Methicillin-Resistant Staphylococcus aureus: A 5-Year Review of Surveillance Data in a Tertiary Care Hospital in Saudi Arabia

2007 ◽  
Vol 28 (8) ◽  
pp. 976-982 ◽  
Author(s):  
H. H. Balkhy ◽  
Z. A. Memish ◽  
M. A. Almuneef ◽  
G. C. Cunningham ◽  
C. Francis ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Saudi Arabia ◽  
Infection Control ◽  
Tertiary Care ◽  
Surveillance Data ◽  
Control Policies ◽  
Methicillin Resistant ◽  
Increasing Trend ◽  
Mrsa Infection ◽  
Hospital Acquired

Background.Staphylococcus aureus is an important pathogen that leads to serious infections in the community and in hospitals. Evidence has shown that the prevalence of infection and colonization with drug-resistant S. aureus, such as methicillin-resistant S. aureus (MRSA) and glycopeptide intermediately susceptible S. aureus, is increasing. Authorities must be aware of the prevalence of MRSA infection and colonization in their country in order to implement and monitor infection control policies that help curtail further emergence of this pathogen.Objectives.To examine the trend of hospital-acquired MRSA infection and colonization in a tertiary care institution in Saudi Arabia during a 5-year period in order to identify specific areas at high risk for MRSA transmission, and to review our MRSA decolonization procedure and outcomes.Methods.Surveillance data prospectively collected from January 1, 2000, through December 31, 2004, on hospital-acquired (HA) MRSA were analyzed, with an emphasis on the trend of HA-MRSA infection and colonization, areas of high transmission, risk factors, and effectiveness of the implemented decolonization policy.Results.During the study period, 442 cases of HA-MRSA infection and colonization were identified. Of these, 51.2% were infections, and 48.8% were colonizations. An increasing trend in the incidence rates of infection and colonization was noticed during the study period, and most cases were identified on the surgical ward (33.3%) and medical ward (32.1%). Of the 34 infected patients who underwent systematic decolonization, 35.3% were successfully decolonized, and of the 11 who underwent topical decolonization, 63.6% were successfully decolonized.Conclusion.The increasing trend of HA-MRSA infections has been a noticeable global problem. We identified a gradual increase in the rates of MRSA colonization and infection in a tertiary care center Saudi Arabia and recognize the importance of abiding by strict infection control policies, including hand hygiene and proper isolation practices. Continued surveillance for MRSA and other emerging multidrug-resistant pathogens is also needed.

Methicillin-Resistant Staphylococcus aureus in Two Tertiary-Care Centers in Jeddah, Saudi Arabia

2001 ◽  
Vol 22 (4) ◽  
pp. 211-216 ◽  
Author(s):  
Tariq A. Madani ◽  
Nabeela A. Al-Abdullah ◽  
Ali A. Al-Sanousi ◽  
Tawfik M. Ghabrah ◽  
Shadia Z. Afandi ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Saudi Arabia ◽  
Tertiary Care ◽  
Age Groups ◽  
Clinical Manifestations ◽  
Total Mortality ◽  
Control Measures ◽  
Methicillin Resistant ◽  
Mrsa Infection ◽  
Tertiary Care Hospitals

AbstractObjective:To review clinical experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary-care hospitals in Jeddah, Saudi Arabia.Design:Retrospective review for the year 1998.Setting:Two tertiary-care hospitals.Methods:Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the microbiology laboratories' records. Charts of patients were reviewed, with standardized data collection.Results:Of 673 S aureus isolates identified, 222 (33%, or 6.8 isolates/1,000 admissions) were MRSA Overall MRSA prevalence was 2% in 1988. Nosocomial acquisition occurred in 84.2% of cases. All age groups were affected, and 52% of patients had at least one comorbidity. MRSA prevalence was highest in the intensive care units (26.6% of all isolates), the medical wards (24.8%), and the surgical wards (19.8%). Seventy-three percent of isolates caused infection; the rest represented colonization. Surgical wounds (35.2%), the chest (29%), and central venous catheters (13%) were the most common sites of infection. Bacteremia occurred in 15.4% of patients. Local signs (84%) and fever (75.9%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 30.2% and 13.6% of cases, respectively. Of 162 patients with MRSA infection and 60 patients with MRSA colonization, 95.7% and 70% received antibiotics in the preceding 6 weeks, respectively (P<.0001). The total mortality of patients with MRSA infection was 53.7%: 36.4% as a result of MRSA infection and 17.3% as a result of other causes.Conclusions:The prevalence of MRSA is high and rapidly increasing in the two hospitals, as it is worldwide. Control measures to prevent die spread of MRSA in hospitals should continue, with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.

scholarly journals Methicillin Resistant Staphylococcus aureus: Prevalence And Antibiogram In A Tertiary Care Hospital in Western Nepal

2009 ◽  
Vol 3 (09) ◽  
pp. 681-684 ◽  
Author(s):  
Hare Krishna Tiwari ◽  
Ayan Kumar Das ◽  
Darshan Sapkota ◽  
Kunjukunju Sivrajan ◽  
Vijay Kumar Pahwa
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Inhibitory Concentration ◽  
Tertiary Care ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Mrsa Strains ◽  
Susceptibility Tests ◽  
Rational Use Of Antibiotics ◽  
Hospital Acquired

Background: Methicillin resistant Staphylococcus aureus (MRSA) is a major cause of nosocomial and community infections. Its prevalence varies with country and with hospitals within a country. The current study estimates the prevalence of MRSA strains and investigates their antibiogram in western Nepal. Methodology: A total of 162 S. aureus strains were isolated from various clinical specimens, and antibiotic susceptibility tests were performed using disc diffusion, growth on oxacillin screen agar, and oxacillin minimum inhibitory concentration (MIC). Results: One hundred and twelve (69.1%) strains were found to be MRSA, of which 37 (33.1%) were community acquired and 75 (66.9%) were hospital acquired. Of 112 MRSA strains, 45 (40.1%) were multi-drug resistant. All MRSA strains were found resistant to penicillin, and 91.9%, 87.4%, 77%, and 55.5% were resistant to amoxicillin, ampicillin, trimethoprim/sulfamethoxazole, and cephalexin, respectively. However, low resistance was observed with amikacin (19%), ciprofloxacin (26.5%), and norfloxacin (30.6%). All strains were sensitive to vancomycin. Conclusion: The reported rate of MRSA prevalence is alarming. Given the ability of MRSA to spread from person to person, it is necessary to adhere to rational use of antibiotics and to raise awareness among the concerned communities and tourists who visit this area.

A Prolonged Outbreak of Methicillin-Resistant Staphylococcus aureus in the Burn Unit of a Tertiary Medical Center

1996 ◽  
Vol 17 (12) ◽  
pp. 798-802 ◽  
Author(s):  
Patricia A. Meier ◽  
Cheryl D. Carter ◽  
Sarah E. Wallace ◽  
Richard J. Hollis ◽  
Michael A. Pfaller ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Healthcare Workers ◽  
Medical Center ◽  
Tertiary Care ◽  
Chromosomal Dna ◽  
Methicillin Resistant ◽  
Persistent Problem ◽  
Tertiary Care Medical Center ◽  
Burn Unit

AbstractObjective:To report an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) in our burn unit and the steps we used to eradicate the organism.Design And Setting:Outbreak investigation in the burn unit of a 900-bed tertiary-care medical center.Outbreak:Between March and June 1993, MRSA was isolated from 10 patients in our burn unit. All isolates had identical antibiograms and chromosomal DNA patterns.Control Measures:Infection control personnel encouraged healthcare workers to wash their hands after each patient contact. The unit cohorted all infected or colonized patients, placed each affected patient in isolation, and, if possible, transferred the patient to another unit. Despite these measures, new cases occurred. Infection control personnel obtained nares cultures from 56 healthcare workers, 3 of whom carried the epidemic MRSA strain. One healthcare worker cared for six affected patients, and one cared for five patients. We treated the three healthcare workers with mupirocin. Subsequently, no additional patients became colonized or infected with the epidemic MRSA strain.Conclusions:The outbreak ended after we treated healthcare workers who carried the epidemic strain with mupirocin. This approach is not appropriate in all settings. However, we felt it was justified in this case because of a persistent problem after less intrusive measures.

scholarly journals IS ACQUISITION OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS - AN OCCUPATIONAL HAZARD FOR MEDICAL STUDENTS IN INDIA?

2017 ◽  
Vol 10 (12) ◽  
pp. 141 ◽  
Author(s):  
Shreyas K ◽  
Radhakrishna M ◽  
Ashwini Hegde ◽  
Pooja Rao
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Students ◽  
Susceptibility Testing ◽  
Tertiary Care ◽  
Nasal Carriage ◽  
Occupational Hazard ◽  
Carriage Rate ◽  
Methicillin Resistant ◽  
Drug Resistant Strains ◽  
Hospital Acquired

  Objective: The incidence of community-acquired and hospital-acquired Staphylococcus aureus infections has been rising with increasing emergence of drug-resistant strains called methicillin-resistant S. aureus (MRSA). The main objective of this study was to determine the prevalence of carriage rate of MRSA among the interns of tertiary care teaching hospital in Mangalore.Methods: A total of 150 interns were participated, thereby swabs from both anterior nares were collected and processed for S. aureus. The isolated strains of S. aureus were screened for methicillin susceptibility by modified Kirby–Bauer method using cefoxitin (30 μg) disc. Further, antibiotic susceptibility testing for all isolates of S. aureus was also done against selected appropriate antibiotics. Vancomycin susceptibility testing for MRSA was done by E test.Results: The number of strains of S. aureus isolated from our 150 participants was 71 with a percentage rate of 47.3. Of the 71 isolates of S. aureus, one (1.4%) was MRSA. The overall MRSA carriage rate was 0.66%. The S. aureus and MRSA carriage rates recorded in this study were at par and significantly lower, respectively, when compared with other reported studies. It was observed that risk factors such as the use of antibiotics in the past 6 months and smoking were found to be statistically significant in nasal carriage status of S. aureus (<0.05). The only one isolate of MRSA was found to be sensitive to vancomycin, linezolid, and teicoplanin.Conclusion: It was concluded that the acquisition of S. aureus and MRSA would not be an occupational hazard for medical students of developing countries like India.

Colonization With Methicillin-Resistant Staphylococcus aureus in ICU Patients Morbidity, Mortality, and Glycopeptide Use

2001 ◽  
Vol 22 (11) ◽  
pp. 687-692 ◽  
Author(s):  
Maité Garrouste-Orgeas ◽  
Jean-Francois Timsit ◽  
Hatem Kallel ◽  
Adel Ben Ali ◽  
Marie Francoise Dumay ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Tertiary Care ◽  
Icu Mortality ◽  
Icu Patients ◽  
Methicillin Resistant ◽  
Saps Ii ◽  
Icu Stay ◽  
Mrsa Infection ◽  
The Impact ◽  
Mrsa Colonization

Abstract Objective: To determine the impact of methicillin-resis-tant Staphylococcus aureus (MRSA) colonization on the occurrence of S aureus infections (methicillin-resistant and methicillin-suscep-tible), the use of glycopeptides, and outcome among intensive care unit (ICU) patients. Design: Prospective observational cohort survey. Setting: A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital. Patients: A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998. Methods: MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples. Results: One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61±18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4±20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S aureus infections (32 MRSA, 10 methi-cillin-susceptible). After factors associated with the development of an S aureus infection were adjusted for in a multivariate Cox model (SAPS II &gt;36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients. Conclusions: In our unit, MRSA colonization greatly increased the risk of S aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.

scholarly journals Comparative Genomics of Vancomycin-Resistant Staphylococcus aureus Strains and Their Positions within the Clade Most Commonly Associated with Methicillin-Resistant S. aureus Hospital-Acquired Infection in the United States

mBio ◽  
2012 ◽  
Vol 3 (3) ◽  
Author(s):  
Veronica N. Kos ◽  
Christopher A. Desjardins ◽  
Allison Griggs ◽  
Gustavo Cerqueira ◽  
Andries Van Tonder ◽  
...  
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
The United States ◽  
Methicillin Resistant ◽  
Content Type ◽  
Mrsa Infection ◽  
Vancomycin Resistant ◽  
Foreign Dna ◽  
Mrsa Strains ◽  
Hospital Acquired

ABSTRACTMethicillin-resistantStaphylococcus aureus(MRSA) strains are leading causes of hospital-acquired infections in the United States, and clonal cluster 5 (CC5) is the predominant lineage responsible for these infections. Since 2002, there have been 12 cases of vancomycin-resistantS. aureus(VRSA) infection in the United States—all CC5 strains. To understand this genetic background and what distinguishes it from other lineages, we generated and analyzed high-quality draft genome sequences for all available VRSA strains. Sequence comparisons show unambiguously that each strain independently acquired Tn1546and that all VRSA strains last shared a common ancestor over 50 years ago, well before the occurrence of vancomycin resistance in this species. In contrast to existing hypotheses on what predisposes this lineage to acquire Tn1546, the barrier posed by restriction systems appears to be intact in most VRSA strains. However, VRSA (and other CC5) strains were found to possess a constellation of traits that appears to be optimized for proliferation in precisely the types of polymicrobic infection where transfer could occur. They lack a bacteriocin operon that would be predicted to limit the occurrence of non-CC5 strains in mixed infection and harbor a cluster of unique superantigens and lipoproteins to confound host immunity. A frameshift indprA, which in other microbes influences uptake of foreign DNA, may also make this lineage conducive to foreign DNA acquisition.IMPORTANCEInvasive methicillin-resistantStaphylococcus aureus(MRSA) infection now ranks among the leading causes of death in the United States. Vancomycin is a key last-line bactericidal drug for treating these infections. However, since 2002, vancomycin resistance has entered this species. Of the now 12 cases of vancomycin-resistantS. aureus(VRSA), each was believed to represent a new acquisition of the vancomycin-resistant transposon Tn1546from enterococcal donors. All acquisitions of Tn1546so far have occurred in MRSA strains of the clonal cluster 5 genetic background, the most common hospital lineage causing hospital-acquired MRSA infection. To understand the nature of these strains, we determined and examined the nucleotide sequences of the genomes of all available VRSA. Genome comparison identified candidate features that position strains of this lineage well for acquiring resistance to antibiotics in mixed infection.

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