scholarly journals Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors

10.2196/14974 ◽  
2020 ◽  
Vol 12 (2) ◽  
pp. e14974 ◽  
Author(s):  
Courtney M Moore ◽  
Sarah E Wiehe ◽  
Dustin O Lynch ◽  
Gina EM Claxton ◽  
Matthew P Landman ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Skin Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
High Rate ◽  
Healthy Children ◽  
Surgical Incision ◽  
Incision And Drainage ◽  
Methicillin Resistant ◽  
Study Participants ◽  
Medic Study

Background Community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections affect many healthy children. A significant number of these children are hospitalized and require surgical incision and drainage (I&D). Once sent home, these children and families are asked to complete burdensome home decolonization and hygiene procedures in an effort to prevent the high rate of recurrent infections. Objective This component of the Methicillin-resistant Staphylococcus aureus Eradication and Decolonization in Children (MEDiC) study aimed to develop a toolkit to assist MEDiC study participants in completing MRSA decolonization and hygiene procedures at home (the MEDiC kit). Methods In all, 5 adolescents (aged 10-18 years) who had undergone an I&D procedure for a skin infection and 11 parents of children who had undergone an I&D procedure for a skin infection were engaged in a 4-hour group workshop using a human-centered design approach. The topics covered in this workshop and analyzed for this paper were (1) attitudes about MRSA decolonization procedures and (2) barriers to the implementation of MRSA decolonization and hygiene procedures. The team analyzed the audio and artifacts created during the workshop and synthesized their findings to inform the creation of the MEDiC kit. Results The workshop activities uncovered barriers to successful completion of the decolonization and hygiene procedures: lack of step-by-step instruction, lack of proper tools in the home, concerns about adverse events, lack of control over some aspects of the hygiene procedures, and general difficulty coordinating all the procedures. Many of these could be addressed as part of the MEDiC kit. In addition, the workshop revealed that effective communication about decolonization would have to address concerns about the effects of bleach, provide detailed information, give reasons for the specific decolonization and hygiene protocol steps, and include step-by-step instructions (preferably through video). Conclusions Through direct engagement with patients and families, we were able to better understand how to support families in implementing MRSA decolonization and hygiene protocols. In addition, we were able to better understand how to communicate about MRSA decolonization and hygiene protocols. With this knowledge, we created a robust toolkit that uses patient-driven language and visuals to help support patients and families through the implementation of these protocols. Trial Registration ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658

scholarly journals Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors (Preprint)

2019 ◽  
Author(s):  
Courtney M Moore ◽  
Sarah E Wiehe ◽  
Dustin O Lynch ◽  
Gina EM Claxton ◽  
Matthew P Landman ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Skin Infection ◽  
High Rate ◽  
Healthy Children ◽  
Children And Families ◽  
Surgical Incision ◽  
Incision And Drainage ◽  
Methicillin Resistant ◽  
Study Participants ◽  
Medic Study

BACKGROUND Community-acquired methicillin-resistant <i>Staphylococcus aureus</i> (MRSA) skin and soft tissue infections affect many healthy children. A significant number of these children are hospitalized and require surgical incision and drainage (I&amp;D). Once sent home, these children and families are asked to complete burdensome home decolonization and hygiene procedures in an effort to prevent the high rate of recurrent infections. OBJECTIVE This component of the Methicillin-resistant <i>Staphylococcus aureus</i> Eradication and Decolonization in Children (MEDiC) study aimed to develop a toolkit to assist MEDiC study participants in completing MRSA decolonization and hygiene procedures at home (the MEDiC kit). METHODS In all, 5 adolescents (aged 10-18 years) who had undergone an I&amp;D procedure for a skin infection and 11 parents of children who had undergone an I&amp;D procedure for a skin infection were engaged in a 4-hour group workshop using a human-centered design approach. The topics covered in this workshop and analyzed for this paper were (1) attitudes about MRSA decolonization procedures and (2) barriers to the implementation of MRSA decolonization and hygiene procedures. The team analyzed the audio and artifacts created during the workshop and synthesized their findings to inform the creation of the MEDiC kit. RESULTS The workshop activities uncovered barriers to successful completion of the decolonization and hygiene procedures: lack of step-by-step instruction, lack of proper tools in the home, concerns about adverse events, lack of control over some aspects of the hygiene procedures, and general difficulty coordinating all the procedures. Many of these could be addressed as part of the MEDiC kit. In addition, the workshop revealed that effective communication about decolonization would have to address concerns about the effects of bleach, provide detailed information, give reasons for the specific decolonization and hygiene protocol steps, and include step-by-step instructions (preferably through video). CONCLUSIONS Through direct engagement with patients and families, we were able to better understand how to support families in implementing MRSA decolonization and hygiene protocols. In addition, we were able to better understand how to communicate about MRSA decolonization and hygiene protocols. With this knowledge, we created a robust toolkit that uses patient-driven language and visuals to help support patients and families through the implementation of these protocols. CLINICALTRIAL ClinicalTrials.gov NCT02127658; https://clinicaltrials.gov/ct2/show/NCT02127658

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.

Antibacterials as Adjuncts to Incision and Drainage for Adults with Purulent Methicillin-Resistant Staphylococcus aureus (MRSA) Skin Infections

Drugs ◽  
2012 ◽  
Vol 72 (3) ◽  
pp. 339-351 ◽  
Author(s):  
Nicolas A. Forcade ◽  
Nathan P. Wiederhold ◽  
Laurajo Ryan ◽  
Robert L. Talbert ◽  
Christopher R. Frei
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Skin Infections ◽  
Incision And Drainage ◽  
Methicillin Resistant

scholarly journals Comparison of Vancomycin Treatment Failures for Methicillin-Resistant Staphylococcus aureus Bacteremia Stratified by Minimum Inhibitory Concentration

2019 ◽  
Vol 35 (5) ◽  
pp. 203-207 ◽  
Author(s):  
Mary Joyce B. Wingler ◽  
Darrell T. Childress ◽  
Ricardo A. Maldonado
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Retrospective Chart Review ◽  
High Rate ◽  
Methicillin Resistant ◽  
Staphylococcus Aureus Bacteremia ◽  
Vancomycin Mics ◽  
Significant Difference ◽  
Alternative Agent ◽  
Vancomycin Treatment

Background: Optimal treatment of methicillin-resistant Staphylococcus aureus bacteremias (MRSABs) with vancomycin minimum inhibitory concentrations (MICs) high within the susceptible range is of concern due to the high rate of mortality and increased prevalence. Objective: The purpose of this study is to evaluate vancomycin treatment failures in patients with MRSAB stratified by vancomycin MIC. Methods: In this retrospective chart review, patients ≥19 years of age with MRSAB between July 2010 and December 2016 were included if they received intravenous vancomycin for ≥72 hours. Vancomycin treatment failures were compared between patients with vancomycin MICs of ≤1 mg/L and 2 mg/L. Vancomycin treatment failure was defined as microbiological failure at 7 days. Inpatient mortality, 30-day readmission, vancomycin-associated nephrotoxicity, and early bacteremia clearance at 48 to 96 hours were assessed as secondary endpoints. Results: Fifty-eight patients were included in the vancomycin MIC ≤1 mg/L group and 22 patients in the vancomycin MIC 2 mg/L group. No significant difference was found in vancomycin treatment failures at 7 days between groups (88% vs 91%, respectively; P = .850). At 96 hours, there was no significant difference in vancomycin treatment failures between groups (72% vs 90%, respectively; P = .127). No significant difference was found in mortality ( P > .99) or 30-day readmission ( P > .99). Conclusions: In this study, vancomycin treatment failures were not more prevalent in patients with vancomycin MIC of 2 mg/L at 7 days. Regardless of MIC, antibiotics should be switched to an alternative agent at 7 days for persistent bacteremia.

Increasing Rates of Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Healthy Children

2005 ◽  
Vol 24 (7) ◽  
pp. 617-621 ◽  
Author(s):  
Clarence B. Creech ◽  
Douglas S. Kernodle ◽  
Andrew Alsentzer ◽  
Cynthia Wilson ◽  
Kathryn M. Edwards
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Nasal Carriage ◽  
Healthy Children ◽  
Methicillin Resistant
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