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.

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.

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.

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.

Sign in / Sign up

Export Citation Format

Share Document