scholarly journals Estratégia para Controlar o Staphylococcus Aureus Resistente à Meticilina: A Experiência de Cinco Anos de um Hospital

2014 ◽  
Vol 27 (1) ◽  
pp. 67 ◽  
Author(s):  
David Peres ◽  
Isabel Neves ◽  
Fernanda Vieira ◽  
Ilda Devesa
Keyword(s):  
Staphylococcus Aureus ◽  
Health Professionals ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
National Level ◽  
Intermediate Care ◽  
Methicillin Resistant ◽  
Multimodal Strategy ◽  
History Of ◽  
Multistep Procedure

<strong>Introduction:</strong> Methicillin-resistant Staphylococcus aureus remains one of the principal resistant pathogens causing serious healthcareassociated infections. The objective of this study was to control and monitor methicillin-resistant Staphylococcus aureus cases using multimodal strategy in a Portuguese hospital.<br />Material and Methods: Multistep procedure involving isolation measures and active surveillance cultures in a selected population (patients from other hospitals and nursing homes; history of hospitalization/ methicillin-resistant Staphylococcus aureus; intensive and intermediate care patients and, in other inpatient services, direct contacts of newly detected methicillin-resistant Staphylococcus aureus patients and, since 2012, patients doing hemodialysis). Other parallel activities: (a) review of isolation and standard precautions policy, (b) reinforcement of alcohol-based handrubs at point of patient care, (c) information sessions to health professionals, (d) targeted information flyer for health professionals, (e) information leaflet for patients/ visitors; (f) procedure monitoring by audit (g) patient decolonization in intensive and intermediate care units, with follow-up screenings.<br /><strong>Results:</strong> Between 2007 and 2012, methicillin-resistant Staphylococcus aureus surveillance detected a decrease in proportion from 66% to 57% and, in density of incidence, from 1.80 to 0.68 cases per thousand days of hospitalization (p &lt; 0.001; RR 0.38; CI95%: 0.29-0.49).<br /><strong>Discussion/Conclusion:</strong> According to published European data, using blood and cerebrospinal fluid isolates only, Portugal was the country with the highest level of methicillin-resistant Staphylococcus aureus in 2011. Using this inclusion criteria, our hospital reveled a proportion of methicillin-resistant Staphylococcus aureus below its national level (34% versus 55%) in 2011. Fighting methicillinresistant Staphylococcus aureus using a multimodal strategy is being effective in a high endemic level hospital, but perseverance is needed through continuous surveillance of cases, feed-back to professionals and procedure audits.

Tolerability of a probiotic in subjects with a history of methicillin-resistant Staphylococcus aureus colonisation

2014 ◽  
Vol 5 (4) ◽  
pp. 389-395 ◽  
Author(s):  
S. Warrack ◽  
P. Panjikar ◽  
M. Duster ◽  
N. Safdar
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Resistant Bacteria ◽  
Public Health Importance ◽  
Methicillin Resistant ◽  
History Of ◽  
Study Population

Methicillin-resistant Staphylococcus aureus (MRSA) is a pathogen of major public health importance. Colonisation precedes infection; thus reducing MRSA carriage may be of benefit for reducing infection. Probiotics represent a novel approach to reducing MRSA carriage. We undertook a pilot feasibility randomised controlled trial of the tolerability and acceptability of probiotics for reducing nasal and intestinal carriage of MRSA. In addition, subjects were screened for vancomycin-resistant enterocococci (VRE). Subjects with a history of MRSA were recruited from a large, academic medical center and randomised to take either a placebo or probiotic (Lactobacillus rhamnosus HN001). Subjects returned to the clinic after four weeks for further testing to determine adherence to the probiotic regimen and colonisation of MRSA. 48 subjects were enrolled and randomised. Nearly 25% were transplant recipients and 30% had diabetes. The probiotic was well tolerated in the study population though minor side effects, such as nausea and bloating, were observed. A majority of the subjects randomised to HN001 had good adherence to the regimen. At the four week time point among subjects randomised to the probiotic, MRSA was detected in 67 and 50% of subjects colonised in the nares and the gastrointestinal tract, respectively. Three subjects who initially tested positive for VRE were negative after four weeks of probiotic exposure. Probiotics were well tolerated in our study population of largely immunocompromised subjects with multiple comorbidities. Adherence to the intervention was good. Probiotics should be studied further for their potential to reduce colonisation by multidrug resistant bacteria.

Incidence and risk factors for community-associated methicillin-resistant Staphylococcus aureus in New York City, 2006–2012

2015 ◽  
Vol 144 (5) ◽  
pp. 1014-1017 ◽  
Author(s):  
P. BAKER ◽  
B. COHEN ◽  
J. LIU ◽  
E. LARSON
Keyword(s):  
Risk Factors ◽  
New York ◽  
Staphylococcus Aureus ◽  
New York City ◽  
Logistic Regression ◽  
York City ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistant ◽  
Factors Associated ◽  
History Of

SUMMARYThis study aims to describe changes in incidence and risk factors for community-associated methicillin resistant Staphylococcus aureus (CA-MRSA) infections upon admission to two New York City hospitals from 2006 to 2012. We examined the first hospitalization for adult patients using electronic health record and administrative data and determined the annual incidence/1000 admissions of total S. aureus, total MRSA, and CA-MRSA (within 48 h of admission) in clinical specimens over the study period. Logistic regression was used to identify factors associated with CA-MRSA in 2006 and 2012. In 137 350 admissions, the incidence of S. aureus, MRSA, and CA-MRSA/1000 admissions were 15·6, 7·0, and 3·5, respectively. The total S. aureus and MRSA isolations decreased significantly over the study period (27% and 25%, respectively) while CA-MRSA incidence was unchanged. CA-MRSA increased as a proportion of all MRSA between 2006 (46%) and 2012 (62%), and was most frequently isolated from respiratory (1·5/1000) and blood (0·7/1000) cultures. Logistic regression analysis of factors associated with isolation of CA-MRSA showed that age ⩾65 years [odds ratio (OR) 2·3, 95% confidence interval (CI) 1·2–4·5], male gender (OR 1·8, 95% CI 1·2–2·8) and history of renal failure (OR 2·6, 95% CI 1·6–4·2) were significant predictors of infection in 2006. No predictors were identified in 2012.

Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus infections among HIV-infected persons

2007 ◽  
Vol 18 (8) ◽  
pp. 521-526 ◽  
Author(s):  
Nancy F Crum-Cianflone ◽  
Alina A Burgi ◽  
Braden R Hale
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
General Population ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incidence Rates ◽  
Hiv Viral Load ◽  
Syphilis Infection ◽  
Methicillin Resistant ◽  
History Of ◽  
Mrsa Infection

Community-acquired (CA) methicillin-resistant Staphylococcus aureus (MRSA) rates have rapidly increased in the general population; however, little data on recent incidence rates and risk factors of CA-MRSA infections among HIV patients appear in the literature. A retrospective study was conducted from 1993 through 2005 among patients at a large HIV clinic. Trends in CA-MRSA infection incidence rates, clinical characteristics and risk factors for CA-MRSA were evaluated. Seven percent of our cohort developed a CA-MRSA infection during the study period. The rate of CA-MRSA infections among HIV-infected population significantly increased since 2003, with an incidence of 40.3 cases/1000 person-years in 2005, which was 18-fold higher than the general population served at our facility. In all, 90% of infections were skin/soft tissue infections with a predilection for buttock or scrotal abscess formation; 21% of patients experienced a recurrent infection. Risk factors included a low CD4 count at the time of infection (odds ratio [OR] per 100 CD4 cells 0.84, P = 0.03), high maximum log10 HIV viral load (OR 4.54, P<0.001), recent use of β-lactam antibiotics (OR 6.0 for receipt of two prescriptions, P<0.001) and a history of syphilis (OR 4.55, P = 0.01). No patient receiving trimethoprim-sulfamethoxazole prophylaxis developed a CA-MRSA infection. Over the study period, CA-MRSA accounted for an increasing percentage of positive wound cultures and Staphylococcus aureus isolates, 37% and 65%, respectively, during 2005. In conclusion, CA-MRSA infections have rapidly increased among HIV-infected patients, a group which has a higher rate of these infections than the general population. Risk factors for CA-MRSA among HIV-infected patients include low current CD4 cell count, recent β-lactam antibiotic use and potentially high-risk sexual activity as demonstrated by a history of syphilis infection.

Trends in annual incidence of methicillin-resistant Staphylococcus aureus (MRSA) infection in HIV-infected and HIV-uninfected patients

2013 ◽  
Vol 141 (11) ◽  
pp. 2392-2402 ◽  
Author(s):  
G. N. DELORENZE ◽  
M. A. HORBERG ◽  
M. J. SILVERBERG ◽  
A. TSAI ◽  
C. P. QUESENBERRY ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Health Plan ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incidence Rates ◽  
Infected Group ◽  
Rapid Rise ◽  
Infection Rates ◽  
Methicillin Resistant ◽  
Mrsa Infection

SUMMARYWe describe trends in incidence rates of methicillin-resistant Staphylococcus aureus (MRSA) in HIV-infected and HIV-uninfected patients enrolled in a large northern California Health Plan, and the ratio of MRSA to methicillin-susceptible S. aureus (MSSA) case counts. Between 1995 and 2010, 1549 MRSA infections were diagnosed in 14060 HIV-infected patients (11·0%) compared to 89546 MRSA infections in 6597396 HIV-uninfected patients (1·4%) (P = 0·00). A steady rise in MRSA infection rates began in 1995 in HIV-uninfected patients, peaking at 396·5 infections/100000 person-years in 2007. A more rapid rise in MRSA infection rates occurred in the HIV-infected group after 2000, peaking at 3592·8 infections/100000 in 2005. A declining trend in MRSA rates may have begun in 2008–2009. Comparing the ratio of MRSA to MSSA case counts, we observed that HIV-infected patients shouldered a greater burden of MRSA infection during most years of study follow-up compared to HIV-uninfected patients.

scholarly journals Human Origin for Livestock-Associated Methicillin-Resistant Staphylococcus aureus

mBio ◽  
2012 ◽  
Vol 3 (2) ◽  
Author(s):  
J. Ross Fitzgerald
Keyword(s):  
Staphylococcus Aureus ◽  
Evolutionary History ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Agricultural Practices ◽  
Methicillin Resistant ◽  
Content Type ◽  
Zoonotic Infections ◽  
Ancestral Origin ◽  
Important Study ◽  
History Of

ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of human morbidity and mortality worldwide. The emergence in the last decade of a livestock-associated MRSA (LA-MRSA) clone which also has the capacity to cause zoonotic infections in humans has raised important questions regarding its origin and its potential to cause human epidemics. An important study by L. B. Price et al. [mBio 3(1):e00305-11, 2012] provides evidence for a human ancestral origin for LA-MRSA, raising concerns about agricultural practices that may have contributed to its emergence and expansion. The study highlights the potential for comparative whole-genome sequencing of closely related strains to provide valuable insights into the evolutionary history of bacterial pathogens.

scholarly journals Reduced susceptibility to daptomycin in methicillin-resistant Staphylococcus aureus isolated from catheter-related bloodstream infections

2021 ◽  
Author(s):  
Sho Ohyatsu ◽  
Tomoyuki Nariyama ◽  
Kotaro Matsumoto ◽  
Yuki Moritoki ◽  
Kentaro Kikuchi
Keyword(s):  
Staphylococcus Aureus ◽  
Blood Culture ◽  
Drug Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
High Dose ◽  
Methicillin Resistant ◽  
Treatment Methods ◽  
History Of ◽  
The Mean

Abstract Background The appearance of reduced susceptibility to daptomycin in methicillin-resistant Staphylococcus aureus (MRSA) has recently been reported. It is unclear how likely MRSA involved in catheter-related bloodstream infections (CRBSI) is to dampen susceptibility to daptomycin. We investigated the minimum inhibitory concentrations (MIC) of daptomycin in MRSA isolated from the blood of patients with CRBSI and examined how it was affected by previous anti-MRSA drug treatment. Methods A total of 115 patients whose blood culture samples were found to contain MRSA were enrolled in this study. The MIC of daptomycin and vancomycin and whether the subjects had a history of anti-MRSA drug treatment were investigated and compared between the CRBSI and non-CRBSI groups. Results The mean MIC of daptomycin was significantly higher for the 46 CRBSI-related MRSA isolates than for the 69 non-CRBSI-related MRSA isolates (0.78 vs. 0.33, respectively; p<0.0001). Among the CRBSI-related MRSA isolates, those collected from patients with a history of anti-MRSA drug treatment had significantly higher MIC (1.27 vs. 0.53, respectively; p <0.01). During treatment, MRSA was detected again in 10 CRBSI and 4 non-CRBSI patients, and all of the CRBSI-related MRSA isolates exhibited 1-2 log2 increases in their daptomycin MIC. Conclusions It is considered that when MRSA in catheter biofilms is exposed to anti-MRSA drugs, strains with reduced susceptibility to daptomycin are able to survive and disperse into the blood. Catheters should be removed if an MRSA-induced CRBSI is suspected. Further study of whether high-dose daptomycin treatment is effective when catheters cannot be immediately removed is needed.

Mammary Dysbiosis and Nipple Blebs Treated With Intravenous Daptomycin and Dalbavancin

2019 ◽  
Vol 36 (2) ◽  
pp. 365-368 ◽  
Author(s):  
Katrina B. Mitchell ◽  
Anne Eglash ◽  
Ethan T. Bamberger
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Clinical Presentation ◽  
Breast Surgery ◽  
Management Strategies ◽  
Left Breast ◽  
Drug Resistant ◽  
Intravenous Antibiotic ◽  
Methicillin Resistant ◽  
History Of

Introduction Mammary dysbiosis, also known as subacute mastitis, may be associated with nipple blebs. These overlapping diagnoses represent a challenging clinical scenario during lactation. Little research has been published on etiology, management strategies, and outcomes of these concurrent diagnoses. Main issue We document the treatment and outcome of a patient who presented with left-breast dysbiosis and nipple blebs and whose milk culture grew multi-drug-resistant, methicillin-resistant Staphylococcus aureus. She was treated safely and effectively with intravenous daptomycin and dalbavancin. This has not been described previously in the lactation literature. Management The 35-year-old lactating gravida 3, para 3 patient presented at 6 months postpartum to a breast surgery clinic with a 1-week history of worsening deep left-breast pain, blebs, and recurrent plugging. She was afebrile and she had no erythema or induration on her breast exam. A culture of her milk grew multi-drug-resistant, methicillin-resistant Staphylococcus aureus, and she was referred to infectious disease for assistance with intravenous antibiotic therapy. She continued to feed expressed milk throughout treatment and demonstrated complete resolution of symptoms 8 weeks later. Conclusions We report that in patients with a multi-drug-resistant, methicillin-resistant Staphylococcus aureus–positive human milk culture and a clinical presentation of mammary dysbiosis and nipple blebs, intravenous daptomycin and dalbavancin may be an effective treatment.

scholarly journals Evaluation of methicillin-resistant Staphylococcus aureus nasal carriage in Malagasy patients

2013 ◽  
Vol 7 (04) ◽  
pp. 318-322 ◽  
Author(s):  
Tsiry Rasamiravaka ◽  
Saida Rasoanandrasana ◽  
Norosoa Julie Julie Zafindraibe ◽  
Aimee Olivat Rakoto Alson ◽  
Andry Rasamindrakotroka
Keyword(s):  
Staphylococcus Aureus ◽  
Risk Factor ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Nasal Carriage ◽  
Multidrug Resistant ◽  
High Rate ◽  
Methicillin Resistant ◽  
History Of ◽  
Training And Research ◽  
Strategic Policy

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is an important cause of infections. It is well recognized that nasal carriage of S. aureus represents a potent and increasingly prevalent risk factor for subsequent S. aureus infection. However, in Madagascar no data exist concerning this nasal carriage of S. aureus. Methodology: Nasal swabs from 304 different patients attending the Laboratory of Training and Research in Medical Biology of Madagascar were cultured for methicillin sensitive (MSSA) and MRSA. Results: One hundred and sixteen patients had S. aureus in their noses (38.16 ± 5.46%) of whom 45 (14.80 ± 3.99%) had MRSA.  A risk factor for MSSA nasal carriage included a history of hospitalization when antibiotics were administered (odds ratio [OR] 2.25, 1.09 - 4.64). Among MRSA nasal isolates, high rate of resistance to other antibiotics was observed, particularly for trimethoprim-sulfamethoxazole (68.89%), erythromycin (66.67%) and ofloxacin (53.33%). Conclusion: Our data showed a high rate of MRSA nasal carriage and a high rate of multidrug resistance. A strategic policy against the spread of multidrug resistant strains is desirable.

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