scholarly journals Should Vascular Surgery Patients Be Screened Preoperatively for Methicillin-Resistant Staphylococcus aureus?

2009 ◽  
Vol 30 (12) ◽  
pp. 1158-1165 ◽  
Author(s):  
Bruce Y. Lee ◽  
Becky Y. Tsui ◽  
Rachel R. Bailey ◽  
Kenneth J. Smith ◽  
Robert R. Muder ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Vascular Surgery ◽  
Success Rate ◽  
Economic Value ◽  
Cost Effective ◽  
Third Party ◽  
Computer Simulation Model ◽  
Success Rates ◽  
Methicillin Resistant ◽  
Wide Range

Background.Methicillin-resistant Staphylococcus aureus (MRSA) can cause severe infection in patients who are undergoing vascular surgical operations. Testing all vascular surgery patients preoperatively for MRSA and attempting to decolonize those who have positive results may be a strategy to prevent MRSA infection. The economic value of such a strategy has not yet been determined.Methods.We developed a decision-analytic computer simulation model to determine the economic value of using such a strategy before all vascular surgical procedures from the societal and third-party payer perspectives at different MRSA prevalence and decolonization success rates.Results.The model showed preoperative MRSA testing to be cost-effective (incremental cost-effectiveness ratio, <$50,000 per quality-adjusted life year) when the MRSA prevalence is ≥0.01 and the decolonization success rate is ≥0.25. In fact, this strategy was dominant (ie, less costly and more effective) at the following thresholds: MRSA prevalence ≥0.01 and decolonization success rate ≥0.5, and MRSA prevalence ≥0.025 and decolonization success rate ≥0.25.Conclusion.Testing and decolonizing patients for MRSA before vascular surgery may be a cost-effective strategy over a wide range of MRSA prevalence and decolonization success rates.

scholarly journals The Economic Effect of Screening Orthopedic Surgery Patients Preoperatively for Methicillin-Resistant Staphylococcus aureus

2010 ◽  
Vol 31 (11) ◽  
pp. 1130-1138 ◽  
Author(s):  
Bruce Y. Lee ◽  
Ann E. Wiringa ◽  
Rachel R. Bailey ◽  
Vishal Goyal ◽  
Becky Tsui ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Orthopedic Surgery ◽  
Economic Value ◽  
Third Party ◽  
Computer Simulation Model ◽  
Preoperative Screening ◽  
Methicillin Resistant ◽  
Party Payer ◽  
The Third ◽  
The Third Party

Background and Objective.Patients undergoing orthopedic surgery are susceptible to methicillin-resistant Staphylococcus aureus (MRSA) infections, which can result in increased morbidity, hospital lengths of stay, and medical costs. We sought to estimate the economic value of routine preoperative MRSA screening and decolonization of orthopedic surgery patients.Methods.A stochastic decision-analytic computer simulation model was used to evaluate the economic value of implementing this strategy (compared with no preoperative screening or decolonization) among orthopedic surgery patients from both the third-party payer and hospital perspectives. Sensitivity analyses explored the effects of varying MRSA colonization prevalence, the cost of screening and decolonization, and the probability of decolonization success.Results.Preoperative MRSA screening and decolonization was strongly cost-effective (incremental cost-effectiveness ratio less than $6,000 per quality-adjusted life year) from the third-party payer perspective even when MRSA prevalence was as low as 1%, decolonization success was as low as 25%, and decolonization costs were as high as $300 per patient. In most scenarios this strategy was economically dominant (ie, less costly and more effective than no screening). From the hospital perspective, preoperative MRSA screening and decolonization was the economically dominant strategy for all scenarios explored.Conclusions.Routine preoperative screening and decolonization of orthopedic surgery patients may under many circumstances save hospitals and third-party payers money while providing health benefits.

scholarly journals Complicated carriage with methicillin-resistant Staphylococcus aureus (MRSA): evaluation of the effectiveness of decolonization regimens advised in the Dutch national guideline

2021 ◽  
Author(s):  
A.C. Westgeest ◽  
E.F. Schippers ◽  
N.M. Delfos ◽  
L.J. Ellerbroek ◽  
T. Koster ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Treatment Outcome ◽  
Success Rate ◽  
Day Treatment ◽  
Statistical Significance ◽  
Multivariable Analysis ◽  
Prolonged Treatment ◽  
Success Rates ◽  
Multicenter Cohort Study ◽  
Methicillin Resistant

Introduction Methicillin-resistant Staphylococcus aureus (MRSA) colonization leads to increased infection rates and mortality. Decolonization treatment has proven to prevent infection and reduce transmission. As the optimal antimicrobial strategy is yet to be established, different regimens are currently prescribed to patients. This study aimed to evaluate efficacy of the decolonization treatments recommended by the Dutch guideline. Methods A retrospective multicenter cohort study was conducted in five Dutch hospitals. All patients who visited the outpatient clinic because of complicated MRSA carriage between 2014 - 2018 were included. We obtained data on patient characteristics, clinical and microbiological variables relevant for MRSA decolonization, environmental factors, decolonization regimen and treatment outcome. The primary outcome was defined as three negative MRSA cultures after treatment completion. Outcomes were stratified for the first-line treatment strategies. Results A total of 131/224 patients were treated with systemic antibiotic agents. Treatment was successful in 111/131 (85%) patients. The success rate was highest in patients treated with doxycycline-rifampicin (32/37, 86%), but the difference with any of the other regimens did not reach statistical significance. There was no difference in success rate of a 7-day treatment compared to 10-14 days of treatment (OR 0.99, 95%CI 0.39-2.53, p=1.00). Side effects were reported in 27/131 (21%) of patients and consisted mainly of mild gastrointestinal complaints. In a multivariable analysis, an immunocompromised status was an independent risk factor for failure at the first treatment attempt (OR 4.65, 95%CI 1.25-17.25, p=0.02). Conclusion The antimicrobial combinations recommended to treat complicated MRSA carriage yielded high success rates. Prolonged treatment did not affect treatment outcome. A randomized trial is needed to resolve whether the most successful regimen in this study (doxycycline plus rifampicin) is superior to other combinations.

scholarly journals Universal Methicillin-ResistantStaphylococcus aureus(MRSA) Surveillance for Adults at Hospital Admission: An Economic Model and Analysis

2010 ◽  
Vol 31 (6) ◽  
pp. 598-606 ◽  
Author(s):  
Bruce Y. Lee ◽  
Rachel R. Bailey ◽  
Kenneth J. Smith ◽  
Robert R. Muder ◽  
Elsa S. Strotmeyer ◽  
...  
Keyword(s):  
Cost Effectiveness ◽  
Hospital Admission ◽  
Hospital Admissions ◽  
Cost Effective ◽  
Dominant Strategy ◽  
Reproductive Rate ◽  
Third Party ◽  
Computer Simulation Model ◽  
Surveillance Culture ◽  
Wide Range

Background.Methicillin-resistantStaphylococcus aureus(MRSA) transmission and infections are a continuing problem in hospitals. Although some have recommended universal surveillance for MRSA at hospital admission to identify and to isolate MRSA-colonized patients, there is a need for formal economic studies to determine the cost-effectiveness of such a strategy.Methods.We developed a stochastic computer simulation model to determine the potential economic impact of performing MRSA surveillance (ie, single culture of an anterior nares specimen) for all hospital admissions at different MRSA prevalences and basic reproductive rate thresholds from the societal and third party-payor perspectives. Patients with positive surveillance culture results were placed under isolation precautions to prevent transmission by way of respiratory droplets. MRSA-colonized patients who were not isolated could transmit MRSA to other hospital patients.Results.The performance of universal MRSA surveillance was cost-effective (defined as an incremental cost-effectiveness ratio of less than $50,000 per quality-adjusted life-year) when the basic reproductive rate was 0.25 or greater and the prevalence was 1% or greater. In fact, surveillance was the dominant strategy when the basic reproductive rate was 1.5 or greater and the prevalence was 15% or greater, the basic reproductive rate was 2.0 or greater and the prevalence was 10% or greater, and the basic reproductive rate was 2.5 or greater and the prevalence was 5% or greater.Conclusions.Universal MRSA surveillance of adults at hospital admission appears to be cost-effective at a wide range of prevalence and basic reproductive rate values. Individual hospitals and healthcare systems could compare their prevailing conditions (eg, the prevalence of MRSA colonization and MRSA transmission dynamics) with the benchmarks in our model to help determine their optimal local strategies.

scholarly journals Trans-Cinnamaldehyde Exhibits Synergy with Conventional Antibiotic against Methicillin-Resistant Staphylococcus aureus

2021 ◽  
Vol 22 (5) ◽  
pp. 2752
Author(s):  
Shu Wang ◽  
Ok-Hwa Kang ◽  
Dong-Yeul Kwon
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Synergistic Effects ◽  
Regulatory Gene ◽  
Western Blot Assay ◽  
Methicillin Resistant ◽  
Wide Range ◽  
Kill Curve ◽  
Conventional Antibiotics ◽  
Time Kill

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide and has acquired multiple resistance to a wide range of antibiotics. Hence, there is a pressing need to explore novel strategies to overcome the increase in antimicrobial resistance. The present study aims to investigate the efficacy and mechanism of plant-derived antimicrobials, trans-cinnamaldehyde (TCA) in decreasing MRSA’s resistance to eight conventional antibiotics. A checkerboard dilution test and time–kill curve assay are used to determine the synergistic effects of TCA combined with the antibiotics. The results indicated that TCA increased the antibacterial activity of the antibiotics by 2-16-fold. To study the mechanism of the synergism, we analyzed the mecA transcription gene and the penicillin-binding protein 2a level of MRSA treated with TCA by quantitative RT-PCR or Western blot assay. The gene transcription and the protein level were significantly inhibited. Additionally, it was verified that TCA can significantly inhibit the biofilm, which is highly resistant to antibiotics. The expression of the biofilm regulatory gene hld of MRSA after TCA treatment was also significantly downregulated. These findings suggest that TCA maybe is an exceptionally potent modulator of antibiotics.

Cost-Effective Eradication of an Outbreak of Methicillin-Resistant Staphylococcus aureus in a Community Teaching Hospital

1988 ◽  
Vol 9 (6) ◽  
pp. 255-260 ◽  
Author(s):  
Nalini Rao ◽  
Sharon Jacobs ◽  
Linda Joyce
Keyword(s):  
Staphylococcus Aureus ◽  
Teaching Hospital ◽  
Cost Effective ◽  
Methicillin Resistant ◽  
Critical Care Units ◽  
Outbreak Period ◽  
Surgical Teaching ◽  
The Cost ◽  
Community Teaching ◽  
Microbiological Surveillance

AbstractDuring an eight-month period, 25 hospitalized patients became infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a 464-bed acute care, medical-surgical teaching hospital. There were only five cases during the eight months prior to the outbreak period (P < 0.0001). Initial measures, including category-specific isolation and education, did not limit the spread of the outbreak of a strain of MRSA. This prompted institution of additional measures including (1) strict isolation of all infected and colonized cases; (2) prospective microbiological surveillance to detect additional cases; (3) multiple site cultures of identified cases to determine the extent of colonization; (4) employee and environment surveillance; (5) antibiotic decolonization of patients and employees; and (6) educational efforts. The highest number of personnel carriers were noted in one of the critical care units where most of the cases occurred. The decolonization protocol was 100% effective for personnel carriers. The incidence of nosocomial cases of MRSA fell to zero in the five months following the implementation of the strategy. The cost of the entire eradication process was approximately half that of treating a single MRSA bacteremia.

Evaluation of antibiotic resistance pattern and mecA gene frequency in methicillin-resistant Staphylococcus aureus strains collected from clinical specimens in Marand hospital and treatment centers, Iran

2021 ◽  
Author(s):  
Abolfazl Jafari-Sales ◽  
Zahra Sadeghi Deylamdeh ◽  
Afsoon Shariat
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Resistance ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Meca Gene ◽  
Disk Diffusion ◽  
Diffusion Method ◽  
Disk Diffusion Method ◽  
Methicillin Resistant ◽  
Medical Centers ◽  
Wide Range

Introduction: Staphylococcus aureus causes a wide range of infections and as a multivalent pathogen is one of the causative agents of nosocomial and community infections. Therefore, the aim of this study was to identify and determine the pattern of antibiotic resistance of methicillin-resistant Staphylococcus aureus (MRSA) isolates from patients in hospitals and medical centers in Marand city and also to evaluate the presence of mecA gene. Materials and Methods: In this cross-sectional descriptive study, 385 samples of S. aureus were collected from different clinical samples of patients in hospitals and medical centers of Marand city. S. aureus was identified using standard biochemical methods.  Methicillin resistance was determined by disk diffusion method in the presence of oxacillin and cefoxitin. The pattern of antibiotic resistance of the strains was determined by disk diffusion method and according to CLSI recommendation and also PCR method was used to evaluate the frequency of MecA gene. Results: In the present study, out of 385 samples of S. aureus, 215 (55.84%) samples were methicillin resistant. PCR results for mecA gene showed that 110 samples had mecA gene.  The highest antibiotic resistance was observed against penicillin (100%) and erythromycin (83.63%). Most MRSA were isolated from urine and wound samples. Conclusion: The results of this study indicate the prevalence of methicillin-resistant species and also the increase in antibiotic resistance of MRSA to various antibiotics.  Therefore, in order to prevent increased resistance to other antibiotics, it is recommended to avoid inappropriate use of antibiotics.

scholarly journals Genome Sequence of a Recently Emerged, Highly Transmissible, Multi-Antibiotic- and Antiseptic-Resistant Variant of Methicillin-Resistant Staphylococcus aureus, Sequence Type 239 (TW)

2009 ◽  
Vol 192 (3) ◽  
pp. 888-892 ◽  
Author(s):  
Matthew T. G. Holden ◽  
Jodi A. Lindsay ◽  
Craig Corton ◽  
Michael A. Quail ◽  
Joshua D. Cockfield ◽  
...  
Keyword(s):  
Heavy Metals ◽  
Staphylococcus Aureus ◽  
Genome Sequence ◽  
Resistance Genes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Housekeeping Genes ◽  
Sequence Type ◽  
Resistant Variant ◽  
Methicillin Resistant ◽  
Wide Range

ABSTRACT The 3.1-Mb genome of an outbreak methicillin-resistant Staphylococcus aureus (MRSA) strain (TW20) contains evidence of recently acquired DNA, including two large regions (635 kb and 127 kb). The strain is resistant to a wide range of antibiotics, antiseptics, and heavy metals due to resistance genes encoded on mobile genetic elements and also mutations in housekeeping genes.

scholarly journals A Mini-Review on Ceftaroline in Bacteremia Patients with Methicillin-Resistant Staphylococcus aureus (MRSA) Infections

Antibiotics ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 30 ◽  
Author(s):  
Nicole Lounsbury ◽  
Mary Reeber ◽  
Georges Mina ◽  
Christiane Chbib
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Trials ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Clinical Success ◽  
Case Reports ◽  
Case Series ◽  
Cochrane Library ◽  
Success Rates ◽  
Ceftaroline Fosamil ◽  
Methicillin Resistant

Objective: The objective of this review is to describe the outcomes of patients treated with ceftaroline in the non-Food and Drug Administration (FDA) approved indication of methicillin-resistant Staphylococcus aureus (MRSA) infections in both pediatric and adult populations. Data sources: A systematic overview was conducted by searching PubMed, Medline, and The Cochrane Library up to January 2019. Study selection and data extraction: All English-language clinical trials and case reports related to the efficacy of ceftaroline in new, not-yet-approved FDA indications in MRSA infections in pediatric or adult populations. Data synthesis: In the case of MRSA bacteremia (MRSAB) infections, three different randomized studies in pediatric patients showed effectiveness of ceftaroline. When used in the case of adult populations with MRSA bacteremia, a small trial of 16 patients showed 50% clinical success in patients with acute bacterial skin and skin structure infections versus 63% clinical success in patients with community-acquired bacterial pneumonia. Another case series of six refractory case reports showed 50% clinical success of ceftaroline in patients with MRSA. Conclusions: Although there are few case reports and limited data to date, ceftaroline fosamil should continue to be studied as an alternative therapy in MRSA infections in both pediatric and adult populations. Clinical success rates of ceftaroline were, in most cases, considered high when treating patients with MRSA infection. More clinical trials need to be studied. In the specific case of MRSA bacteremia, the treatment options remain few and ceftaroline should be extensively studied for the salvage treatment of MRSAB.

scholarly journals Efficacy and Safety of Endoscopic Third Ventriculostomy in Obstructive Hydrocephalus

2017 ◽  
Vol 14 (2) ◽  
pp. 21-24
Author(s):  
Sachidanad Gautam ◽  
Sumit Kamble
Keyword(s):  
Success Rate ◽  
Endoscopic Third Ventriculostomy ◽  
Obstructive Hydrocephalus ◽  
Case Series ◽  
Cost Effective ◽  
Third Ventriculostomy ◽  
Safe Procedure ◽  
Success Rates ◽  
Replacement Procedure ◽  
Ventricular Hemorrhage

Endoscopic third ventriculostomy is the procedure of choice to treat obstructive hydrocephalus now a days. Published case series of endoscopic third ventriculostomy (ETV) for childhood hydrocephalus have reported widely varying success rates. The purpose of this study is to determine the success rate and complications of ETV for treating obstructive hydrocephalus.Patients with obstructive hydrocephalus and already shunted patients for obstructive hydrocephalus presented with blocked shunt were included in the study. The exclusion criteria consisted ofrecurrent tumor or intra ventricular hemorrhage. Endoscopic third ventriculostomy was performed. Patients were followed up for one year and Clinical and Radiological improvement, complications and mortality was noted. This study was conducted in Neurosurgery Department, Govt. Medical College, Kota between 2015-2016.There were 56 patients including 36 males and 20females. Success rate in the form of clinical and/ or radiological improvement was seen in 88.8% 0f patients. Complications were seen in 6 patients including ETV failure and ventricular hemorrhage. There was no mortality during follow up period of 1 year.ETV is cost effective and safe procedure in patients with obstructive hydrocephalus with good outcome. It may be used as replacement procedure of ventriculo-peritoneal shunt as initial line of management in selected patients based on ETV score. Nepal Journal of Neuroscience, Vol. 14, No. 2,  2017 Page: 21-24

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