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.

Prevalence of Nasal Colonization Among Patients With Community-Associated Methicillin-ResistantStaphylococcus aureusInfection and Their Household Contacts

2007 ◽  
Vol 28 (8) ◽  
pp. 966-969 ◽  
Author(s):  
Uzma Zafar ◽  
Leonard B. Johnson ◽  
Michel Hanna ◽  
Kathleen Riederer ◽  
Mamta Sharma ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Center ◽  
Academic Medical Center ◽  
Nasal Colonization ◽  
Household Contacts ◽  
Type Iv ◽  
Single Clone ◽  
Household Members ◽  
Mrsa Strains ◽  
Multiple Strains

Objective.To evaluate the prevalence of colonization among patients with community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) infection and their household contacts.Design.Prospective, observational laboratory study of nasal colonization among patients and their household members from September 15, 2004, to February 20, 2006.Setting.A 600-bed, urban, academic medical center.Patients.Fifty-one patients who presented with CA-MRSA infections and 49 household members had cultures of nasal swab specimens performed.Results.Skin and soft-tissue infections were seen in 50 patients (98%) and 2 household members. Twenty-one (41%) of 51 patients and 10 (20%) of 49 household members were colonized with MRSA. An additional 5 patients (10%) and 12 household members (24%) were colonized with methicillin-susceptibleStaphylococcus aureus.Most MRSA isolates (95%; infective and colonizing) carried the staphylococcal cassette chromosomemectype IV complex, and 67% represented a single clone, identical to USA 300. Of the colonized household members, 5 had isolates related to the patients' infective isolate.Conclusions.The frequency of CA-MRSA colonization among household members of patients with CA-MRSA infections is higher than rates reported among the general population. Among colonized household members, only half of the MRSA strains were related to the patients' infective isolate. Within the same household, multiple strains of CA-MRSA may be present.

Clinical and Laboratory Features of Community-Associated Methicillin-ResistantStaphylococcus aureus:Is It Really New?

2006 ◽  
Vol 27 (2) ◽  
pp. 133-138 ◽  
Author(s):  
Leonard B. Johnson ◽  
Sajjad Saeed ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Response To Therapy ◽  
Laboratory Analysis ◽  
Molecular Characteristics ◽  
Molecular Features ◽  
Type Iv ◽  
Single Clone ◽  
Systemic Antibiotics ◽  
Staphylococcal Cassette Chromosome

Objective.To review the epidemiologic and molecular characteristics of community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) in Detroit, Michigan, to assess the risk factors for infection and the response to therapy.Design.Prospective clinical and laboratory study of 2003-2004 CA-MRSA isolates. Molecular features were compared with CA-MRSA isolates from 1980.Setting.A 600-bed urban academic medical center.Patients.Twenty-three patients with CA-MRSA infections from 2003-2004 were evaluated. In addition, laboratory analysis was performed on 13 CA-MRSA isolates from 1980.Main Outcome Measures.Laboratory analysis of isolates included antimicrobial susceptibility testing, pulsed-field genotyping, testing for Panton-Valentine leukocidin (PVL) genes, and staphylococcal cassette chromosomemectyping.Results.Patients were predominantly young African American males and presented with skin and soft-tissue infections. All isolates were resistant to erythromycin and highly susceptible to other agents. Patients were generally treated successfully with combination incision and drainage and systemic antibiotics. Among the 23 isolates, 20 (87%) were the same strain. This strain carried the staphylococcal cassette chromosomemectype IV and PVL genes and is genetically identical to USA 300. Thirteen isolates of patients from our community who presented with CA-MRSA infections in 1980 represented a single clone that is unique compared with the 2003-2004 isolates. This strain carried staphylococcal cassette chromosomemectype IVA but did not carry the PVL genes.Conclusions.In our community, CA-MRSA is largely due to a single clone with a type IVmecgene and PVL gene. The type IV staphylococcal cassette chromosomemectype can be demonstrated in CA-MRSA isolates from a remote period, suggesting that earlier outbreaks were not related to healthcare exposure.

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.

Methicillin-Resistant Staphylococcus aureus Bacteremia in Patients With End-Stage Renal Disease in Taiwan: Distinguishing Between Community-Associated and Healthcare-Associated Strains

2009 ◽  
Vol 30 (1) ◽  
pp. 89-92 ◽  
Author(s):  
Chung-Chih Lin ◽  
Jiun-Ling Wang ◽  
Chi-Ying Lin ◽  
Shey-Ying Chen ◽  
Jann-Tay Wang ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Renal Disease ◽  
End Stage Renal Disease ◽  
Medical Center ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Mrsa Strains ◽  
Stage Renal Disease ◽  
End Stage ◽  
Healthcare Associated

We reviewed genotyping and medical records of 53 patients with end-stage renal disease and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia in a medical center in Taiwan. In multivariate analysis, hospitalization within the previous year was independently negatively associated with infection with community-associated MRSA strains, and an increased number of years of dialysis predicted the recovery of patients infected with community-associated MRSA strains.

Emergence of Community-Associated Methicillin-ResistantStaphylococcus aureusInfection Among Patients With End-Stage Renal Disease

2006 ◽  
Vol 27 (10) ◽  
pp. 1057-1062 ◽  
Author(s):  
Leonard B. Johnson ◽  
Anilrudh A. Venugopal ◽  
Joan Pawlak ◽  
Louis D. Saravolatz
Keyword(s):  
Renal Disease ◽  
End Stage Renal Disease ◽  
Academic Medical Center ◽  
Molecular Features ◽  
Type Iv ◽  
Mrsa Strains ◽  
Stage Renal Disease ◽  
End Stage ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

Objective.To evaluate the frequency of infections due to community-associated methicillin-resistantStaphylococcus aureus(CA-MRSA) strains among our patients with end-stage renal disease.Design.Prospective observational clinical and laboratory study of patients in 2005. Molecular features of isolates recovered from these patients were compared with those of isolates recovered in 2000 from patients with end-stage renal disease.Setting.A 600-bed urban academic medical center.Patients.Thirty-two patients with end-stage renal disease and MRSA infection at the time of hospitalization from 2005 were evaluated. For comparison, laboratory analysis was performed for 17 MRSA isolates recovered from patients with end-stage renal disease in 2000.Results.The patients from 2005 were more likely than the patients from 2000 to have infection with strains that carried the staphylococcal cassette chromosome (SCC)mectype IV complex (50% vs 11.8%; relative risk, 4.25 [95% confidence interval, 1.17-25.98];P= .012) and the Panton-Valentine leukocidin toxin genes (25% vs 0%;P= .038). Eight patients from 2005 were infected with a strain that is identical to MRSA clone USA300 in terms of molecular type and presence of SCCmectype IV and Panton-Valentine leukocidin genes. Among the patients from 2005, those infected with SCCmectype IV strains (ie, CA-MRSA strains) and those infected with SCCmectype II strains (ie, healthcare-associated MRSA [HA-MRSA] strains) were similar with respect to demographic characteristics, risk factors, and outcomes.Conclusions.We documented an increased proportion of infections with CA-MRSA strains, including clone USA300, among our population of patients undergoing dialysis. Patients infected with CA-MRSA strains and HA-MRSA strains were similar with respect to presenting illness and outcomes.

scholarly journals 493. Clinical and Epidemiological Features of Healthcare Workers Detected with Coronavirus Disease

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S313-S313
Author(s):  
Melissa Campbell ◽  
Rupak Datta ◽  
Anne Wyllie ◽  
Arnau Casanovas-Massana ◽  
Ryan Handoko ◽  
...  
Keyword(s):  
Active Surveillance ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Severity Of Illness ◽  
Face Mask ◽  
Health Department ◽  
Nasopharyngeal Swab ◽  
Symptom Screening ◽  
Healthcare Associated

Abstract Background Data early in the SARS-CoV-2 pandemic suggested frontline healthcare workers (HCW) may account for 10–20% of all infections. CDC estimated 600,000 infections in HCWs. Symptom screening is a strategy to prevent healthcare-associated transmission. This method may not identify asymptomatic or pre-symptomatic carriers. Methods We conducted a prospective cohort study in asymptomatic or minimally symptomatic healthcare workers in a 1541-bed academic medical center. Although recruitment began in designated COVID-19 units, we expanded to all HCWs providing care to hospitalized patients during the pandemic. Data was gathered on demographics, work area in the hospital and daily questionnaires were sent listing symptoms of SARS-CoV-2. Protocol included twice weekly self-collected nasopharyngeal swab and saliva for SARS-CoV-2 N1 and N2.Those with positive PCR result, underwent telephone survey to assess symptomatology and severity of illness. Results A total 525 HCWs began the study protocol and 16 were identified as PCR positive. Samples included concordant saliva and NP samples on 9 (56%), exclusively NP samples on 5 (31%) and 2 (12%) HCWs were positive by saliva PCR only. Majority were female, and all were nursing staff; with 19% reported not working in a designated COVID-19 unit. During the course of this active surveillance, universal masking was mandated in the institution. Rhinorrhea and headache were reported by 6 (38%), 5 (31%) reported cough and 3 (19%) developed myalgia. Changes in smell and taste preceded the positive PCR test in 2 (12%). One HCW reported developing a fever with acute illness. All were notified about their PCR positive status by institution’s occupational health department and self-isolated to monitor for symptoms. Conclusion The spectrum of disease in this HCW cohort is similar to mild disease in the community. Due to high incidence of asymptomatic or mildly symptomatic HCWs, active surveillance with routine testing proves be beneficial to prevent hospital transmission of SARS-CoV-2. Universal masking significantly decreased the HCW positive rate in our study, underscoring the need for universal efforts to mitigate healthcare-associated transmission with self-monitoring, face mask use, and other infection prevention behaviors like hand hygiene. Disclosures All Authors: No reported disclosures

Abstract 208: Effects of Gender and BMI on Comorbidities in Patients With Non Hemorrhagic Stroke

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Michael Ashamalla ◽  
Justin Pieper ◽  
Daniel Sedhom ◽  
Neil Yager ◽  
Mikhail Torosoff
Keyword(s):  
Hemorrhagic Stroke ◽  
Medical Center ◽  
Academic Medical Center ◽  
Retrospective Chart Review ◽  
Obesity Paradox ◽  
Morbidly Obese ◽  
Academic Medical ◽  
Conflicting Evidence ◽  
Stage Renal Disease ◽  
End Stage

Background: There is conflicting evidence concerning the obesity paradox in stroke patients. We sought to examine the relationship between gender, BMI, and prevalence of comorbidities in patients with non-hemorrhagic stroke. Materials and Methods: Retrospective chart review was performed in 996 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Patients were divided according to gender and specific BMI groups according to the National Institute of Health. This study was approved by the institutional IRB. Results: Patients with BMI from 0-18.5 and 18.5-24.9 were more likely to be female (63.2% and 58.4% p<.05). Whereas patients with BMI over 25-30 and 30-35 were more likely to be male (60.82% and 59.2% p<.05). Morbidly obese patients (BMI>35) were equally likely to be men or women. In men higher BMI correlated with presentation at younger age. Diabetes was most prevalent in patients with BMI over 35 (40% males, 44% females, p<.05). In females, HTN was associated with BMI 30-34.5 and 35+ (80.5% and 73.3%, P<.05). Males showed a similar though non-significant trend. The prevalence of end stage renal disease, systemic atherosclerosis, and PVD was not significantly correlated with BMI in either gender. Conclusion: Gender and BMI significantly affect associated comorbidities in patients with non-hemorrhagic stroke, possibly suggestive of unique gender specific disease mechanisms. Additional studies investigating the effect of gender and BMI on diagnostic evaluation and treatment of patients with non-hemorrhagic stroke are warranted.

scholarly journals 421. Effect of SARs-Cov-2 mRNA Vaccination in Healthcare Workers with Household COVID Exposure

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S311-S311
Author(s):  
Laura Selby ◽  
Richard Starlin
Keyword(s):  
Healthcare Workers ◽  
Screening Program ◽  
Medical Center ◽  
Severe Disease ◽  
Academic Medical Center ◽  
Tertiary Care ◽  
Limited Data ◽  
Viral Shedding ◽  
Academic Medical ◽  
Significant Burden

Abstract Background Healthcare workers have experienced a significant burden of COVID-19 disease. COVID mRNA vaccines have shown great efficacy in prevention of severe disease and hospitalization due to COVID infection, but limited data is available about acquisition of infection and asymptomatic viral shedding. Methods Fully vaccinated healthcare workers at a tertiary-care academic medical center in Omaha Nebraska who reported a household exposure to COVID-19 infection are eligible for a screening program in which they are serially screened with PCR but allowed to work if negative on initial test and asymptomatic. Serial screening by NP swab was completed every 5-7 days, and workers became excluded from work if testing was positive or became symptomatic. Results Of the 94 employees who were fully vaccinated at the time of the household exposure to COVID-19 infection, 78 completed serial testing and were negative. Sixteen were positive on initial or subsequent screening. Vaccine failure rate of 17.0% (16/94). Healthcare workers exposed to household COVID positive contact Conclusion High risk household exposures to COVID-19 infection remains a significant potential source of infections in healthcare workers even after workers are fully vaccinated with COVID mRNA vaccines especially those with contact to positive domestic partners. Disclosures All Authors: No reported disclosures

scholarly journals COVID-19 vaccine impact on rates of SARS-CoV-2 cases and post vaccination strain sequences among healthcare workers at an urban academic medical center: a prospective cohort study

2021 ◽  
Author(s):  
Tara C. Bouton ◽  
Sara Lodi ◽  
Jacquelyn Turcinovic ◽  
Sarah E. Weber ◽  
Emily Quinn ◽  
...  
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Healthcare Workers ◽  
Positive Impact ◽  
Medical Center ◽  
Academic Medical Center ◽  
Post Vaccination ◽  
Unvaccinated Control ◽  
Rate Ratios

AbstractBackgroundCOVID-19 vaccine trials and post-implementation data suggest vaccination decreases SARS-CoV-2 infections. We examine COVID-19 vaccination’s impact on SARS-CoV-2 case rates and viral diversity among healthcare workers (HCW) during a high community prevalence period.MethodsA prospective cohort study from Boston Medical Center (BMC)’s HCW vaccination program, where staff received two doses of BNT162b2 or mRNA-1273. We included PCR-confirmed SARS-CoV-2 cases among HCWs from December 09, 2020 to February 23, 2021. Weekly SARS-CoV-2 rates per 100,000 person-day overall and by time from first injection (1-14 and >14 days) were compared with surrounding community rates. Viral genomes were sequenced from SARS CoV-2 positive samples.ResultsSARS-CoV-2 cases occurred in 1.4% (96/7109) of HCWs given at least a first dose and 0.3% (17/5913) of HCWs given both vaccine doses. Adjusted SARS-CoV-2 infection rate ratios were 0.73 (95% CI 0.53-1.00) 1-14 days and 0.18 (0.10-0.32) >14 days from first dose. HCW SARS-CoV-2 cases >14 days from initial dose compared to within 14 days were more often older (46 versus 38 years, p=0.007), Latinx (10% versus 8%, p=0.03), and asymptomatic (48% versus 11%, p=0.0002). SARS-CoV-2 rates among HCWs fell below those of the surrounding community, with a 18% versus 11% weekly decrease respectively (p=0.14). Comparison of 48 SARS-CoV-2 genomes sequenced from post-first dose cases did not indicate selection pressure towards known spike-antibody escape mutations.ConclusionsOur results indicate a positive impact of COVID-19 vaccines on SARS-CoV-2 case rates. Post-vaccination isolates did not show unusual genetic diversity or selection for mutations of concern.Main PointCases of SARS-CoV-2 among health care workers dropped rapidly with COVID-19 vaccination. Sequencing 48 breakthrough infections (overwhelmingly in 14 days after 1st dose) showed no clear sign of any differences in spike protein compared with time-matched, unvaccinated control sequences.

scholarly journals In depth characterization of vaccine breakthrough infections with SARS-CoV-2 among healthcare workers of a Dutch academic medical center

2021 ◽  
Author(s):  
Lidewij W Rümke ◽  
Femke C Groenveld ◽  
Yvonne M G van Os ◽  
Patrique Praest ◽  
Anniek A N Tanja ◽  
...  
Keyword(s):  
Immune Responses ◽  
Healthcare Workers ◽  
Medical Center ◽  
Academic Medical Center ◽  
Risk Exposure ◽  
Live Virus ◽  
Viral Loads ◽  
Academic Medical ◽  
T Cell Immune Responses

Abstract SARS-CoV-2 infection after COVID-19 vaccination raises concerns about the emergence of vaccine escape variants. Here we characterize 14 breakthrough infections among 5860 fully vaccinated Dutch healthcare workers ≥14 days post final dose of vaccination with either BNT162b2, mRNA-1273 or Ad26.COV2.S. These breakthrough infections presented with regular B.1.1.7 (Alpha) and B.1.617.2 (Delta) variants and high viral loads, despite normal vaccine induced B- and T-cell immune responses detected by live virus neutralization assays and ELISpot. High-risk exposure settings, such as in households, indicate a potential risk of viral transmission despite full vaccination.

Sign in / Sign up

Export Citation Format

Share Document