Extranasal Methicillin-Resistant Staphylococcus aureus Colonization at Admission to an Acute Care Veterans Affairs Hospital

2010 ◽  
Vol 31 (1) ◽  
pp. 42-46 ◽  
Author(s):  
Stacey E. Baker ◽  
Stephen M. Brecher ◽  
Ernest Robillard ◽  
Judith Strymish ◽  
Elizabeth Lawler ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Insertion Site ◽  
Veterans Affairs ◽  
Care Hospital ◽  
Convenience Sample ◽  
Methicillin Resistant ◽  
Culture Techniques ◽  
Mrsa Colonization

Objective.To evaluate the prevalence of and risk factors for extranasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and its relationship to nasal colonization among veterans hospitalized for acute care.Design.Prospective observational study.Setting.Veterans Affairs (VA) acute care hospital in Boston, Massachusetts.Patients.Convenience sample of 150 patients hospitalized within the previous 36 hours and screened for nasal MRSA who were not known to have an active MRSA infection or MRSA isolates recovered from a wound during the past 12 months.Methods.Potential risk factors for MRSA colonization were assessed, and oropharynx, axilla, hand, perirectal, wound, and catheter insertion site samples were obtained for culture. MRSA was identified in chromogenic agar and confirmed by use of routine culture techniques. Nasal MRSA colonization was detected by means of polymerase chain reaction (PCR).Results.Nasal swab samples analyzed by use of PCR yielded results positive for MRSA in 16 (11%) of 150 patients. Extranasal cultures yielded positive results for 3 (2%) of 134 patients who tested negative for nasal MRSA colonization and for 9 (56%) of 16 patients who tested positive for nasal MRSA colonization (odds ratio [OR], 56.1 [95% confidence interval {CI}, 12.4-254.6]; P <.001). The oropharynx was the most commonly colonized extranasal site (10 patients [7%]). Independent risk factors for extranasal MRSA colonization included nasal MRSA colonization (OR, 66.9 [95% CI, 11.8-379.7]; P <.001) and end-stage hepatic disease (OR, 98.5 [95% CI, 3.1-3,112.4]; P = .01).Conclusions.Extranasal MRSA colonization is infrequent among veterans admitted for acute care to VA Boston Healthcare System. Extranasal MRSA colonization was strongly associated with nasal MRSA colonization, which suggests that the VA MRSA Prevention Initiative is not missing a large number of MRSA-colonized patients by focusing on nasal-only screening.

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

2008 ◽  
Vol 29 (7) ◽  
pp. 600-606 ◽  
Author(s):  
Christine Moore ◽  
Jastej Dhaliwal ◽  
Agnes Tong ◽  
Sarah Eden ◽  
Cindi Wigston ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Significant Risk ◽  
Acute Care Hospital ◽  
Skin Lesions ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
The Impact

Objective.To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.Design.Retrospective cohort study.Setting.A 472-bed acute-care teaching hospital in Toronto, Canada.Patients.Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.Methods.Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.Results.Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.Conclusions.Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

Acquisition of Methicillin-Resistant Staphylococcus aureus in the Acute Care Setting: Incidence and Risk Factors

2007 ◽  
Vol 28 (6) ◽  
pp. 733-736 ◽  
Author(s):  
Christophe Rioux ◽  
Laurence Armand-Lefevre ◽  
Wafaa Guerinot ◽  
Antoine Andremont ◽  
Jean-Christophe Lucet
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Acute Care ◽  
Care Setting ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Acute Care Setting ◽  
Methicillin Resistant ◽  
Chronic Skin ◽  
Mrsa Colonization

Our objective was to assess the incidence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among patients in acute care wards. For 5 months, patients were screened for MRSA colonization at admission and at discharge. At admission, 6.6% of patients had cultures positive for MRSA, and 3.1% of patients who had tested negative for MRSA on admission had cultures positive for MRSA at discharge. Only the presence of chronic skin breaks at admission was independently associated with MRSA acquisition.

Sustained Reduction in the Clinical Incidence of Methicillin-Resistant Staphylococcus aureus Colonization or Infection Associated with a Multifaceted Infection Control Intervention

2011 ◽  
Vol 32 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Katherine Ellingson ◽  
Robert R. Muder ◽  
Rajiv Jain ◽  
David Kleinbaum ◽  
Pei-Jean I. Feng ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Acute Care ◽  
Veterans Affairs ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Methicillin Resistant ◽  
The Impact ◽  
Mrsa Colonization

Objective.To assess the impact and sustainability of a multifaceted intervention to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission implemented in 3 chronologically overlapping phases at 1 hospital.Design.Interrupted time-series analyses.Setting.A Veterans Affairs hospital in the northeastern United States.Patients and Participants.Individuals admitted to acute care units from October 1, 1999, through September 30, 2008. To calculate the monthly clinical incidence of MRSA colonization or infection, the number of MRSA-positive cultures obtained from a clinical site more than 48 hours after admission among patients with no MRSA-positive clinical cultures during the previous year was divided by patient-days at risk. Secondary outcomes included clinical incidence of methicillin-sensitive S. aureus colonization or infection and incidence of MRSA bloodstream infections.Interventions.The intervention—implemented in a surgical ward beginning October 2001, in a surgical intensive care unit beginning October 2003, and in all acute care units beginning July 2005—included systems and behavior change strategies to increase adherence to infection control precautions (eg, hand hygiene and active surveillance culturing for MRSA).Results.Hospital-wide, the clinical incidence of MRSA colonization or infection decreased after initiation of the intervention in 2001, compared with the period before intervention (P = .002), and decreased by 61% (P < .001) in the 7-year postintervention period. In the postintervention period, the hospital-wide incidence of MRSA bloodstream infection decreased by 50% (P = .02), and the proportion of S. aureus isolates that were methicillin resistant decreased by 30% (P < .001).Conclusions.Sustained decreases in hospital-wide clinical incidence of MRSA colonization or infection, incidence of MRSA bloodstream infection, and proportion of S. aureus isolates resistant to methicillin followed implementation of a multifaceted prevention program at one Veterans Affairs hospital. Findings suggest that interventions designed to prevent transmission can impact endemic antimicrobial resistance problems.

scholarly journals Frequent Methicillin-Resistant Staphylococcus aureus Introductions Into an Inner-city Jail: Indications of Community Transmission Networks

2019 ◽  
Vol 71 (2) ◽  
pp. 323-331 ◽  
Author(s):  
Kyle J Popovich ◽  
Evan S Snitkin ◽  
Chad Zawitz ◽  
Alla Aroutcheva ◽  
Darjai Payne ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Drug Use ◽  
Molecular Epidemiology ◽  
Skin Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Transmission Networks ◽  
Methicillin Resistant ◽  
Community Transmission ◽  
Mrsa Colonization

Abstract Background Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration. Methods Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks. We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA. Results There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P &lt; .01), men who have sex with men (P &lt; .001), and methamphetamine users (P &lt; .001). Conclusions A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.

scholarly journals What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy

2020 ◽  
Vol 71 (10) ◽  
pp. 2732-2735
Author(s):  
Judith M Strymish ◽  
William O’ Brien ◽  
Kamal Itani ◽  
Kalpana Gupta ◽  
Westyn Branch-Elliman
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Veterans Affairs ◽  
Common Reason ◽  
Surgical Prophylaxis ◽  
Surgical Specialty ◽  
Methicillin Resistant ◽  
Primary Driver ◽  
Mrsa Colonization

Abstract Factors driving vancomycin surgical prophylaxis are poorly understood. In a national Veterans Affairs cohort with manually validated data, surgical specialty (cardiac, orthopedics) and perception of high facility methicillin-resistant Staphylococcus aureus (MRSA) prevalence—not MRSA colonization—were the primary drivers of prescribing. A β-lactam allergy was the second most common reason. These data may inform perioperative stewardship.

S294 – Pre-op Prevalence of MRSA in Intranasal Surgery Patients

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P173-P173
Author(s):  
Brian Nicholas ◽  
Geeta Bhargave ◽  
Ryan Heffelfinger ◽  
Marc R Rosen ◽  
Edmund A Pribitkin
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Potential Risk ◽  
Preliminary Data ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Sinus Surgery ◽  
Methicillin Resistant ◽  
Potential Risk Factors ◽  
Intranasal Surgery ◽  
Mrsa Colonization

Objectives 1) Understand the extent of methicillin-resistant Staphylococcus aureus among those undergoing intranasal surgery. 2) Be able to describe potential risk factors for MRSA colonization. The purpose of this study is to outline a prevalance of MRSA colonization among those undergoing inranasal surgery, with an exploration of potential risk factors for colonization. Methods Patients undergoing intranasal surgery (endoscopic sinus surgery, rhinoplasty, septoplasty, etc) at a tertiary care medical center had preoperative nasal swab cultures. The primary endpoint was positive culture of methicillin-resistant Staphylococcus aureus (MRSA). Patient demographic information was also collected to ascertain potential risk factors for colonization of MRSA. Results Early results have demonstrated that the prevalence of MRSA in patients is less than the reported prevalence in hospital inpatient populations. Of the initial 25 patients enrolled in this study, none were shown to be colonized with methicillin-resistant Staphylococcus aureus (0/25), with 1 patient having reported a history of MRSA infection (4%). Conclusions Preliminary data suggests that the prevalence of methicillin-resistant Staphylococcus aureus among patients undergoing intranasal surgery is less than the prevalence of inpatient populations as reported in several previous studies. While preliminary data suggests a potential decreased prevalence of MRSA in this population, a much larger sample of patients is needed to make a more definitive statement. In the coming weeks and months, as more data is gathered and the sample size included in the study grows, it will be interesting to note whether the initial trend, as suggested here, continues.

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