Community-Associated Strains of Methicillin-ResistantStaphylococccus aureusas the Cause of Healthcare-Associated Infection

2006 ◽  
Vol 27 (10) ◽  
pp. 1051-1056 ◽  
Author(s):  
Blanca E. Gonzalez ◽  
Adriana M. Rueda ◽  
Samuel A. Shelburne ◽  
Daniel M. Musher ◽  
Richard J. Hamill ◽  
...  
Keyword(s):  
Medical Center ◽  
Tertiary Care ◽  
Strain Analysis ◽  
Bloodstream Infections ◽  
Pfge Type ◽  
Molecular Characteristics ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Mrsa Strains ◽  
Healthcare Associated

Objective:Methicillin-resistantStaphylococcus aureus(MRSA) isolates from patients with community-associated infection have been described as strains genetically distinct from the strains isolated from patients with healthcare-associated infection. This study examines the hypothesis that community-associated MRSA (CA-MRSA) strains now cause serious infections in hospitalized patients.Methods.Thirty-seven clinical MRSA isolates were randomly selected from blood isolates obtained from July 2003 through June 2004. Strains were tested for staphylococcal chromosomal cassettemec(SCCmec) type, pulsed-field gel electrophoresis (PFGE) type, and presence of Panton-Valentine leukocidin (PVL) genes. Medical records review and epidemiologic classification was performed by an investigator blinded to the results of the bacterial strain analysis. Episodes of bloodstream infection were independently classified as either community-associated or healthcare-associated infections, and bacterial isolates were independently classified as either CA-MRSA strains or healthcare-associated MRSA (HA-MRSA) strains, according to established definitions.Setting.A tertiary care Veterans Affairs Medical Center.Results.Twenty-four (65%) of 37 MRSA isolates were SCCmectype IV, a genetic type characteristic of CA-MRSA strains; 22 of these 24 isolates belonged to the CA-MRSA clone USA300 and carried PVL genes. Thirteen (35%) of the 37 strains were SCCmectype II, of which 12 were USA100-ST5 and 12 lacked PVL genes. Thirty patients (81%) had healthcare-associated infections; 18 (60%) of these 30 were infected with isolates carrying markers of CA-MRSA strains. Of 7 patients with CA-MRSA infections, 6 were infected with isolates belonging to the USA300 clone. Patients with healthcare-associated bloodstream infections were as likely to be infected with a CA-MRSA strain as patients with a community-associated infection (P= .38).Conclusions.MRSA strains with molecular characteristics of CA-MRSA strains have emerged as an important cause of serious health-care-associated infection in our hospital.

scholarly journals Indirect Versus Direct Standardization Methods for Reporting Healthcare-Associated Infections: An Analysis of Central Line–Associated Bloodstream Infections in Maryland

2017 ◽  
Vol 38 (8) ◽  
pp. 989-992 ◽  
Author(s):  
Lyndsay M. O’Hara ◽  
Max Masnick ◽  
Surbhi Leekha ◽  
Sarah S. Jackson ◽  
Natalia Blanco ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Acute Care ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Healthcare Associated ◽  
Direct Standardization ◽  
Standardization Methods

Whether healthcare-associated infection data should be presented using indirect (current CMS/CDC methodology) or direct standardization remains controversial. We applied both methods to central-line–associated bloodstream infection data from 45 acute-care hospitals in Maryland from 2012 to 2014. We found that the 2 methods generate different hospital rankings with payment implications.Infect Control Hosp Epidemiol 2017;38:989–992

Prevalence of Colonization With Community-Associated Methicillin-ResistantStaphylococcus aureusAmong End-Stage Renal Disease Patients and Healthcare Workers

2009 ◽  
Vol 30 (1) ◽  
pp. 4-8 ◽  
Author(s):  
Leonard B. Johnson ◽  
Jinson Jose ◽  
Farah Yousif ◽  
Joan Pawlak ◽  
Louis D. Saravolatz
Keyword(s):  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
High Rate ◽  
Molecular Characteristics ◽  
Dialysis Patients ◽  
Type Iv ◽  
Mrsa Strains ◽  
Stage Renal Disease ◽  
Healthcare Associated

Objective.To evaluate the prevalence, epidemiologic features, and molecular characteristics of colonization with community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) among hospitalized dialysis patients and their healthcare workers (HCWs).Design.Prospective observational clinical and laboratory study of nasal colonization.Setting.A 600-bed urban academic medical center.Subjects.One hundred twenty hospitalized dialysis inpatients and 100 HCWs.Results.Of 120 patients, 40 (33%) were colonized withS. aureus; 26 (65%) of these 40 were colonized with MRSA. Among the 26 MRSA isolates, 10 (38.5%) carried staphylococcal cassette chromosome (SCC)mectype IV (ie, CA-MRSA), and 7 of these 10 carried the genes for the Panton-Valentine leukocidin (PVL) toxin. Patients colonized with healthcare-associated MRSA strains and those colonized with CA-MRSA strains were similar, except for a higher frequency of a history of congestive heart failure among those with healthcare-associated MRSA strains (P= .014). Among 10 patients who presented with or developed anS. aureusinfection while hospitalized, 8 were colonized withS. aureus, 7 with MRSA, and 3 with SCCmectype IV strains. Among 100 HCWs, 31 were colonized withS. aureus, including 6 with MRSA; 2 of the MRSA isolates belonged to CA-MRSA strains, and soft-tissue infections were reported in one of the HCWs and in the family member of the other HCW colonized with these strains.Conclusions.There is a high rate of colonization with MRSA and CA-MRSA among hospitalized dialysis patients and their HCWs. As other studies have found, it appears that individuals are being colonized with both CA-MRSA strains and healthcare-associated MRSA strains.

Burden of healthcare-associated infections at six tertiary-care hospitals in Saudi Arabia: A point prevalence survey

2019 ◽  
Vol 40 (3) ◽  
pp. 355-357 ◽  
Author(s):  
Majid M. Alshamrani ◽  
Aiman El-Saed ◽  
Asim Alsaedi ◽  
Ayman El Gammal ◽  
Wafa Al Nasser ◽  
...  
Keyword(s):  
Saudi Arabia ◽  
Tertiary Care ◽  
Bloodstream Infections ◽  
Point Prevalence ◽  
Healthcare Associated Infections ◽  
Prevalence Survey ◽  
Point Prevalence Survey ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Tertiary Care Hospitals

AbstractA point prevalence survey was conducted on May 11, 2017, among inpatients at 6 hospitals in Saudi Arabia. The overall point prevalence was 6.8% (114 of 1,666). The most common types of infections were pneumonia (27.2%), urinary tract infections (20.2%), and bloodstream infections (10.5%). Approximately 19.2% of healthcare-associated infections were device associated.

Emergence of Community-Associated Methicillin-ResistantStaphylococcus aureusStrains as a Cause of Healthcare-Associated Bloodstream Infections in Korea

2009 ◽  
Vol 30 (2) ◽  
pp. 146-155 ◽  
Author(s):  
Sun Hee Park ◽  
Chulmin Park ◽  
Jin-Hong Yoo ◽  
Su-Mi Choi ◽  
Jung-Hyun Choi ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Protein A ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Pfge Type ◽  
Type D ◽  
Epidemiological Changes ◽  
Mrsa Strains ◽  
Associated Risk Factors ◽  
Healthcare Associated

Background.The prevalence of community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) strains causing bloodstream infection (BSI) has not been studied in Korea.Objective.We sought to determine the prevalence of CA-MRSA strains among isolates recovered from patients with MRSA BSIs and to explore epidemiological changes in Korea. We also sought to evaluate clinical characteristics relevant to the development of healthcare-associated BSIs.Methods.We prospectively collected consecutive MRSA isolates from patients with BSI at 4 hospitals from July 1 through November 30, 2007, and we also included MRSA isolates recovered from culture of blood samples collected during a previous year (October 1, 2004 through September 30, 2005) at a different hospital. Molecular typing studies were performed, including pulsed-field gel electrophoresis (PFGE), multilocus sequence typing,Staphylococcusprotein A (spa) typing, and staphylococcal cassette chromosomemec(SCCmec) typing. We compared the clinical characteristics and outcomes of patients with healthcare-associated BSI due to CA-MRSA strains with those of patients with healthcare-associated BSI due to healthcare-associated MRSA (HA-MRSA) strains.Results.There were 76 cases of MRSA BSI, of which 4 (5.3%) were community-associated and 72 (94.7%) were healthcare-associated. Among the 72 HA-MRSA BSIs, 18 (25%) were community onset, and 54 (75%) were hospital onset. PFGE type D-ST72–spaB-SCCmectype IVA MRSA, the predominant genotype of CA-MRSA in Korea, accounted for 19 (25%) of all 76 MRSA BSIs, including 17 (23.6%) of 72 HA-MRSA BSIs and 11 (20.8%) of 53 hospital-onset HA-MRSA BSIs. Patients with healthcare-associated BSIs due to CA-MRSA strains carrying SCCmectype IVA tended to have fewer healthcare-associated risk factors, compared with patients with healthcare-associated BSIs due to HA-MRSA strains carrying other SCCmectypes. The presence of a central venous catheter or other invasive device was the only independent factor differentiating patients infected with hospital-associated genotype strains from patients infected with other strains. Clinical outcomes were similar between both groups.Conclusions.CA-MRSA strains are emerging as a major cause of BSI in healthcare settings in Korea. This changing epidemiology of MRSA poses a challenge to public health and infection control in hospital settings.

scholarly journals Healthcare associated infections in a tertiary care cardiac hospital: A point prevalence survey.

2019 ◽  
Vol 2 (1) ◽  
pp. 8-12
Author(s):  
Maham Zahid ◽  
Aysha Siddiqa ◽  
Rehna Javaid ◽  
Hafsa Khalil ◽  
Farrah Pervaiz
Keyword(s):  
Hospital Stay ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Public Health Problem ◽  
Hospitalized Patients ◽  
Point Prevalence ◽  
Major Public Health Problem ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

Objective: Hospitalized patients can pick infections from healthcare facilities which may lead to extended hospital stay, increased morbidity and mortality of hospitalized patients and economic burden on health care. Active surveillance of HAIs that is continuous and prospective in nature has been accepted as a gold standard approach in preventing and controlling healthcare associated infections. To estimate the prevalence HAIs and their types in a tertiary care cardiac center and to identify associated risk factors. Methodology: Nine prospective point prevalence surveys were conducted on three separate days in three consecutive weeks for three months. A data collectors team comprising of two research officers and an infection control nurse, visited the enrolled patients and patient’s history, demographics, physical examination, laboratory findings and other details were reviewed from patient files and recorded on study questionnaire. Results: A total of 559 patients were enrolled in the study. The prevalence of HAIs was 6.4%, which means 36 HAIs were identified in 559 patients. Univariate analysis showed a significant association between HAI and being in ICU/CCU ward (OR 3.4, 95% CI 1.5-7.4) longer duration of hospital stay (OR 3.0, 95% CI 1.5-6.0, P=0.001), exposure to urinary catheter, use of antimicrobials (OR 2.8, 95% CI 1.3-6.1, P=0.006), and diabetes (OR 2.5, 95% CI 1.2-5.2, P=0.008). Conclusion: Healthcare associated infection is a major public health problem and rate of HAIs in the selected centers was found to be 6.4%. Present survey provided baseline evidence for further surveillance and multifaceted infection.

scholarly journals Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work?

2018 ◽  
Vol 33 (5) ◽  
Author(s):  
Anne L. Armour ◽  
Mark E. Patrick ◽  
Zelda Reddy ◽  
Wilbert Sibanda ◽  
Logandran Naidoo ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Infection Control ◽  
Bloodstream Infections ◽  
Venous Catheter ◽  
Control Programme ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Tract Infections ◽  
Healthcare Associated ◽  
Infection Control Programme

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.

Effect of Hospital-Wide Chlorhexidine Patient Bathing on Healthcare-Associated Infections

2012 ◽  
Vol 33 (11) ◽  
pp. 1094-1100 ◽  
Author(s):  
Mark E. Rupp ◽  
R. Jennifer Cavalieri ◽  
Elizabeth Lyden ◽  
Jennifer Kucera ◽  
MaryAnn Martin ◽  
...  
Keyword(s):  
Critical Care ◽  
Relative Risk ◽  
Washout Period ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Significant Rise ◽  
Healthcare Associated Infections ◽  
Dose Escalation Study ◽  
Healthcare Associated

Background.Chlorhexidine gluconate (CHG) bathing has been used primarily in critical care to prevent central line-associated bloodstream infections and infections due to multidrug-resistant organisms. The objective was to determine the effect of hospital-wide CHG patient bathing on healthcare-associated infections (HAIs).Design.Quasi-experimental, staged, dose-escalation study for 19 months followed by a 4-month washout period, in 3 cohorts.Setting.Academic medical center.Patients.All patients except neonates and infants.Intervention and Measurements.CHG bathing in the form of bed basin baths or showers administered 3 days per week or daily. CHG bathing compliance was monitored, and the rate of HAIs was measured.Results.Over 188,859 patient-days, 68,302 CHG baths were administered. Adherence to CHG bathing in the adult critical care units (90%) was better than that observed in other units (57.7%, P< .001). A significant decrease in infections due to Clostridium difficile was observed in all cohorts of patients during the intervention period, followed by a significant rise during the washout period. For all cohorts, the relative risk of C. difficile infection compared to baseline was 0.71 (95% confidence interval [CI], 0.57–0.89; P = .003) for 3-days-per-week CHG bathing and 0.41 (95% CI, 0.29–0.59; P < .001) for daily CHG bathing. During the washout period, the relative risk of infection was 1.85 (95% CI, 1.38–2.53; P =< .001), compared to that with daily CHG bathing. A consistent effect of CHG bathing on other HAIs was not observed. No adverse events related to CHG bathing were reported.Conclusions.CHG bathing was well tolerated and was associated with a significant decrease in C. difficile infections in hospitalized patients.

Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 06-12
Author(s):  
Zahidul Hasan ◽  
Md. Kamrul Islam ◽  
Arifa Hossain
Keyword(s):  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Gram Negative ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

Mycobacteriosis as a Healthcare-Associated Infection: A Review of Epidemiologic Studies

2020 ◽  
pp. 37-41
Author(s):  
IV Petrov ◽  
TKh Amirova ◽  
LV Petrova ◽  
FS Petrova
Keyword(s):  
Skin Diseases ◽  
Nontuberculous Mycobacteria ◽  
Clinical Manifestations ◽  
Mycobacterial Infection ◽  
Epidemiologic Studies ◽  
Health Facilities ◽  
Water Supply Systems ◽  
Healthcare Associated Infections ◽  
Healthcare Associated Infection ◽  
Healthcare Associated

Introduction: Healthcare-associated infections are of great socio-economic importance and are characterized by a large number of different pathogens. Nontuberculous mycobacteria are ubiquitous microorganisms that can circulate in a medical organization. The purpose of this review of epidemiologic studies was to establish the main features of mycobacteriosis as a healthcare-associated infection, taking into account the significance of the results and the compliance of the reviewed studies with the criteria of evidence-based medicine. Methods: We did a key word search for “nontuberculous mycobacteria”, “healthcare-associated infections”, and “mycobacteriosis” in several electronic bibliographic databases including Web of Science, PubMed, eLIBRARY, and ResearchGate and selected 127 out of 342 search results. Having analyzed the selected articles, we decided to include 34 of them in this study according to the topic of work. We established that nontuberculous mycobacteria can be found in various objects of health facilities, e.g. water supply systems, medical products and equipment. We also found that mycobacterial infection of nosocomial etiology could have various clinical manifestations (arthritis, keratitis, circulatory and skin diseases, etc.) determined by various aspects, such as heterogeneity of the group of nontuberculous mycobacteria, portals of entry (surgical procedures on various organs and systems of the human body, etc.), pathways of exposure and transmission factors. Resistance of nontuberculous mycobacteria to a number of disinfectants is a special question defining the importance of profound research in terms of ensuring sanitary and anti-epidemic (disinfection) safety within health facilities. Conclusions: Our findings indicate that mycobacterial infection can be considered as a healthcare-associated infection requiring an in-depth assessment from various perspectives including a microbiological monitoring of medical objects, statistical accounting of nosocomial infections, and clinical alertness in the diagnosis of mycobacteriosis by attending physicians and bacteriologists, etc.

scholarly journals Pathogens Associated With Repeat Versus Single Central-Line–Associated Bloodstream Infections, Acute-Care Hospitals, NHSN

2020 ◽  
Vol 41 (S1) ◽  
pp. s343-s344
Author(s):  
Margaret A. Dudeck ◽  
Katherine Allen-Bridson ◽  
Jonathan R. Edwards
Keyword(s):  
Acute Care ◽  
National Level ◽  
Bloodstream Infections ◽  
Acute Care Hospitals ◽  
Central Line ◽  
Patient Specific ◽  
Healthcare Associated Infections ◽  
Healthcare Associated ◽  
Repeat Infection ◽  
Single Versus

Background: The NHSN is the nation’s largest surveillance system for healthcare-associated infections. Since 2011, acute-care hospitals (ACHs) have been required to report intensive care unit (ICU) central-line–associated bloodstream infections (CLABSIs) to the NHSN pursuant to CMS requirements. In 2015, this requirement included general medical, surgical, and medical-surgical wards. Also in 2015, the NHSN implemented a repeat infection timeframe (RIT) that required repeat CLABSIs, in the same patient and admission, to be excluded if onset was within 14 days. This analysis is the first at the national level to describe repeat CLABSIs. Methods: Index CLABSIs reported in ACH ICUs and select wards during 2015–2108 were included, in addition to repeat CLABSIs occurring at any location during the same period. CLABSIs were stratified into 2 groups: single and repeat CLABSIs. The repeat CLABSI group included the index CLABSI and subsequent CLABSI(s) reported for the same patient. Up to 5 CLABSIs were included for a single patient. Pathogen analyses were limited to the first pathogen reported for each CLABSI, which is considered to be the most important cause of the event. Likelihood ratio χ2 tests were used to determine differences in proportions. Results: Of the 70,214 CLABSIs reported, 5,983 (8.5%) were repeat CLABSIs. Of 3,264 nonindex CLABSIs, 425 (13%) were identified in non-ICU or non-select ward locations. Staphylococcus aureus was the most common pathogen in both the single and repeat CLABSI groups (14.2% and 12%, respectively) (Fig. 1). Compared to all other pathogens, CLABSIs reported with Candida spp were less likely in a repeat CLABSI event than in a single CLABSI event (P < .0001). Insertion-related organisms were more likely to be associated with single CLABSIs than repeat CLABSIs (P < .0001) (Fig. 2). Alternatively, Enterococcus spp or Klebsiella pneumoniae and K. oxytoca were more likely to be associated with repeat CLABSIs than single CLABSIs (P < .0001). Conclusions: This analysis highlights differences in the aggregate pathogen distributions comparing single versus repeat CLABSIs. Assessing the pathogens associated with repeat CLABSIs may offer another way to assess the success of CLABSI prevention efforts (eg, clean insertion practices). Pathogens such as Enterococcus spp and Klebsiella spp demonstrate a greater association with repeat CLABSIs. Thus, instituting prevention efforts focused on these organisms may warrant greater attention and could impact the likelihood of repeat CLABSIs. Additional analysis of patient-specific pathogens identified in the repeat CLABSI group may yield further clarification.Funding: NoneDisclosures: None

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