in mainland China before.
S. aureus isolates in Hainan have unique molecular characteristics, virulence gene and antibiotic resistance profiles, and main antibiotic resistance genes which may be associated with the special geographical location of Hainan and local trends in antibiotic use.
Clinical Infectious Diseases Advance Access, 1.10.2019
Tilføjet 04.10.2019 07:25
Determining the utility of methicillin-resistant Staphylococcus aureus nares screening in antimicrobial stewardship
AbstractBackgroundTreatment of suspected methicillin-resistant Staphylococcus aureus (MRSA) is a cornerstone of many antibiotic regimens; however, antibiotics are associated with toxicity. The Department of Veterans Affairs (VA) hospitals screen each patient on admission and transfer for MRSA nares colonization. The objective of this study was to determine the negative predictive value (NPV) of MRSA screening in the determinization of subsequent positive clinical culture for MRSA. High NPVs with MRSA nares screening maybe used as a stewardship tool for de-escalation as well as avoidance of anti-MRSA therapy.MethodsThis was a retrospective cohort study across VA medical centers nationwide from January 1, 2007 to January 1, 2018. Data from patients with MRSA nares screening upon admission or transfer were obtained from the VA Corporate Data Warehouse. Subsequent clinical cultures within 7 days of the nares swab were evaluated for presence of MRSA. Sensitivity, specificity, positive predictive values (PPVs), and NPVs were calculated for the entire cohort, as well as subgroups for specific culture sites.ResultsThis cohort yielded 561,325 clinical cultures from a variety of anatomical sites. The sensitivity and specificity for positive MRSA clinical culture were 67.4% and 81.2%, respectively. The NPV of MRSA nares screening for ruling out MRSA infection was 96.5%. The NPV for bloodstream infections was 96.5%, for intra-abdominal cultures was 98.6%, for respiratory cultures was 96.1%, for wound cultures was 93.1%, and for cultures from the urinary system was 99.2%.ConclusionGiven the high NPVs, MRSA nares screening may be a powerful stewardship tool for de-escalation and avoidance of empirical anti-MRSA therapy.
Clinical Infectious Diseases Advance Access, 18.09.2019
Tilføjet 19.09.2019 10:15
Antimicrobial Stewardship in a Hematological Malignancy Unit: Carbapenem Reduction and Decreased Vancomycin-resistant Enterococcus Infection
AbstractBackgroundAntibiotic stewardship is challenging in hematological malignancy patients.MethodsQuasi-experimental implementation study of two antimicrobial stewardship interventions in a hematological malignancy unit: 1) monthly antibiotic cycling for febrile neutropenia: cefepime (+/- metronidazole) and piperacillin-tazobactam and 2) a clinical prediction rule to guide anti-VRE therapy. We used interrupted time-series analysis (ITS) to compare antibiotic use and logistic regression to adjust observed unit-level changes in resistant infections by background community rates.Results2434 admissions spanning 3 years prior and 2 years post-implementation were included. Unadjusted carbapenem and daptomycin use decreased significantly. In ITS analysis, carbapenem use decreased by -230 DOT/1000 patient days (95% confidence interval (CI) -290 to -180), p
Clinical Infectious Diseases Advance Access, 20.08.2019
Tilføjet 20.08.2019 03:10
Frequent MRSA Introductions into an Inner-City Jail: Indications of Community Transmission Networks
AbstractBackgroundJails may facilitate spread of MRSA in urban areas. We examined MRSA colonization at entrance to a large urban jail to determine if there are community transmission networks for MRSA that precede incarceration.MethodsIncarcerated males at the Cook County Jail were enrolled—with enrichment for HIV-positive subjects—within 72hours of intake. Surveillance cultures were collected to determine prevalence of MRSA colonization. Genomic analysis and epidemiologic data were used to identify community transmission networks.ResultsThere were 800 incarcerations (718 individuals) enrolled; 58% were HIV-infected. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among HIV patients, recent injection drug use, current skin infection, and HIV care at outpatient Clinic A that emphasizes comprehensive care to the LGBTQ community were predictors of MRSA. 14(45%) of 31 detainees with care at Clinic A had colonization. WGS revealed that the high prevalence of MRSA in Clinic A was not due to clonal spread in the clinic but rather an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a community network. Members of this USA500 network were more likely to be HIV-infected (p
Clinical Infectious Diseases Advance Access, 12.08.2019
Tilføjet 13.08.2019 08:18
Combination Therapy for MRSA Bacteremia: To β or Not to β?
Clinical Infectious Diseases Advance Access, 12.08.2019
Tilføjet 13.08.2019 08:18
Daptomycin plus beta-lactam combination therapy for methicillin-resistant Staphylococcus aureus bloodstream infections: a retrospective, comparative cohort study
AbstractBackgroundMounting evidence suggests the addition of a beta-lactam (BL) to daptomycin (DAP) results in synergistic in vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and bolsters the innate immune response to infection. The objective of this study was to provide clinical translation to this experimental data and determine if DAP+BL combination therapy results in improved clinical outcomes compared to treatment with DAP alone in patients with MRSA bloodstream infections (BSI).MethodsThis was a retrospective, comparative cohort study conducted at two academic medical centers between 2008 and 2018. Adults with MRSA BSI treated with DAP for ≥72 hours and initiated within five days of culture collection were included. Patients who received a BL for ≥24 hours and initiated within 24 hours of DAP comprised the DAP+BL group. The primary outcome was composite clinical failure (60-day all-cause mortality and/or 60-day recurrence). Analyses were adjusted for confounding using inverse probability of treatment weighting (IPTW).ResultsA total of 229 patients were included (72 DAP+BL and 157 DAP). In unadjusted and IPTW-adjusted analyses, DAP+BL was associated with significantly reduced odds of clinical failure (OR 0.362, 95% CI 0.164, 0.801; aOR 0.386, 95% CI 0.175, 0.853). Adjusted analyses restricted to pre-specified subgroups based on infection complexity and baseline health status, were consistent with the main analysis.ConclusionsThe addition of a BL to DAP was associated with improved clinical outcomes in patients with MRSA BSI. This study provides support to ongoing and future studies evaluating the impact of combination therapy for invasive MRSA infections.
Clinical Infectious Diseases Advance Access, 1.08.2019
Tilføjet 01.08.2019 08:32
IL-1β and IL-10 Host Responses in Patients with Staphylococcus aureus Bacteremia Determined by Antimicrobial Therapy
AbstractIntroductionPatient IL-1β and IL-10 responses early in the course of Staphylococcus aureus bacteremia (SaB) are associated with bacteremia duration and mortality. We hypothesized that these responses vary depending on choice of antimicrobial therapy, with particular interest in knowing whether the superior performance of -lactams may be linked to key cytokine signaling pathways.MethodsThree medical centers included 59 patients with SaB (47 MRSA, 12 MSSA) from 2015-2017. In the first 48 h, patients were treated with either a β-lactam (n=24), including oxacillin, cefazolin, or ceftaroline, or a glyco-/lipopeptide (n=35), i.e. vancomycin or daptomycin (VAN/DAP). Patient sera from days 1, 3 and 7 were assayed for IL-1β and IL-10 by ELISA and compared using Mann-Whitney U.ResultsOn day 1 of presentation, IL-10 was elevated in patients with outcomes of mortality (P=0.008) and persistent bacteremia (P=0.034), while no difference occurred in IL-1β. Regarding treatment groups, IL-1β and IL-10 was similar at presentation prior to receiving an antibiotic. Patients treated with β-lactam had higher IL-1β on day 3 (median +5.6 pg/mL; P=0.007) and day 7 (+10.9 pg/ml; P=0.016). Ex vivo, the addition of IL-1 receptor antagonist anakinra to whole blood reduced staphylococcal killing, supporting a functional significance of the host IL-1β response in SaB clearance. β-lactam treated patients had sharper declines in IL-10 than VAN/DAP treated patients at days 3 and 7.
Latest Results for BMC Infectious Diseases, 9.07.2019
Tilføjet 09.07.2019 16:54
Methicillin-resistant Staphylococcus aureus (MRSA) in East Africa: red alert or red herring?
Methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality and has resultant important economic and societal costs underscoring the need for accurate surveillance. In recent years, prevalence rates reported in East Africa have been inconsistent, sparking controversy and raising concern.
We described antimicrobial susceptibility patterns of Staphylococcus aureus isolates cultured from patients within the Internal Medicine department of the largest public healthcare facility in East and Central Africa- the Kenyatta National Hospital (KNH) in Nairobi, Kenya. Routine antimicrobial susceptibility data from non-duplicate Staphylococcus aureus isolates cultured between the years 2014–2016 from the medical wards in KNH were reviewed.
Antimicrobial susceptibility data from a total of 187 Staphylococcus aureus isolates revealed an overall MRSA prevalence of 53.4%. Isolates remained highly susceptible to linezolid, tigecycline, teicoplanin and vancomycin.
The prevalence of MRSA was found to be much higher than that reported in private tertiary facilities in the same region. Careful interrogation of antimicrobial susceptibility results is important to uproot any red herrings and reserve genuine cause for alarm, as this has a critical bearing on health and economic outcomes for a population.
Latest Results for Infection, 3.07.2019
Tilføjet 03.07.2019 19:26
Epidemiology and Outcome Determinants of Staphylococcus aureus Bacteremia Revisited: A Population-Based Study
Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality. We sought to re-define the burden, epidemiology and mortality-associated risk factors of SAB in a large Canadian health region.
Residents (> 18 years) experiencing SAB from 2012 to 2014 were assessed. Incidence rates were calculated using civic census results. Factors associated with 30-day mortality were determined through multivariate logistic regression. Incidence and risk factors for SAB were compared to 2000–2006 data.
780 residents experienced 840 episodes of SAB (MRSA; 20%). Incidence rates increased from 23.5 to 32.0 cases/100,000 from 2012 to 2014; [IRR 1.15 (95% CI 1.07–1.23); p