scholarly journals Characteristics Associated With Invasive Staphylococcus aureus Infection Rates in Nursing Homes, Emerging Infections Program

2020 ◽  
Vol 41 (S1) ◽  
pp. s60-s61
Author(s):  
Runa Gokhale ◽  
Kelly Jackson ◽  
Kelly Hatfield ◽  
Susan Petit ◽  
Susan Ray ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Homes ◽  
Influenza Vaccination ◽  
Incidence Rates ◽  
Resistant Organism ◽  
Short Stay ◽  
Emerging Infections ◽  
Infection Rates ◽  
Targeted Interventions ◽  
Surveillance Area

Background: Most invasive methicillin-resistant Staphylococcus aureus (iMRSA) infections have onset in the community but are associated with healthcare exposures. More than 25% of cases with healthcare exposure occur in nursing homes (NHs) where facility-specific iMRSA rates vary widely. We assessed associations between nursing home characteristics and iMRSA incidence rates to help target prevention efforts in NHs. Methods: We used active, laboratory- and population-based surveillance data collected through the Emerging Infections Program during 2011–2015 from 25 counties in 7 states. NH-onset cases were defined as isolation of MRSA from a normally sterile site in a surveillance area resident who was in a NH within 3 days before the index culture. We calculated MRSA incidence (cases per NH resident day) using Centers for Medicare & Medicaid Services (CMS) skilled nursing facility cost reports and described variation in iMRSA incidence by NH. We used Poisson regression with backward selection, assessing variables for collinearity, to estimate adjusted rate ratios (aRRs) for NH characteristics (obtained from the CMS minimum dataset) associated with iMRSA rates. Results: Of 590 surveillance area NHs included in analysis, 89 (15%) had no NH-onset iMRSA infections. Rates ranged from 0 to 23.4 infections per 100,000 resident days. Increased rate of NH-onset iMRSA infection occurred with increased percentage of residents in short stay ≤30 days (aRR, 1.09), exhibiting wounds or infection (surgical wound [aRR, 1.08]; vascular ulcer/foot infection [aRR, 1.09]; multidrug-resistant organism infection [aRR, 1.13]; receipt of antibiotics [aRR, 1.06]), using medical devices or invasive support (ostomy [aRR, 1.07]; dialysis [aRR, 1.07]; ventilator support [aRR, 1.17]), carrying neurologic diagnoses (cerebral palsy [aRR, 1.14]; brain injury [aRR, 1.1]), and demonstrating debility (requiring considerable assistance with bed mobility [aRR, 1.05]) (Table). iMRSA rates decreased with increased percentage of residents receiving influenza vaccination (aRR, 0.96) and with the presence of any patients in isolation for any active infection (aRR, 0.83). Conclusions: iMRSA incidence varies greatly across nursing homes, with many NH patient and facility characteristics associated with NH-onset iMRSA rate differences. Some associations (short stay, wounds and infection, medical device use and invasive support) suggest that targeted interventions utilizing known strategies to decrease transmission may help to reduce infection rates, while others (neurologic diagnoses, influenza vaccination, presence of patients in isolation) require further exploration to determine their role. These findings can help identify NHs in other areas more likely to have higher rates of NH-onset iMRSA who could benefit from interventions to reduce infection rates.Funding: NoneDisclosures: None

Trends in annual incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-infected and HIV-uninfected patients

2013 ◽  
Vol 141 (11) ◽  
pp. 2392-2402 ◽  
Author(s):  
G. N. DELORENZE ◽  
M. A. HORBERG ◽  
M. J. SILVERBERG ◽  
A. TSAI ◽  
C. P. QUESENBERRY ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Health Plan ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incidence Rates ◽  
Infected Group ◽  
Rapid Rise ◽  
Infection Rates ◽  
Methicillin Resistant ◽  
Mrsa Infection

SUMMARYWe describe trends in incidence rates of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected and HIV-uninfected patients enrolled in a large northern California Health Plan, and the ratio of MRSA to methicillin-susceptible S. aureus (MSSA) case counts. Between 1995 and 2010, 1549 MRSA infections were diagnosed in 14060 HIV-infected patients (11·0%) compared to 89546 MRSA infections in 6597396 HIV-uninfected patients (1·4%) (P = 0·00). A steady rise in MRSA infection rates began in 1995 in HIV-uninfected patients, peaking at 396·5 infections/100000 person-years in 2007. A more rapid rise in MRSA infection rates occurred in the HIV-infected group after 2000, peaking at 3592·8 infections/100000 in 2005. A declining trend in MRSA rates may have begun in 2008–2009. Comparing the ratio of MRSA to MSSA case counts, we observed that HIV-infected patients shouldered a greater burden of MRSA infection during most years of study follow-up compared to HIV-uninfected patients.

scholarly journals 1228. Incidence of Staphylococcus aureus Infection after Elective Surgeries Among Adults in US Hospitals

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S372-S373
Author(s):  
Jill Dreyfus ◽  
Elizabeth Begier ◽  
Holly Yu ◽  
Alvaro Quintana ◽  
Julie Gayle ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Elective Surgery ◽  
Methicillin Resistance ◽  
The United States ◽  
Incidence Rates ◽  
Infection Rates ◽  
Surveillance Network ◽  
Healthcare Database ◽  
Aureus Infection ◽  
Diagnosis Codes

Abstract Background Staphylococcus aureus is a leading cause of postsurgical infections. National estimates of these infections after elective surgeries based on microbiology data are limited. This study assessed 180-day postsurgical S. aureus incidence in real-world hospital settings. Methods Adults (≥18 years) who underwent elective surgery during a hospital-based outpatient or inpatient encounter from July 1, 2010–June 30, 2015 at one of 181 hospitals reporting microbiology results in the Premier Healthcare Database (PHD). Eighty-seven surgical categories were defined using ICD-9-CM and CPT procedure codes according to National Hospital Surveillance Network groupings plus additional categories. Microbiology results and ICD-9-CM diagnosis codes were used to identify invasive (e.g., deep incisional and organ-space SSI, bloodstream) and overall (i.e., invasive, superficial incisional, urinary tract, respiratory) S. aureus infections. Cumulative 180-day S. aureus infection rates were calculated as number of infections divided by number of discharges with elective surgeries. National infection volumes were calculated by multiplying infection rates by national inpatient elective surgery estimates using surgery counts in the entire PHD (665 hospitals) and weights based on hospital characteristics. Results Following 1,116,994 hospital-based outpatient elective surgeries, 180-day S. aureus incidence was 1.19% overall, with 0.38% complicated by invasive S. aureus infections. Among 884,803 inpatient elective surgeries, overall and invasive 180-day S. aureus infection incidence was 1.35% and 0.53%, respectively. This translated to an estimated 57,200 S. aureus infections (22,400 invasive) among an estimated 4.2 million elective inpatient surgeries annually in the US methicillin-resistance (MRSA) was observed in 45% and 46% of S. aureus infections after inpatient and outpatient surgeries, respectively. Figure 1 shows cumulative S. aureus incidence rates at each time point after outpatient and inpatient elective surgeries. Figure 2 delineates the incidence rates for each type of S. aureus infection. Conclusion Our study indicated similar S. aureus infection rates after inpatient and outpatient elective surgeries. The results highlight the much larger burden of disease of S. aureus infection in the United States beyond inpatient surgeries. Disclosures J. Dreyfus, Premier, Inc.: Employee and Shareholder, Salary. E. Begier, Pfizer, Inc.: Employee and Shareholder, Salary. H. Yu, Pfizer, Inc.: Employee and Shareholder, Salary. A. Quintana, Pfizer, Inc.: Employee and Shareholder, Salary. J. Gayle, Premier, Inc.: Employee, Salary. M. A. Olsen, Pfizer: Consultant, Consulting fee.

Prevalence of Meticillin-Resistant Staphylococcus aureus Colonisation amongst Residents in Maltese Nursing Homes

2018 ◽  
Vol 14 (1) ◽  
Author(s):  
Ryan Fredi Borg ◽  
Christine Gatt ◽  
Michael A Borg
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Nasal Carriage ◽  
Incidence Rates ◽  
Carriage Rate ◽  
Hospital Acquired

Since the 1960’s, meticillin-resistant Staphylococcus aureus (MRSA) has become a major pathogen with ever-increasing incidence rates of hospital-acquired and community-acquired infections. Malta has currently one of the highest rates of hospital-acquired and community-acquired infections in Europe. In addition, reports have estimated community carriage at more than 8%. MRSA carriage in homes for the elderly is very important because these residents are often hospitalized and therefore serve as a source of transmission. The aims of this study were to establish the prevalence of MRSA nasal carriage amongst residents in nursing homes in Malta, to determine their antibiotic susceptibility and to determine the significance of specific risk factors found in the literature. Nasal swabs were taken from 397 randomly chosen residents in 10 governmental nursing homes. A short questionnaire including possible risk factors reported to be associated with MRSA nasal carriage was also filled. MRSA carriage amongst nursing home residents was 19.4% (95% CI 17.6 – 21.2%) ranging from 0% to 25% amongst the nursing homes studied. Logistic regression analyses indicated that previous hospital admission was the only risk factor that was found to be significantly (OR: 1.956, p: 0.011; 95CI 1.163 - 3.290) associated with MRSA nasal colonization amongst nursing home residents. A high carriage rate of MRSA was identified in Maltese nursing care residents which can contribute to maintaining MRSA incidence in hospitals. Possible interventions include screening of these patients when they are admitted to an acute care facility and possible decolonization attempts in the nursing homes.

scholarly journals Trends in Staphylococcus aureus Bloodstream Infections in Nursing Homes in Monroe County, New York

2020 ◽  
Vol 41 (S1) ◽  
pp. s417-s418
Author(s):  
Marissa Tracy ◽  
Christina B. Felsen ◽  
Anita Gellert ◽  
Ghinwa Dumyati
Keyword(s):  
Risk Factors ◽  
New York ◽  
Staphylococcus Aureus ◽  
Nursing Home ◽  
Nursing Homes ◽  
Positive Culture ◽  
Bloodstream Infections ◽  
Population Based ◽  
Emerging Infections ◽  
Monroe County

Background: Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) are common in hospitals and nursing homes. Infection prevention efforts reduced MRSA BSI in hospitals but the trend in nursing homes is not well described. In addition, the contribution of methicillin sensitive S. aureus (MSSA) to the total burden of invasive S. aureus (iSA) in nursing homes remains unknown. Methods: As part of the CDC Emerging Infections Program, we conduct population-based surveillance for iSA infections in Monroe County, New York. Case patients were county residents with S. aureus isolated from a sterile site. Our analysis was limited to data from 2009–2018 for MRSA and 2015–2018 for MSSA and to cases classified as hospital-onset (HO, positive culture ≥3 calendar days after admission) or nursing home-onset (NHO, positive culture in nursing homes or within 3 days of hospital admission from a nursing home). Risk factors for iSA BSI in nursing homes were compared using the χ2 and Student t tests in SAS version 9.4 software. Results: During 2009–2014, 664 MRSA cases occurred and 427 (64%) were BSIs. Of these, 228 (53%) were NHO and 199 (47%) were HO. The BSI incidence per 100,000 population of NHO cases declined from 7.9 in 2009 to 2.8 in 2014, mirroring the decline in HO incidence from 8.7 in 2009 to 3.1 in 2014 (Fig. 1). During 2015–2018, 203 MRSA cases (163 BSIs, 80%) and 235 MSSA cases (163 BSIs, 69%) occurred. Of the 163 MRSA BSIs, 94 (58%) were NHO and 69 (42%) were HO, whereas of the 235 MSSA BSIs, only 56 (34%) were NHO and 107 (66%) were HO. MRSA BSI incidence per 100,000 population in both settings plateaued during 2015–2018 (Fig. 1) and MSSA NHO BSI incidence was lower than HO (1.9 NHO vs 3.6 HO). The total iSA BSI incidence was similar in both settings (5.9 vs 5.0 per 100,000 population in HO and NHO, respectively). NHO MSSA and MRSA cases have similar risk factors for BSI; 45 (30%) had decubitus ulcers, 34 (23%) were on chronic dialysis, 41 (27%) had a CVC in place within 2 days of BSI onset, and 63% had prior healthcare exposures. Most of these developed within 4 weeks of hospital discharge (Fig. 2). Conclusions: The incidence of MRSA BSI in nursing homes has declined since 2009 but plateaued starting in 2015. Compared to MRSA, MSSA caused fewer BSIs in nursing homes; however, iSA risk factors, including previous healthcare exposure, were similar. Continued study is needed to identify interventions effective against all iSA infections in nursing homes.Funding: NoneDisclosures: None

scholarly journals Universal Decolonization Reduces MDRO Burden on High-Touch Objects in Nursing Home Resident Rooms and Common Areas

2020 ◽  
Vol 41 (S1) ◽  
pp. s54-s55
Author(s):  
Gabrielle M. Gussin ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Tabitha D. Catuna ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Cluster Randomized Trial ◽  
Baseline Period ◽  
Multidrug Resistant ◽  
Routine Care ◽  
Resistant Organism ◽  
Short Stay ◽  
Care Needs ◽  
The Impact

Background: More than half of nursing home (NH) residents harbor a multidrug-resistant organism (MDRO), and MDRO contamination of the environment is common. Whether NH decolonization of residents reduces MDRO contamination remains unclear. The PROTECT trial was a cluster-randomized trial of decolonization versus routine care in 28 California NHs from April 2017 through December 2018. Decolonization involved chlorhexidine bathing plus nasal iodophor (Monday–Friday, every other week), and it reduced resident nares and skin MDRO colonization by 36%. Methods: We swabbed high-touch objects in resident rooms and common areas for MDROs before and after the 3-month decolonization phase-in (April–July 2017). Five high-touch objects (bedrail, call button and TV remote, doorknob, light switch, and bathroom handles) were swabbed in 3 resident rooms per NH based on care needs (Alzheimer’s disease and related dementias (ADRD), ie, total care; ADRD, ambulatory care; and short stay). Five high-touch objects were also swabbed in the common area (nursing station, table, chair, railing, and drinking fountain). Swabs were processed for methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). We used generalized linear mixed models to assess the impact of decolonization on MDRO environmental contamination when clustering by NH and room and adjusting for room type and object because unclustered and unadjusted results are likely to be inaccurate. Results: A high proportion of rooms were contaminated with any MDRO in control NHs: 43 of 56 (77%) in the baseline period and 46 of 56 (82%) in the intervention period. In contrast, decolonization NHs had similar baseline contamination (45 of 56, 80%) but lower intervention MDRO contamination (29 of 48, 60%). When evaluating the intervention impact using multivariable models, decolonization was associated with significantly less room contamination for any MDRO (OR, 0.25; 95% CI, 0.06–0.96; P = .04) and MRSA (OR, 0.16; 95% CI, 0.05–0.55; P = .004) but nonsignificant reductions in VRE contamination (OR, 0.86; 95% CI, 0.23–3.13) and ESBL contamination (OR, 0.13; 95% CI, 0.01–1.62). CRE was not modeled due to rare counts (2 rooms total). In addition, room type was important, with common areas associated with 5-fold, 9-fold, and 3-fold higher contamination with any MDRO, MRSA, and VRE, respectively, compared with short-stay rooms. Conclusions: The high burden of MDROs in NHs calls for universal prevention strategies that can protect all residents. Although decolonization was associated with an 84% reduction in odds of MRSA contamination of inanimate room objects, significant reductions in VRE or ESBL contamination were not seen, possibly due to the lower proportion of baseline contamination due to these organisms. Multimodal strategies are needed to address high levels of MDRO contamination in NHs.Funding: NoneDisclosures: Gabrielle Gussin: Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals The Incidence, Characteristics, and Outcomes of Community and Hospital-Associated S. aureus Disease in Fulton County, Georgia

2020 ◽  
Vol 41 (S1) ◽  
pp. s81-s82
Author(s):  
Andrew Webster ◽  
Scott Fridkin ◽  
Susan Ray
Keyword(s):  
Hospital Discharge ◽  
Population Based ◽  
Incidence Rates ◽  
Outcome Data ◽  
Hospital Discharge Data ◽  
Invasive Infection ◽  
Emerging Infections ◽  
Inpatient Hospitalization ◽  
Discharge Data ◽  
Total Treatment

Background: Due to reliance on hospital discharge data for case identification, the burden of noninvasive and community-acquired S. aureus disease is often underestimated. To determine the full burden of S. aureus infections, we utilized population-based surveillance in a large urban county. Methods: The Georgia Emerging Infections Program (GA EIP) conducted CDC-funded, population-based surveillance by finding cases of S. aureus infections in 8 counties around Atlanta in 2017. Cases were residents with S. aureus isolated from either a normally sterile site in a 30-day period (invasive cases) or another site in a 14-day period (noninvasive cases). Medical records (all invasive and 1:4 sample of noninvasive cases) among Fulton County residents were abstracted for clinical, treatment, and outcome data. Cases treated were mapped to standard therapeutic site codes. Noninvasive specimens were reviewed and attributed to an invasive case if both occurred within 2 weeks. Incidence rates were calculated using 2017 census population and using a weight-adjusted cohort to account for sampling. Results: In total, 1,186 noninvasive (1:4 sample) and 529 invasive cases of S. aureus in Fulton county were reviewed. Only 35 of 1,186 (2.9%) noninvasive cases were temporally linked to invasive cases, resulting in 5,133 cases after extrapolation (529 invasive, 4,604 noninvasive). All invasive cases and 3,776 of 4,604 noninvasive cases (82%) were treated (4,305 total). Treatment was highest in skin (90%) and abscess (97%), lowest in urine (62%) and sputum (60%), and consisted of antibacterial agents alone (65%) or in addition to drainage procedures (35%). Overall, 41% of all cases were hospitalized, 12% required ICU admission, and 2.7% died, almost exclusively with bloodstream and pulmonary infections. Attribution of noninvasive infection was most often outside healthcare settings (87%); only 341 (7.9%) were hospital-onset cases; however, 34% of cases had had healthcare exposure in the preceding year, most often inpatient hospitalization (75%) or recent surgery (35%). Estimated countywide incidence was 414 per 100,000 (130 for MRSA and 284 for MSSA), invasive infection was 50 per 100,000. Among treated cases, 57% were SSTI, and the proportion of cases caused by MRSA was ~33% but varied slightly by therapeutic site (Fig. 1). Conclusions: The incidence of treated S. aureus infection in our large urban county is estimated to be 414 per 100,000 persons, which exceeds previously estimated rates based on hospital discharge data. Only 12% of treated infections were invasive, and <1 in 10 were hospital onset. Also, two-thirds of treated disease cases were MSSA; most were SSTIs.Funding: Proprietary Organization: Pfizer.Disclosures: Scott Fridkin, consulting fee - vaccine industry (spouse).

scholarly journals Profile of Nursing Homes Enrolled in the National Health Safety Network: Focus on Interfacility Communication

2020 ◽  
Vol 41 (S1) ◽  
pp. s523-s524
Author(s):  
Karen Jones ◽  
John Mills ◽  
Sarah Krein ◽  
Ana Montoya ◽  
Jennifer Meddings ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Infection Prevention ◽  
Phase 1 ◽  
Infection Prevention And Control ◽  
Internal Quality ◽  
Resistant Organism ◽  
Fisher Exact Test ◽  
Stewardship Program ◽  
Infection Surveillance ◽  
Communication Methods

Background: A robust infection prevention infrastructure is critical for creating a safe resident environment in nursing homes. The CDC NHSN provides a standardized approach to infection surveillance and analysis, which can drive internal quality improvement efforts in nursing homes and could serve as an indicator of facilities’ infection prevention aptitude. The purpose of this study was to compare the characteristics of nursing homes enrolled to those not enrolled in the NHSN, including interfacility communication methods, as an essential part of reducing resident infection-related risks. Methods: Over a 2-year period, 50 nursing homes participated in a 12-month program designed to reduce healthcare-associated infections (HAIs) by enhancing relationships between nursing homes and hospitals. Overall, 11 demographic surveys were administered to nursing homes prior to the start of the phase 1 pilot year between January and March 2018, and another 39 were administered prior to beginning phase 2 in January–February 2019. The survey consisted of 36 questions on facility characteristics, including NHSN enrollment, infection prevention and control (IPC) program and infection preventionist characteristics, and communication methods related to interfacility transfer of care. We compared facility, IPC program characteristics, and communication methods between nursing homes stratified based on NHSN enrollment. These were compared using the Fisher exact test. Results: In total, 50 nursing homes, varying in size and services provided, completed the demographic survey (Table 1). Of these 50 nursing homes, 11 (22%) were enrolled in the NHSN. Nursing homes enrolled in the NHSN were more likely to use a telephone report prior to resident transfer in and out of the facility (P = .04) and to disseminate infection data to all facility nursing staff (P = .02). Overall, less than half of nursing homes included a telephone report as part of their routine hand-off communication, and most nursing homes relied only on written transfer forms or discharge documentation. Moreover, 65% of the nursing homes reported use of a standardized method to accept new residents with history of multidrug-resistant organism (MDRO), including a review of infection or MDRO type, antibiotic orders, and ambulation status. NHSN-enrolled nursing homes were also more likely to have an antibiotic stewardship program and to use the electronic health record (EHR) to facilitate infection surveillance, though these differences were not statistically significant. Conclusions: A higher percentage of nursing homes enrolled in the NHSN engaged in activities connected with resident safety including verbal report prior to interfacility transfer and antimicrobial stewardship programs. Dedicating resources for nursing homes to enhance their IPC program including NHSN enrollment should be encouraged.Funding: This study was supported by a grant from the AHRQ (grant no. RO1HS25451).Disclosures: None

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