Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

2003 ◽  
Vol 24 (6) ◽  
pp. 431-435 ◽  
Author(s):  
Leonard B. Johnson ◽  
Arti Bhan ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Electric Fields ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Facility ◽  
Retrospective Case ◽  
Term Care ◽  
Methicillin Resistant ◽  
Community Onset

AbstractObjectives:To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.Design:Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.Setting:A 600-bed urban academic medical center.Patients:Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.Results:The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.Conclusions:Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.

scholarly journals 469. Contributions of Infections among Persons Who Inject Drugs to the Changing Incidence of Healthcare-Associated, Community-Onset Methicillin-Resistant Staphylococcus aureus Infections, 2009–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S229-S230
Author(s):  
Kelly A Jackson ◽  
Runa Hatti Gokhale ◽  
Joelle Nadle ◽  
Susan Petit ◽  
Susan Ray ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Care Facility ◽  
Term Care ◽  
Persons Who Inject Drugs ◽  
Methicillin Resistant ◽  
Long Term Care Facility ◽  
Active Population ◽  
Healthcare Associated ◽  
Community Onset

Abstract Background Recently, overall reductions for invasive MRSA infections (isolation from a normally sterile site) have slowed. Healthcare-associated community-onset (HACO) invasive methicillin-resistant Staphylococcus aureus (MRSA) infections are those with recent healthcare exposures who develop MRSA infection outside acute care hospitals, and account for most invasive MRSA infections. HACO incidence decreased 6.6% per year during 2005–2008; the contribution of persons who inject drugs (PWID) to HACO incidence has not been reported. Methods We identified invasive MRSA infections using active, population- and laboratory-based surveillance data during 2009–2017 from 25 counties in 7 sites (CA, CT, GA, MD, MN, NY, TN). Cases were HACO if culture was obtained from an outpatient, or ≤3 days after hospitalization in a patient with ≥1 of the following healthcare exposures (HEs): hospitalization, surgery, dialysis, or residence in a long-term care facility (LTCF) in the past year; or central vascular catheter ≤2 days before culture. We calculated incidence (per census population) overall, for PWID cases and others, and for cases associated with each HE. For each HE, we calculated the proportion of overall incidence increase for PWID and others. Results HACO MRSA incidence declined overall from 2009 to 2016 but increased from 2016 to 2017 overall (8%), for both PWID (63%) and others (5%) (figure). For both PWID and non-PWID, incidence from 2016 to 2017 increased by 0.5 cases/100,000 population; 91% of the increase in PWID occurred in cases with a past year hospitalization while 78% of the increase in cases not associated with injection drug use (IDU) occurred in cases with past year LTCF residence. Past year LTCF residence was less common among PWID (16%) then among other cases (38%, P < 0.01). Conclusion After years of declines, HACO MRSA incidence increased equally in 2017 for cases associated with IDU and in cases unrelated to IDU. Increases in PWID-associated cases account for half the overall increase, indicating that efforts to reduce HACO MRSA should address PWID risk factors as these infections may be due to self-injection. In addition, increases not related to PWID, if sustained, would be a reversal of historic trends and require further investigation into causes. Disclosures All authors: No reported disclosures.

Topical Therapy for Methicillin-Resistant Staphylococcus aureus Colonization Impact on Infection Risk

2009 ◽  
Vol 30 (7) ◽  
pp. 623-632 ◽  
Author(s):  
Ari Robicsek ◽  
Jennifer L. Beaumont ◽  
Richard B. Thomson ◽  
Geetha Govindarajan ◽  
Lance R. Peterson
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Topical Therapy ◽  
Care Facility ◽  
Term Care ◽  
Methicillin Resistant ◽  
Mrsa Infection ◽  
Independent Risk Factors ◽  
The Impact

Objective.We evaluated the usefulness of topical decolonization therapy for reducing the risk of methicillin-resistant Staphylococcus aureus (MRSA) infection among MRSA-colonized inpatients.Design.Retrospective cohort study.Setting and Intervention.Three hospitals with universal surveillance for MRSA; at their physician's discretion, colonized patients could be treated with a 5-day course of nasal mupirocin calcium 2%, twice daily, plus Chlorhexidine gluconate 4% every second day.Patients and Methods.MRSA carriers were later retested for colonization (407 subjects; study 1) or followed up for development of MRSA infection (933 subjects; study 2). Multivariable methods were used to determine the impact of decolonization therapy on the risks of sustained colonization (in study 1) and MRSA infection (in study 2).Results.Independent risk factors for sustained colonization included residence in a long-term care facility (odds ratio [OR], 1.8 [95% confidence interval {CI}, 1.1–3.2]) and a pressure ulcer (OR, 2.3 195% CI, 1.2–4.4]). Mupirocin at any dose decreased this risk, particularly during the 30-60-day period after therapy; mupirocin resistance increased this risk (OR, 4.1 [95% CI, 1.6–10.7]). Over a median follow-up duration of 269 days, 69 (7.4%) of 933 patients developed infection. Independent risk factors for infection were length of stay (hazard ratio [HR], 1.2 per 5 additional days [95% CI, 1.0–1.4]), chronic lung disease (HR, 1.7 [95% CI, 1.0–2.8]), and receipt of non-MRSA-active systemic antimicrobial agents (HR, 1.8 [95% CI, 1.1–3.1]). Receipt of mupirocin did not affect the risk of infection, although there was a trend toward delayed infection among patients receiving mupirocin (median time to infection, 50 vs 15.5 days; P = .06).Conclusions.Mupirocin-based decolonization therapy temporarily reduced the risk of continued colonization but did not decrease the risk of subsequent infection.

Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation

2014 ◽  
Vol 5 (4) ◽  
pp. 389-395 ◽  
Author(s):  
S. Warrack ◽  
P. Panjikar ◽  
M. Duster ◽  
N. Safdar
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Resistant Bacteria ◽  
Public Health Importance ◽  
Methicillin Resistant ◽  
History Of ◽  
Study Population

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.

Evidence of Delays in Transferring Patients With Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococcus to Long-Term–Care Facilities

2000 ◽  
Vol 21 (4) ◽  
pp. 270-271 ◽  
Author(s):  
Elizabeth A. Bryce ◽  
Shelley M. Tiffin ◽  
Judith L. Isaac-Renton ◽  
Charles J. Wright
Keyword(s):  
Staphylococcus Aureus ◽  
Long Term Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Retrospective Case ◽  
Term Care ◽  
Methicillin Resistant ◽  
Care Facilities ◽  
Vancomycin Resistant ◽  
Control Study

This retrospective case-control study examined whether there was a difference in length of time awaiting long-term-care lacement for patients identified as having methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus compared to controls. Thirty-nine patients with methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus waited for placement an average of 61 days longer than controls (P<.0002). The average number of requests for placement was 2.5 compared to 1.7 for controls (P=.015).

scholarly journals Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Clinical Isolates during 7.5 Years in One Regional Hospital in Israel

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Regev Cohen ◽  
Svetlana Paikin ◽  
Talya Finn ◽  
Frida Babushkin ◽  
Einav Anuka ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Molecular Epidemiology ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Care Facility ◽  
Bloodstream Infections ◽  
Regional Hospital ◽  
Spa Typing ◽  
Term Care ◽  
Methicillin Resistant ◽  
Spa Types

Background. The clonal repertoire of community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) strains appear to differ between hospitals and geographic locations. We aimed to study the molecular epidemiology of MRSA infections in our regional hospital in Israel. Methods. A retrospective analysis of MRSA isolates from hospitalized patients, which underwent spa typing between 2012 and 2019. Mainly, MRSA-bloodstream isolates were typed. Isolates were grouped into healthcare-associated (HcA) or community-associated (CA). HcA were further divided into hospital-related or long-term care facility- (LTCF-) related. Several representatives underwent SCCmec typing. Results. We analyzed 166 clinical MRSA isolates: 115 (70%) bloodstream, 42 (25%) wounds/abscesses, and 9 (5%) screening isolates. 145 (87%) were HcA, and 21 (13%) were CA. Common (72%) spa types were t002, t032, t008, t001, and t065. Eighty (55%) isolates were attributed to LTCFs and 65 isolates to our hospital, both showing similar spa types distribution. The most prevalent spa type among patients with HcA infection was t002 (50 isolates, 32%), followed by t032, t065, t578, t008, and t001. Most (88/115, 77%) bloodstream infections (BSIs) were HcA, typically occurring in the same facility in which the infection was acquired. In 27 cases (23%), the BSI developed in the community setting, and in half of these cases, a previous healthcare system exposure was evident. Conclusions. The MRSA clonal population in this longitudinal study was stable and consisted mainly of molecular lineages widespread in Europe. SCCmec-IV strains play a major role in causing MRSA infections in the healthcare settings, especially in LTCFs. Community-acquired MRSA BSIs without any previous healthcare exposure are still relatively rare.

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