165 results on '"Methicillin Resistant Staphylococcus Aureus"'
Search Results
2. Sporadic late-onset Darier's disease.
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Chew C.Y., Nguyen R.A.D., Chew C.Y., and Nguyen R.A.D.
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- 2021
3. Daptomycin Plus Fosfomycin Versus Daptomycin Alone for Methicillin-resistant Staphylococcus aureus Bacteremia and Endocarditis: A Randomized Clinical Trial
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Universitat Rovira i Virgili, Haddadin, Zaid; Batarseh, Einas; Hamdan, Lubna; Stewart, Laura S.; Piya, Bhinnata; Rahman, Herdi; Spieker, Andrew J.; Chappell, James; Wikswo, Mary E.; Dunn, John R.; Payne, Daniel C.; Vinje, Jan; Hall, Aron J.; Halasa, Natasha, Universitat Rovira i Virgili, and Haddadin, Zaid; Batarseh, Einas; Hamdan, Lubna; Stewart, Laura S.; Piya, Bhinnata; Rahman, Herdi; Spieker, Andrew J.; Chappell, James; Wikswo, Mary E.; Dunn, John R.; Payne, Daniel C.; Vinje, Jan; Hall, Aron J.; Halasa, Natasha
- Abstract
Background. We aimed to determine whether daptomycin plus fosfomycin provides higher treatment success than daptomycin alone for methicillin-resistant Staphylococcus aureus (MRSA) bacteremia and endocarditis.Methods. A randomized (1:1) phase 3 superiority, open-label, and parallel group clinical trial of adult inpatients with MRSA bacteremia was conducted at 18 Spanish hospitals. Patients were randomly assigned to receive either 10 mg/kg of daptomycin intravenously daily plus 2 g of fosfomycin intravenously every 6 hours, or 10 mg/kg of daptomycin intravenously daily. Primary endpoint was treatment success 6 weeks after the end of therapy.Results. Of 167 patients randomized, 155 completed the trial and were assessed for the primary endpoint. Treatment success at 6 weeks after the end of therapy was achieved in 40 of 74 patients who received daptomycin plus fosfomycin and in 34 of 81 patients who were given daptomycin alone (54.1% vs 42.0%; relative risk, 1.29 [95% confidence interval, .93-1.8]; P = .135). At 6 weeks, daptomycin plus fosfomycin was associated with lower microbiologic failure (0 vs 9 patients; P = .003) and lower complicated bacteremia (16.2% vs 32.1%; P = .022). Adverse events leading to treatment discontinuation occurred in 13 of 74 patients (17.6%) receiving daptomycin plus fosfomycin, and in 4 of 81 patients (4.9%) receiving daptomycin alone (P = .018).Conclusions. Daptomycin plus fosfomycin provided 12% higher rate of treatment success than daptomycin alone, but this difference did not reach statistical significance. This antibiotic combination prevented microbiological failure and complicated bacteremia, but it was more often associated with adverse events.
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- 2021
4. Intermittent negative blood cultures in Staphylococcus aureus bacteremia; a retrospective study of 1071 episodes.
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Graham M., Stewart J.D., Kotsanas D., Woolley I., Korman T.M., Graham M., Stewart J.D., Kotsanas D., Woolley I., and Korman T.M.
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Background. Recommended management of Staphylococcus aureus bacteremia (SAB) includes follow-up blood culture sets (BCs) to determine the duration of bacteremia. Duration of bacteremia is an important prognostic factor in SAB, and follow-up BCs have a critical role in differentiation of uncomplicated and complicated SAB. However, intermittent negative BCs occur in SAB. Clinical guidelines for SAB management do not specify an approach to follow-up BCs' collection or define the number of negative BCs required to demonstrate resolution of bacteremia. This study assessed the frequency of intermittent negative BCs in SAB and used these findings to formulate a recommendation for collection of follow-up BCs. Methods. This retrospective study reviewed 1071 episodes of SAB. Clinical and microbiological data including the duration of bacteremia and the occurrence of intermittent negative BCs (those preceded and followed by positive cultures) were considered. Results. Intermittent bacteremia occurred in 13% (140/1071) of episodes. A single negative BC on days 1-3 had a predictive value of 87%-93% for resolution of bacteremia, although this was improved if all BCs collected within the same day were considered. Conclusions. Intermittent negative BCs are common in SAB. Given this, we would not recommend accepting a single negative BC as demonstrating resolution of the bacteremia. This is particularly important if a patient is to be classified as having uncomplicated SAB.Copyright © The Author(s) 2019.
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- 2020
5. Root cause analysis to identify medication and non-medication strategies to prevent infection-related hospitalizations from australian residential aged care services.
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Cooper T., Bell J.S., Robson L., Cairns K.A., Visvanathan R., Ilomki J., Sluggett J.K., Lalic S., Hosking S.M., Ritchie B., McLoughlin J., Shortt T., Cooper T., Bell J.S., Robson L., Cairns K.A., Visvanathan R., Ilomki J., Sluggett J.K., Lalic S., Hosking S.M., Ritchie B., McLoughlin J., and Shortt T.
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Infections are leading causes of hospitalizations from residential aged care services (RACS), which provide supported accommodation for people with care needs that can no longer be met at home. Preventing infections and early and effective management are important to avoid unnecessary hospital transfers, particularly in the Australian setting where new quality standards require RACS to minimize infection-related risks. The objective of this study was to examine root causes of infection-related hospitalizations from RACS and identify strategies to limit infections and avoid unnecessary hospitalizations. An aggregate root cause analysis (RCA) was undertaken using a structured local framework. A clinical nurse auditor and clinical pharmacist undertook a comprehensive review of 49 consecutive infection-related hospitalizations from 6 RACS. Data were collected from nursing progress notes, medical records, medication charts, hospital summaries, and incident reports using a purpose-built collection tool. The research team then utilized a structured classification system to guide the identification of root causes of hospital transfers. A multidisciplinary clinical panel assessed the root causes and formulated strategies to limit infections and hospitalizations. Overall, 59.2% of hospitalizations were for respiratory, 28.6% for urinary, and 10.2% for skin infections. Potential root causes of infections included medications that may increase infection risk and resident vaccination status. Potential contributors to hospital transfers included possible suboptimal selection of empirical antimicrobial therapy, inability of RACS staff to establish on-site intravenous access for antimicrobial administration, and the need to access subsidized medical services not provided in the RACS (e.g., radiology and pathology). Strategies identified by the panel included medication review, targeted bundles of care, additional antimicrobial stewardship initiatives, earlier identification of infe
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- 2020
6. Patienters upplevelser av att vårdas med resistenta bakterier inom slutenvården : En litteraturöversikt
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Fridell, Elin, Fridell, Rebecka, Fridell, Elin, and Fridell, Rebecka
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Bakgrund: Utveckling av antibiotikaresistenta bakterier är ett globalt folkhälsoproblem. Meticillinresistenta Staphylococcus aureus (MRSA) är en av dom vanligaste antibiotikaresistenta bakterien och smittas vanligtvis via kontaktsmitta. I Sverige ses MRSA som en allmänfarlig sjukdom som kan innebära livshotande tillstånd samt lidande hos patienten. Smittspridning av MRSA kan minskas genom följsamhet av basala hygienrutiner. Sjuksköterskans ansvar är att arbeta smittförebyggande, patientsäkert, lindra lidande samt hålla sig uppdaterad med ny kunskap. Trots detta upplever sjuksköterskor kunskapsbrist gällande MRSA och rädsla över att själva bli smittade. Syfte: Studiens syfte är att belysa patienters upplevelser av att vårdas med MRSA inom slutenvården. Metod: Studien är gjord som en litteraturöversikt som baseras på 15 vetenskapliga artiklar med kvalitativ-, kvantitativ- och mixad metod. Datasökning har gjorts i databaserna CINAHL och PubMed. Resultat: I resultatet framkom tre teman där patienternas upplevelser av att vårdas med MRSA inom slutenvården belyses: Upplevelser av bemötande från vårdpersonal, Upplevelser av information samt kunskap hos vårdpersonal och Upplevelser av att vårdas i isoleringsrum. Resultatet visade att patienter med MRSA upplever stigmatisering, kränkning och oprofessionellt bemötande av vårdpersonal på grund av kunskapsbrist vilket medför psykiskt lidande hos patienterna. Det visade sig även att vårdande i isoleringsrum upplevs negativt och att den fysiska vårdmiljöns utformning har en betydande inverkan på upplevelse och välmående. Slutsats: Vårdpersonal behöver mer fortbildning för att öka kunskap om vårdandet av patienter med MRSA samt en god fysisk vårdmiljö i isoleringsrum skapar förutsättningar för att lindra lidande samt säkerhetsställa god och säker vård i vården av patienter med MRSA inom slutenvård., Background: The development of antibiotic resistant bacteria is a global health problem. Methicillin-resistant Staphylococcus Aureus (MRSA) is one of the most common antibiotic resistant bacteria and is usually transmitted through contact infection. In Sweden MRSA is referred to as a dangerous disease that can cause life-threatening conditions as well as patient suffering. The spread of infection may be reduced by adherence to basic hygiene practices. The nurse’s responsibility involves infection prevention, patient safety, alleviation of suffering and maintaining current knowledge of the disease. Despite this, nurses may lack knowledge concerning MRSA and fear contracting it. Aim: The aim of this study is to highlight the patient’s experience during inpatient treatment of MRSA. Methods: The study was conducted as a literature review based on fifteen scientific articles with qualitative-, quantitative- and mixed method. The article search was conducted via the CINAHL and PubMed databases. Results: The result highlighted three themes involving patient experiences during isolated inpatient care of MRSA: Experience related to treatment by healthcare professionals, Experiences concerning the depth and correctness of information and knowledge by healthcare professionals and Experiences of being cared for in an isolation room. The result indicated that MRSA patients experience stigma experiences psychological distress as they felt stigmatized, violated and unprofessionally treated by healthcare professional due a lack of knowledge. Furthermore, it also showed that isolation room care was negatively experienced and that the care environment design significantly impacted the patient’s experiences and feelings of well-being. Conclusion: Healthcare professionals need further education to increase their knowledge of MRSA patient care and how the maintenance of a good care environment in isolation rooms is important for alleviation of suffering and ensuring the good and safe ca
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- 2020
7. Att vårda patienter med Meticillinresistens Staphylococcus Areus : En litteraturöversikt
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Abdusemed, Sabrin, Karlsson-Rohmée, Jessika, Abdusemed, Sabrin, and Karlsson-Rohmée, Jessika
- Abstract
Meticillinresistent Staphylococcus Aureus (MRSA) är en bakterie som är resistent mot olika typer av antibiotika. Spridningen av MRSA utgör ett hot mot modern medicin och möjligheten till en effektiv behandling och vård. Hälso- och sjukvårdspersonal bör arbeta förebyggande för att på så vis minska spridningen av MRSA, vilket är en viktig del av arbetet mot antibiotikaresistens. Hälso- och sjukvårdspersonalen är de som är i frontlinjen för att vårda patienter med MRSA, därmed fokuserar denna studie på deras upplevelser av att vårda dessa patienter. En litteraturöversikt genomfördes och resultatet visar att det finns kunskapsskillnader mellan hälso- och sjukvårdspersonal. Mängden kunskap påverkar även hälso- och sjukvårdspersonalens attityd av att vårda MRSA - smittade patienter. Det framkommer att hälso- och sjukvårdspersonalen är rädda för att bli smittade av MRSA, vilketupplevs skapa en barriär mellan hälso- och sjukvårdspersonal och patient. Denna rädsla kan prägla vården som ges vilket kan riskera att drabba patienterna negativt med en känsla av att vården distanseras som följd. Dessutom anses tidsbrist vara en faktor som gör det svårare att förebygga infektioner och kan leda till en bristande handhygien. Sammanfattningsvis medför en ökad kunskap om MRSA att hälso- och sjukvårdspersonalen känner sig säkrare och tryggare i sitt vårdande jämfört med de med lite kunskap, som ofta är rädda och kan överdriva användandet av handskar och desinfektionsmedel., Methicillin Resistant Staphylococcus Aureus (MRSA) is a bacteria that is resistant to several forms of antibiotics. The spread of MRSA thus possess a threat to modern medicine and the possibility of effective treatment and care. To reduce the risk of MRSA spreading, healthcare professionals should work preventively, which is an important part of the work regarding antibiotic resistance. Due to the fact that healthcare professionals are those in the frontlines in the care of patients with MRSA, this study focuses on their experiences caring for said patients. Furthermore, a literature overview was used to perform this study. The result shows that there are differences in knowledge between the healthcare professionals. The amount of knowledge is also found to influence the attitude of healthcare professionals in caring for MRSA-infected patients. The results also showed that healthcare professionals were afraid of being infected by MRSA themselves. This fear could be reflected in their care which risked affecting the patients negatively with a feeling of isolation as a result. Furthermore, increased workload and lack of time was seen as a factor that made it more difficult to prevent infections and could lead to a poor execution of hand hygiene. In conclusion, Increased knowledge regarding MRSA made the healthcare workers more secure and comfortable in their care in comparison to those with little knowledge who were often scared and exaggerated their use of gloves and disinfection.
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- 2020
8. Methicillin resistant Staphylococcus aureus infective endocarditis presenting as neutrophilic meningoencephalitis.
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Bajaj, Tushar, Bajaj, Tushar, Karapetians, Anthony, Karapetians, Natalie, Duong, Hanh, Heidari, Arash, Bajaj, Tushar, Bajaj, Tushar, Karapetians, Anthony, Karapetians, Natalie, Duong, Hanh, and Heidari, Arash
- Abstract
Infective endocarditis (IE) with Staphylococcus aureus is associated with intravenous drug abuse or infected cardiac devices and commonly presents with non-specific constitutional symptoms. A 53-year-old female presented to the hospital with back pain, altered mental status, fever, and tachycardia. Due to patient's lethargy and decline in respiratory effort, she was intubated and lumbar puncture was performed that revealed neutrophil-predominant leukocytosis of the cerebrospinal fluid. The patient was empirically started on ceftriaxone and vancomycin, and blood cultures were positive for methicillin resistant Staphylococcus aureus (MRSA). A chest X-ray demonstrated pulmonary congestion and an implanted pacemaker; furthermore, a transesophageal echocardiogram (TEE) revealed a vegetation on the atrial lead of the pacemaker. As the patient's condition improved after a few days, she was extubated and was able to provide a clear history. The source of her infection was a pus pocket around her pacemaker which was placed two months prior to her admission. As expected, the infection resolved with proper source control and antibiotic therapy.
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- 2020
9. Kidney Health Australia - Caring for Australasians with Renal Impairment guideline recommendations for infection control for haemodialysis units.
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Athan E., Jardine M., Commons R.J., de Zoysa J.R., Wong M.G., Gilroy N., Green J., Henderson B., Tunnicliffe D.J., van Eps C., Stuart R.L., Athan E., Jardine M., Commons R.J., de Zoysa J.R., Wong M.G., Gilroy N., Green J., Henderson B., Tunnicliffe D.J., van Eps C., and Stuart R.L.
- Abstract
Aim: There is no national consensus on infection control in haemodialysis units in Australia and New Zealand. The primary aim of this guideline was to provide recommendations on screening for blood-borne viruses and multi-resistant organisms for dialysis units based on the available evidence. Method(s): The Kidney Health Australia Caring for Australasians with Renal Impairment guidelines, overall approach to guideline development follows the GRADE framework. A facilitated workshop was conducted to ensure that patient and caregiver concerns were considered. The evidence from relevant medical databases on the impact of screening on detection and transmission rates, hospitalization, mortality and psychosocial care, was reviewed and critically appraised. The guideline group made recommendations from the evidence available. Result(s): The main guideline recommendations are: Dialysis units adopt a comprehensive approach that encompasses standard infection control precautions. Conduct routine surveillance for key blood-borne viruses and methicillin-resistant Staphylococcus aureus. Conduct routine surveillance of individual levels of protection against hepatitis B for patients on haemodialysis. Use dedicated dialysis machines for HBV-infected patients. The evidence in totality was not found to support routine surveillance of vancomycin-resistant Enterococci. Enhanced surveillance in light of the local risk of transmittable infectious agents should be considered by dialysis units. Very few studies have reported on the potential adverse effects of screening and associated practices. Conclusion(s): Future research should focus on the potential benefits and adverse effects of screening and associated practices on clinical outcomes including infections prevented and health service delivery, and psychosocial domains for patients. Given the results of trials in the critical setting, the effectiveness of methicillin-resistant Staphylococcus aureus decolonization in people receiving
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- 2019
10. Detection of chromosomal cassette in MRSA Staphylococcus aureus strains isolated in a University Hospital in Maracaibo City
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Romero-Añez, Sonia Coromoto, Castellano-González, Maribel Josefina, Perozo Mena, Armindo José, Rincón-Villalobos, Gresleida Coromoto, Zabala-Romero, Diana Patricia, Romero-Añez, Sonia Coromoto, Castellano-González, Maribel Josefina, Perozo Mena, Armindo José, Rincón-Villalobos, Gresleida Coromoto, and Zabala-Romero, Diana Patricia
- Abstract
Methicillin-resistant Staphylococcus aureus is an important nosocomial and community pathogen. The genetic determinant of resistance is the mecA gene. 11 types of SCCmec have been described, with types II, III frequently found in hospital infections, and types IV and V in community infections. The present investigation was carried out to study the distribution of the SCCmec types and their relation with the Panton-Valentine Leucocidin, typified by the reaction in the Polymerase Chain. To this end, a total of 42 methicillin-resistant strains carrying the mecA gene were studied. Twenty-nine (29) strains showed the presence of type IV chromosomal cassette (69.05%); 30.95% presented SCCmec type I. A 61.95% (n= 13) of the strains were carriers of SCCmec IV, all of which were positive for the PVL gene. It is worth noting the dissemination of the type IV cassette in intrahospital strains carrying PVL, which is worrisome both for the therapeutic and for the aggravation of infections in patients., Staphylococcus aureus resistente a meticilina, es un importante patógeno nosocomial y comunitario. El determinante genético de resistencia es el gen mecA. Se han descrito 11 tipos de SCCmec, encontrándose con frecuencia los tipos II, III en infecciones hospitalarias, y los tipos IV y V en infecciones comunitarias. La presente investigación se llevó a cabo para estudiar la distribución de los tipos de SCCmec y su relación con la Leucocidina Panton-Valentine, tipificados mediante la reacción en Cadena de la Polimerasa. Para ello se estudiaron un total de 42 cepas resistentes a meticilina portadoras del gen mecA. Veintinueve (29) cepas mostraron la presencia del cassette cromosomal tipo IV (69,05%); 30,95% presentaron el SCCmec tipo I. Un 61,95% (n=13) de las cepas fueron portadoras del SCCmec IV resultando todas positivas para el gen PVL. Cabe destacar la diseminación del cassette tipo IV en cepas intrahospitalarias portadoras de PVL, lo que es preocupante tanto para la terapéutica como para el agravamiento de las infecciones en los pacientes.
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- 2018
11. Adherence to best practice consensus guidelines for implant-based breast reconstruction: Results from the iBRA national practice questionnaire survey.
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Mazari F.A.K., Youssef M., Graja T., Huf S., Deol H., Brindle R., Gawne S., Egbeare D., Dash I., Galea M., Laws S., Tayeh S., Parvanta L., Down S., Westbroek D., Roberts J.W., Massey J., Turton P., Achuthan R., Fawzy M., Dickson M., Carmichael A.R., Akingboye A., James R., Kirkpatrick K., Nael E., Vidya R., Thorne A., Rostom M., Depasquale I., Cawthorn S.J., Gangamihardja T., Joglekar S., Smith J., Halka A., MacMillan D., Clark S., Pearce B., Mansfield L., King I., Hazari A., Smith B., Volleamere A.J., Ferguson D., Barnes N., Knight A., MacNeill F., Conway A., Irvine T., Mylavaganam S., Dunne N., Kohlhardt S., Hoo C., Kirk S., Hu J., Ledwidge S., Tang S., Banerjee D., Waheed S., Voynov V., Soumian S., Henderson J., Harvey J., Robertson S., Waters R., Carbone A., Farooq A., Tafazal H., Clarke D., Cocker D., Lai L.M., Winter Beatty J., Barkeji M., Vinayagam R., Mullan M., Osborne C., Baker E., Piper J., Mylvaganam S., Conroy E.J., Williamson P.R., Barnes N.L.P., Cutress R.I., Gardiner M.D., Jain A., Skillman J.M., Thrush S., Whisker L.J., Blazeby J.M., Potter S., Holcombe C., Branford O.A., McEvoy K., Mills N., Teasdale E.M., Tang L., Nguyen D., Johnson R., Muralikrishnan V., Chopra S., Reid A., Benyon S., Murphy C., Soliman F., Lefemine V., Saha S., Ogedegbe K., Olyinka O.S., Dicks J.R., Manoloudakis N., Conroy F., Irwin G., McIntosh S., Michalakis I., Hignett S., Linforth R., Rathinaezhil R., Osman H., Anesti K., Griffiths M., Jacklin R., Waterworth A., Foulkes R., Davies E., Bisarya K., Allan A., Leon-Villapalos J., Azmy I., George S., Fahmy F.S., Hargreaves A., Seward J., Henton J., Collin T., Mallon P., Turner J., Sarakbi W., Athanasiou I., Rogers C., Mazari F.A.K., Youssef M., Graja T., Huf S., Deol H., Brindle R., Gawne S., Egbeare D., Dash I., Galea M., Laws S., Tayeh S., Parvanta L., Down S., Westbroek D., Roberts J.W., Massey J., Turton P., Achuthan R., Fawzy M., Dickson M., Carmichael A.R., Akingboye A., James R., Kirkpatrick K., Nael E., Vidya R., Thorne A., Rostom M., Depasquale I., Cawthorn S.J., Gangamihardja T., Joglekar S., Smith J., Halka A., MacMillan D., Clark S., Pearce B., Mansfield L., King I., Hazari A., Smith B., Volleamere A.J., Ferguson D., Barnes N., Knight A., MacNeill F., Conway A., Irvine T., Mylavaganam S., Dunne N., Kohlhardt S., Hoo C., Kirk S., Hu J., Ledwidge S., Tang S., Banerjee D., Waheed S., Voynov V., Soumian S., Henderson J., Harvey J., Robertson S., Waters R., Carbone A., Farooq A., Tafazal H., Clarke D., Cocker D., Lai L.M., Winter Beatty J., Barkeji M., Vinayagam R., Mullan M., Osborne C., Baker E., Piper J., Mylvaganam S., Conroy E.J., Williamson P.R., Barnes N.L.P., Cutress R.I., Gardiner M.D., Jain A., Skillman J.M., Thrush S., Whisker L.J., Blazeby J.M., Potter S., Holcombe C., Branford O.A., McEvoy K., Mills N., Teasdale E.M., Tang L., Nguyen D., Johnson R., Muralikrishnan V., Chopra S., Reid A., Benyon S., Murphy C., Soliman F., Lefemine V., Saha S., Ogedegbe K., Olyinka O.S., Dicks J.R., Manoloudakis N., Conroy F., Irwin G., McIntosh S., Michalakis I., Hignett S., Linforth R., Rathinaezhil R., Osman H., Anesti K., Griffiths M., Jacklin R., Waterworth A., Foulkes R., Davies E., Bisarya K., Allan A., Leon-Villapalos J., Azmy I., George S., Fahmy F.S., Hargreaves A., Seward J., Henton J., Collin T., Mallon P., Turner J., Sarakbi W., Athanasiou I., and Rogers C.
- Abstract
Introduction: The 2008 National Mastectomy and Breast Reconstruction Audit demonstrated marked variation in the practice and outcomes of breast reconstruction in the UK. To standardise practice and improve outcomes for patients, the British professional associations developed best-practice guidelines with specific guidance for newer mesh-assisted implant-based techniques. We explored the degree of uptake of best-practice guidelines within units performing implant-based reconstruction (IBBR) as the first phase of the implant Breast Reconstruction Evaluation (iBRA) study. Method(s): A questionnaire developed by the iBRA Steering Group was completed by trainee and consultant leads at breast and plastic surgical units across the UK. Simple summary statistics were calculated for each survey item to assess compliance with current best-practice guidelines. Result(s): 81 units from 79 NHS Trusts completed the questionnaire. Marked variation was observed in adherence to guidelines, especially those relating to clinical governance and infection prevention strategies. Less than half (n = 28, 47%) of units obtained local clinical governance board approval prior to offering new mesh-based techniques and prospective audit of the clinical, cosmetic and patient-reported outcomes of surgery was infrequent. Most units screened for methicillin-resistant staphylococcus aureus prior to surgery but fewer than 1 in 3 screened for methicillin-sensitive strains. Laminar-flow theatres (recommended for IBBR) were not widely-available with less than 1 in 5 units having regular access. Peri-operative antibiotics were widely-used, but the type and duration were highly-variable. Conclusion(s): The iBRA national practice questionnaire has demonstrated variation in reported practice and adherence to IBBR guidelines. High-quality evidence is urgently required to inform best practice.Copyright © 2018 The Authors
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- 2018
12. Bronchiectasis in indigenous and non-indigenous residents of Australia and New Zealand.
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Remond M.G.W., Maguire G.P., Woods C., Blackall S.R., Hong J.B., King P., Wong C., Einsiedel L., Remond M.G.W., Maguire G.P., Woods C., Blackall S.R., Hong J.B., King P., Wong C., and Einsiedel L.
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Background and objective: Bronchiectasis not associated with cystic fibrosis is an increasingly recognized chronic lung disease. In Oceania, indigenous populations experience a disproportionately high burden of disease. We aimed to describe the natural history of bronchiectasis and identify risk factors associated with premature mortality within a cohort of Aboriginal Australians, New Zealand Maori and Pacific Islanders, and non-indigenous Australians and New Zealanders. Method(s): This was a retrospective cohort study of bronchiectasis patients aged >15 years at three hospitals: Alice Springs Hospital and Monash Medical Centre in Australia, and Middlemore Hospital in New Zealand. Data included demographics, ethnicity, sputum microbiology, radiology, spirometry, hospitalization and survival over 5 years of follow-up. Result(s): Aboriginal Australians were significantly younger and died at a significantly younger age than other groups. Age- and sex-adjusted all-cause mortality was higher for Aboriginal Australians (hazard ratio (HR): 3.9), and respiratory-related mortality was higher for both Aboriginal Australians (HR: 4.3) and Maori and Pacific Islander people (HR: 1.7). Hospitalization was common: Aboriginal Australians had 2.9 admissions/person-year and 16.9 days in hospital/person-year. Despite Aboriginal Australians having poorer prognosis, calculation of the FACED score suggested milder disease in this group. Sputum microbiology varied with Aspergillus fumigatus more often isolated from non-indigenous patients. Airflow obstruction was common (66.9%) but not invariable. Conclusion(s): Bronchiectasis is not one disease. It has a significant impact on healthcare utilization and survival. Differences between populations are likely to relate to differing aetiologies and understanding the drivers of bronchiectasis in disadvantaged populations will be key.Copyright © 2018 Asian Pacific Society of Respirology
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- 2018
13. Membrane interactions of microgels as carriers of antimicrobial peptides
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Nordström, R., Nyström, L., Andrén, Oliver C. J., Malkoch, Michael, Umerska, A., Davoudi, M., Schmidtchen, A., Malmsten, M., Nordström, R., Nyström, L., Andrén, Oliver C. J., Malkoch, Michael, Umerska, A., Davoudi, M., Schmidtchen, A., and Malmsten, M.
- Abstract
Microgels are interesting as potential delivery systems for antimicrobial peptides. In order to elucidate membrane interactions of such systems, we here investigate effects of microgel charge density on antimicrobial peptide loading and release, as well as consequences of this for membrane interactions and antimicrobial effects, using ellipsometry, circular dichroism spectroscopy, nanoparticle tracking analysis, dynamic light scattering and z-potential measurements. Anionic poly(ethyl acrylate-co-methacrylic acid) microgels were found to incorporate considerable amounts of the cationic antimicrobial peptides LL-37 (LLGDFFRKSKEKIGKEFKRIVQRIKDFLRNLVPRTES) and DPK-060 (GKHKNKGKKNGKHNGWKWWW) and to protect incorporated peptides from degradation by infection-related proteases at high microgel charge density. As a result of their net negative z-potential also at high peptide loading, neither empty nor peptide-loaded microgels adsorb at supported bacteria-mimicking membranes. Instead, membrane disruption is mediated almost exclusively by peptide release. Mirroring this, antimicrobial effects against several clinically relevant bacteria (methicillin-resistant Staphylococcus aureus (MRSA), Escherichia coli, and Pseudomonas aeruginosa) were found to be promoted by factors facilitating peptide release, such as decreasing peptide length and decreasing microgel charge density. Microgels were further demonstrated to display low toxicity towards erythrocytes. Taken together, the results demonstrate some interesting opportunities for the use of microgels as delivery systems for antimicrobial peptides, but also highlight several key factors which need to be controlled for their successful use., QC 20180327
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- 2018
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14. Commercial biocides induce transfer of prophage Φ13 from human strains of Staphylococcus aureus to livestock CC398
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Tang, Yuanyue, Nielsen, Lene Nørby, Hvitved, Annemette, Haaber, Jakob Krause, Wirtz, Christiane, Andersen, Paal S., Larsen, Jesper, Wolz, Christiane, Ingmer, Hanne, Tang, Yuanyue, Nielsen, Lene Nørby, Hvitved, Annemette, Haaber, Jakob Krause, Wirtz, Christiane, Andersen, Paal S., Larsen, Jesper, Wolz, Christiane, and Ingmer, Hanne
- Abstract
Human strains of Staphylococcus aureus commonly carry the bacteriophage ΦSa3 that encodes immune evasion factors. Recently, this prophage has been found in livestock-associated, methicillin resistant S. aureus (MRSA) CC398 strains where it may promote human colonization. Here, we have addressed if exposure to biocidal products induces phage transfer, and find that during co-culture, Φ13 from strain 8325, belonging to ΦSa3 group, is induced and transferred from a human strain to LA-MRSA CC398 when exposed to sub-lethal concentrations of commercial biocides containing hydrogen peroxide. Integration of ΦSa3 in LA-MRSA CC398 occurs at multiple positions and the integration site influences the stability of the prophage. We did not observe integration in hlb encoding β-hemolysin that contains the preferred ΦSa3 attachment site in human strains, and we demonstrate that this is due to allelic variation in CC398 strains that disrupts the phage attachment site, but not the expression of β-hemolysin. Our results show that hydrogen peroxide present in biocidal products stimulate transfer of ΦSa3 from human to LA-MRSA CC398 strains and that in these strains prophage stability depends on the integration site. Knowledge of ΦSa3 transfer and stability between human and livestock strains may lead to new intervention measures directed at reducing human infection by LA-MRSA strains.
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- 2017
15. Staphylococcus aureus Prostatic abscess: A clinical case report and a review of the literature.
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Carroll D.E., Huang G.K.L., Holt D.C., Tong S.Y.C., Marr I., Boutlis C.S., Carroll D.E., Huang G.K.L., Holt D.C., Tong S.Y.C., Marr I., and Boutlis C.S.
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Background: Prostatic abscess is a rare complication of acute bacterial prostatitis and is most commonly caused by Enterobacteriaceae. We report on a case of prostatic abscess caused by Staphylococcus aureus and conduct a review of the literature. Case presentation: We present a case of S. aureus prostatic abscess that was successfully treated with a combination of antibiotic and surgical therapy. The isolate was non-multidrug-resistant, methicillin-resistant Staphylococcus aureus and was genotyped as clonal complex 5, an emerging regional clone that is trimethoprim resistant and Panton-Valentine leukocidin positive. This current case report is the first to describe the use of clindamycin step-down therapy. A literature review identified a further 39 cases of S. aureus prostatic abscesses, of which 26 were methicillin resistant. Conclusion(s):S. aureus is an uncommon cause of prostatic abscess. Optimal management includes both antibiotic therapy and surgical drainage. Our use of clindamycin as step-down therapy was guided by its excellent prostatic penetration.Copyright © 2017 The Author(s).
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- 2017
16. CO‐MRSA Infections in Australia Cost $3.5B Per Annum
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Cameron, Jessica, Paterson, David L., Britton, Philip N., Tong, Steven Y.C., Hall, Lisa, Nimmo, Graeme R., Bennett, Catherine, Halton, Kate, Cameron, Jessica, Paterson, David L., Britton, Philip N., Tong, Steven Y.C., Hall, Lisa, Nimmo, Graeme R., Bennett, Catherine, and Halton, Kate
- Abstract
Introduction The health and economic burdens of community-onset methicillin resistant Staphylococcus aureus (CO-MRSA) infections are needed to inform policy, planning and evidence-based practice. We aimed to synthesise data from a range of public sources to generate the first estimate of the national incidence and cost of CO-MRSA infections. Methods Incidences of CO-MRSA skin and soft tissue (SSTI), lower respiratory tract (LRTI) and bloodstream (BSI) infections were calculated for regions of Australia using data from existing literature and correspondence with specialists. Simulations estimated costs using treatment models developed for children and adults in primary or tertiary care settings and including bed-stay, diagnostics, procedures, mortalities and loss of productivity. Results Annually, in Australia there were found to be 3702 CO-MRSA SSTIs, 559 CO-MRSA BSIs and 425 CO-MRSA LRTIs, occupying 147,000 bed-days, including 1600 bed-days in intensive care. Incidence ranged from 4 /100,000 person-years in Tasmania to 243 /100,000 person-years in central Australia. CO-MRSA cost $3.5b annually in Australia. The higher incidence of SSTIs resulted in costs greater than summing the costs of BSIs and LRTIs. The greatest cost was mortality. The cost to the health system was found to be $1.9b, with bed occupancies accounting for ≥94%. Conclusion This was the first evaluation of the health and economic burden of CO-MRSA in Australia. We found a need for increased and more consistent data collection for a significant and expensive disease. Disclosure of Interest Statement: This research was funded by NHMRC grant GNT1027589.
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- 2017
17. Treatment of MRSA pneumonia: Clinical and economic comparison of linezolid vs. vancomycin - a retrospective analysis of medical charts and re-imbursement data of real-life patient populations
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Wilke, MH, Becker, K, Kloss, S, Heimann, SM, Goldmann, A, Weber, B, Pletz, MW, Simon, P, Petrik, C, Wilke, MH, Becker, K, Kloss, S, Heimann, SM, Goldmann, A, Weber, B, Pletz, MW, Simon, P, and Petrik, C
- Abstract
Objectives: To supplement the data collected in randomized clinical trials, the present study in patients with methicillin resistant Staphylococcus aureus (MRSA) pneumonia was conducted to explore the clinical effectiveness of linezolid and vancomycin in a routine clinical setting. Further, the overall costs of the patients' stay in the intensive care unit (ICU) were compared.Methods: This was a retrospective analysis of medical and reimbursement data of adult patients who were treated for MRSA pneumonia with linezolid or vancomycin. Since the subjects were not randomly assigned to treatments, propensity score adjustment was applied to reduce a potential selection bias.Results: In total, 226 patients were included; 95 received linezolid and 131 received vancomycin as initial therapy for MRSA pneumonia. Switches to another antibiotic were observed in 4 patients (4.2%) receiving linezolid and in 23 patients (17.6%) receiving vancomycin (logistic regression analysis; odds ratio linezolid/vancomycin: 0.183; 95% confidence interval [CI]: 0.052-0.647; p<0.01). All-cause in-hospital mortality was also lower in patients receiving linezolid (22 patients [23.2%] vs. 54 patients [41.2%]) (logistic regression analysis; odds ratio linezolid/vancomycin: 0.351; 95% CI: 0.184-0.671; p<0.01). The analysis of the total costs of stay in ICU did not reveal any major differences between the two treatment groups (cost ratio linezolid/vancomycin: 1.29; 95% CI: 0.84-1.98; p=0.24).Conclusions: These findings confirm in a routine clinical setting that linezolid is a valuable therapeutic alternative to vancomycin for the treatment of MRSA pneumonia. However, prospective studies in real-life patient populations are warranted.
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- 2017
18. Infecciones de piel y partes blandas
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Peralta, Ruth, Torres de Taboada, Estela, Peralta, Ruth, and Torres de Taboada, Estela
- Abstract
Introduction: Skin and soft tissues infections (SSTI) are common reasons for consulting and the clinical spectrum ranges from trivial to lethal processes. In the last years, methicillin resistant Staphylococcus aureus has been the main causative agent. Objectives: To determine the clinical and microbiological characteristics of SSTI from the community and apply Shapiro rule to calculate the profitability of cultures. Methodology: Observational descriptive and prospective design that included 181 adult patients admitted in the Clinical Service of the National Hospital (Itauguá, Paraguay) during 2015 and 2016. Results: Mean age was 56 years and there was a predominance of male sex (57%). The most frequently diagnosed SSTI was cellulitis: 106 (59%) patients followed by 61 (34%) patients with necrotizing fasciitis. The most frequent comorbidity was type 2 diabetes mellitus. Staphylococcus aureus was the most frequently isolated bacteria. Relating patients according to the blood culture results and Shapiro rule, the patients who scored higher than 5 had more reports of positive blood cultures. Eighty five patients presented sepsis, 44% required surgical intervention and 5 died. Conclusions: Cellulitis was the most frequent SSTI and most infections were caused by Staphylococcus aureus. Diabetes mellitus was the most frquent comorbidity. The application of Shapiro rule for the selection of patients who should have blood cultures will improve their profitability., Introducción: las infecciones de piel y partes blandas (IPPB) son motivo de consulta frecuente y el espectro clínico va desde procesos banales hasta letales. En los últimos años, el Staphylococcus aureus meticilino resistente ha sido el principal agente causal.Objetivos: determinar las características clínicas y microbiológicas de IPPB provenientes de la comunidad, aplicar regla de Shapiro para calcular la rentabilidad de los cultivos.Metodología: diseño observacional, descriptivo, prospectivo, que incluyó a 181 pacientes adultos internados en el Servicio de Clínica Médica del Hospital Nacional (Itauguá, Paraguay) durante 2015 y 2016.Resultados: la edad media fue 56 años, hubo predominio de sexo masculino (57%). La IPPB más frecuentemente diagnosticada fue la celulitis: 106 pacientes (59%), seguido por fascitis necrotizante 61 (34%). La comorbilidad más frecuente fue la diabetes mellitus tipo 2. El Staphylococcus aureus fue el germen más frecuentemente aislado. Relacionando a los pacientes según el resultado de hemocultivo y la regla de Shapiro, los pacientes que tuvieron puntajes mayores a 5 tuvieron mayor reporte de hemocultivos positivos. Presentaron sepsis 85 pacientes, requirieron intervención quirúrgica 44% y fallecieron 5 sujetos.Conclusiones: la celulitis fue la IPPB más frecuente, la mayoría causada por Staphylococcus aureus. La diabetes mellitus fue la comorbilidad más frecuente. La aplicación de la regla de Shapiro para la selección de pacientes a quienes realizar hemocultivos mejoraría su rentabilidad.
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- 2017
19. Reply to Deeny et al
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Hetem, David J., Bootsma, Martin C. J., Bonten, Marc J. M., Hetem, David J., Bootsma, Martin C. J., and Bonten, Marc J. M.
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- 2016
20. Disposable antimicrobial and sporicidal privacy curtains: Cost benefit of hanging longer.
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Gillespie E., Kotsanas D., Gillespie E., and Kotsanas D.
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- 2016
21. Smittad av den moderna pesten : Att vara smittbärare av meticillinresistenta staphylococcus aureus (MRSA)
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Kristensson, Nina, Lindberg, Ulrika, Kristensson, Nina, and Lindberg, Ulrika
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Historiskt sett har personer med smittsamma infektioner uteslutits från samhället. Personerna har setts med avsky och rädsla från omgivningen med risk för att överföra smittan. Multiresistenta bakterier (MRB) är ett ökande problem världen över och orsakar stort lidande för patienter. Syftet med litteraturstudien var att undersöka patienters upplevelse av att vara smittbärare av meticillinresistenta staphylococcus aureus (MRSA). Litteraturstudiens resultat baseras på nio vetenskapliga artiklar, där resultatet utföll i två kategorier. I kategorin känslan av att vara smittsam framkom underkategorierna att vara smutsig, skuld och skam samt rädsla och oro. I kategorin känslan av att vara annorlunda framkom underkategorierna känna sig kränkt, ilska och frustration samt känna sig stigmatiserad. För att patienter med MRSA-smitta ska få en god vård krävs det att vårdpersonalen har evidensbaserad kunskap. Därför skulle det vara av stort intresse att forskning i framtiden fokuserar på patienters upplevelse av att vara smittbärare. Ytterligare forskning behövs inom området på grund av ett ökat globalt problem med MRB., Historically, people with contagious infections has been excluded from society. The characters have been seen with disgust and fear from the environment with the risk of transmitting the infection. Multi-drug resistant bacteria (MRB) is a growing problem worldwide and causes great suffering for patients. The purpose of this study was to investigate patients' experience of being carriers of methicillin-resistant staphylococcus aureus (MRSA). Literature study results are based on nine scientific articles, which precipitated the result of two categories. In the category of feeling of being contagious emerged subcategories to be dirty, guilt and shame and fear and anxiety. In the category of the feeling of being different subcategories emerged feel hurt, anger and frustration, and feel stigmatized. For patients with MRSA infection should get good care requires that health professionals have evidence-based knowledge. Therefore, it would be of great interest to future research focusing on patient experience of being contaminated. Further research is needed in this area because of the increasing global problem of MRB.
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- 2016
22. The burden of community onset MRSA in Australia
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Cameron, Jessica, Hall, Lisa, Wozniak, Teresa, Halton, Kate, Cameron, Jessica, Hall, Lisa, Wozniak, Teresa, and Halton, Kate
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Introduction Little is known about the health and economic burden of community onset methicillin-resistant Staphylococcus aureus (CO-MRSA) in Australia. However, this information is imperative for developing healthcare policy and planning, for prioritising and directing resources and for implementing evidence-based practice. Methods We have collated data from academic literature and government reports on the numbers of CO-MRSA infections, the proportions of infections occurring at various anatomical sites and indicators of treatment costs and morbidity, such as length of admissions and mortality rates. Direct costs of treating patients, such as the cost of hospitalisation, were calculated as well as indirect costs to society, such as loss of productivity because of morbidity or death. Results We estimated that the national incidence of CO-MRSA infections admitted to hospital was at least 24.8 /100,000 person-years. Of these, the majority were skin and soft tissue infections (21.2 /100,000 person-years), while bloodstream (BSI) and lower respiratory tract infections (LRTI) and incidences of 3.9 and 2.8 /100,000 person-years, respectively. Considerable regional differences in the nature and frequency of infection were identified. Mortality was found to be approximately 1 in 5 patients for BSIs and slightly lower for pneumonia. Conclusions CO-MRSA presents a significant health issue and the costs associated merit attention to support medical decision making. Standardised definitions and regular surveillance of the incidence of CO-MRSA infections are necessary. Surveillance should also capture data on the consequences and treatments required for a better understanding of the cost of CO-MRSA to Australia.
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- 2016
23. High burden of diabetic foot infections in the top end of Australia: An emerging health crisis (DEFINE study)
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Commons, Robert J., Robinson, Claire H., Gawler, David, Davis, Joshua S., Price, Ric N., Commons, Robert J., Robinson, Claire H., Gawler, David, Davis, Joshua S., and Price, Ric N.
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IntroductionThe risk of diabetes mellitus is increasing worldwide, and is particularly high in Indigenous Australians. Complicated foot infection is one of the most common sequelae of diabetes. We describe the incidence and associations of Indigenous and non-Indigenous inpatients with diabetic foot infections at Royal Darwin Hospital.MethodsAll adult Royal Darwin Hospital inpatients with diabetic foot infections were enrolled prospectively from September 2012 to November 2013. Incidence, demographics, microbiology, management and clinical outcomes were analysed by Indigenous status, and association with methicillin resistant Staphylococcus aureus and Pseudomonas aeruginosa.ResultsThere were 245 separate hospital admissions in 177 patients with an incidence of 79 admissions per 100,000 person years. Patients occupied a mean of 19.4 hospital beds each day. Compared to the non-Indigenous population, Indigenous patients had a greater incidence of admission (Rate Ratio (RR) = 5.1, [95%CI = 3.8, 7.0]), were younger (mean difference of 11.1 years; p < 0.001), and more likely to undergo major and minor amputations (RR = 4.1 [95%CI = 1.6, 10.7], and 6.2 [95%CI = 3.5, 11.1] respectively). Non-multiresistant methicillin resistant S. aureus was present in 44.7% of wounds from Indigenous patients versus 20.6% of non-Indigenous patients (Odds Ratio (OR) = 3.1, [95%CI = 1.5, 6.4]), whereas P. aeruginosa presence was significantly lower (15.8% versus 46.0%; OR = 0.22; [95%CI = 0.11, 0.45]). Methicillin resistant S. aureus or P. aeruginosa infections were associated with longer antibiotic courses and durations of stay.ConclusionsThis study highlights a rising burden of diabetic foot infections in the Top End of Australia, with a four-fold increase in bed days since 2002 and an overrepresentation in the Indigenous population.
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- 2015
24. Fresh arterial homograft for bypass in critical limb ischaemia with infection.
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Wayne S., Cox G., Milne C., Wayne S., Cox G., and Milne C.
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We present what we believe is Australia's first fresh peripheral arterial transplant for revascularisation of an ischaemic limb. Although cryopreserved homografts are accepted as a management option for revascularisation of critical limb ischaemia in infected fields, cryopreserved peripheral vascular tissue is not currently available in Australia. We describe a 72-year-old man without autologous conduit in whom infected prosthetic grafts were explanted, causing critical limb ischaemia of a below knee stump. Fresh peripheral arterial tissue was procured via the Australian organ donation authority, DonateLife, and was used to revascularise the stump with an axillofemoral bypass. This permitted successful healing of the stump within 6 weeks and mobilisation with a prosthesis. This case illustrates that fresh arterial homografts are a viable bridging solution for revascularisation of limb ischaemia with infection. However, it also highlights the need to establish a peripheral homograft bank so that cryopreserved conduits are readily available for similar scenarios.Copyright 2015 BMJ Publishing Group. All rights reserved.
- Published
- 2015
25. Evolving practice: X-linked agammaglobulinemia and lung transplantation.
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Westall G.P., Stirling R., Snell G.I., Barnes S., Kotecha S., Douglass J.A., Paul E., Hore-Lacey F., Westall G.P., Stirling R., Snell G.I., Barnes S., Kotecha S., Douglass J.A., Paul E., and Hore-Lacey F.
- Abstract
X-linked agammaglobulinemia (XLA) is a rare primary humoral immunodeficiency syndrome characterized by agammaglobulinemia, recurrent infections and bronchiectasis. Despite the association with end-stage bronchiectasis, the literature on XLA and lung transplantation is extremely limited. We report a series of 6 XLA patients with bronchiectasis who underwent lung transplantation. Short-term outcomes were excellent however long-term outcomes were disappointing with a high incidence of pulmonary sepsis and chronic lung allograft dysfunction (CLAD). This case series examines six patients with X-linked agammaglobulinemia and tracks their post-lung transplant course to highlight the challenges of immunosuppression and infection as well as chronic lung allograft dysfunction in these patients.© Copyright 2015 The American Society of Transplantation and the American Society of Transplant Surgeons.
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- 2015
26. Vancomycin vintage: My favourite DRESS.
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Grayson M.L., Korman T.M., Turnidge J.D., Grayson M.L., Korman T.M., and Turnidge J.D.
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- 2015
27. Incidence of resistant mastitis in dairy cows in Tamil Nadu, India
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Chandrasekaran, D., Nambil, A. P., Thirunavukkarasu, P. S., Venkatesan, P., Tirumurugaan, K. G., Vairamuthu, S., Chandrasekaran, D., Nambil, A. P., Thirunavukkarasu, P. S., Venkatesan, P., Tirumurugaan, K. G., and Vairamuthu, S.
- Abstract
The incidence of resistant mastitis in dairy cows in Tamil Nadu, India was 56.l %. The predominant resistant causative pathogen was Escherichia coli (50.64 %) followed by Staphylococcus aureus (44.25 %) and Methicillin resistant Staphylococcus aureus (5.11 %). Incidence of resistant mastitis was high in Holstein Friesian cross breed followed by Jersey cross breed and non descript. Highest incidence was observed in early stage of third lactation. In vitro antibiotic sensitivity test revealed the E. coli, S. aureus and MRSA organisms showed more sensitivity to enrofloxacin, amoxicillin+sulbactam, gentamicin and ceftriaxone and had highest resistant to penicillin followed by amoxicillin, oxytetracycline and methicillin. The study highlights the need for preventing the indiscriminate use of antibiotics.
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- 2015
28. Are nursing homes less likely to admit methicillin-resistant Staphylococcus aureus carriers?
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Reynolds, Courtney, Reynolds, Courtney, Kim, Diane, Kaplan, Sherrie H, Mukamel, Dana B, Cui, Eric, Lee, Cameron, Huang, Susan S, Reynolds, Courtney, Reynolds, Courtney, Kim, Diane, Kaplan, Sherrie H, Mukamel, Dana B, Cui, Eric, Lee, Cameron, and Huang, Susan S
- Abstract
We surveyed administrators at 13 nursing homes in Orange County, CA, on their likelihood to admit methicillin-resistant Staphylococcus aureus (MRSA) carriers and assessed applicant characteristics associated with rejection. In multivariate models, denial of admission was associated with MRSA carriage (odds ratio, 2.7; P = .02) and receiving lower ratings for overall suitability for admission (odds ratio, 5.9; P < .001). Larger studies are needed to determine whether decolonization may remove barriers to accessing postdischarge care for MRSA carriers.
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- 2014
29. The network positions of methicillin resistant Staphylococcus aureus affected units in a regional healthcare system
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Ohst, Jan, Liljeros, Fredrik, Stenhem, Mikael, Holme, Petter, Ohst, Jan, Liljeros, Fredrik, Stenhem, Mikael, and Holme, Petter
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We studied a dataset of care episodes in a regional Swedish hospital system. We followed how 2,314,477 patients moved between 8,507 units (hospital wards and outpatient clinics) over seven years. The data also included information on the date when patients tested positive with methicillin resistant Staphylococcus aureus. To simplify the complex flow of patients, we represented it as a network of units, where two units were connected if a patient moved from one unit to another, without visiting a third unit in between. From this network, we characterized the typical network position of units with a high prevalence of methicillin resistant Staphylococcus aureus, and how the patient’s location in the network changed upon testing positive. On average, units with medium values of the analyzed centrality measures had the highest average prevalence. We saw a weak effect of the hospital system’s response to the patient testing positive - after a positive test, the patient moved to units with a lower centrality measured as degree (i.e. number of links to other units) and in addition, the average duration of the care episodes became longer. The network of units was too random to be a strong predictor of the presence of methicillin resistantStaphylococcus aureus - would it be more regular, one could probably both identify and control outbreaks better. The migration of the positive patients with within the healthcare system, however, helps decreasing the outbreak sizes.
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- 2014
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30. Planned Analyses of the REDUCE MRSA Trial.
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Huang, Susan S, Huang, Susan S, Platt, Richard, Huang, Susan S, Huang, Susan S, and Platt, Richard
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- 2014
31. Genetic and molecular predictors of high vancomycin MIC in Staphylococcus aureus bacteremia isolates.
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Johnson P.D.R., Roberts S.A., Warren S.J.C., Coombs G.W., Tan H.-L., Gao W., Howden B.P., Holmes N.E., Turnidge J.D., Munckhof W.J., Robinson J.O., Korman T.M., O'Sullivan M.V.N., Anderson T.L., Johnson P.D.R., Roberts S.A., Warren S.J.C., Coombs G.W., Tan H.-L., Gao W., Howden B.P., Holmes N.E., Turnidge J.D., Munckhof W.J., Robinson J.O., Korman T.M., O'Sullivan M.V.N., and Anderson T.L.
- Abstract
An elevated vancomycin MIC is associated with poor outcomes in Staphylococcus aureus bacteremia (SAB) and is reported in patients with methicillin-susceptible S. aureus (MSSA) bacteremia in the absence of vancomycin treatment. Here, using DNA microarray and phenotype analysis, we investigated the genetic predictors and accessory gene regulator (agr) function and their relationship with elevated vancomycin MIC using blood culture isolates from a multicenter binational cohort of patients with SAB. Specific clonal complexes were associated with elevated (clonal complex 8 [CC8] [P < 0.001]) or low (CC22 [P < 0.001], CC88 [P < 0.001], and CC188 [P = 0.002]) vancomycin MIC. agr dysfunction (P = 0.014) or agr genotype II (P = 0.043) were also associated with an elevated vancomycin MIC. Specific resistance and virulence genes were also linked to an elevated vancomycin MIC, including blaZ (P = 0.002), sea (P < 0.001), clfA (P < 0.001), splA (P = 0.001), and the arginine catabolic mobile element (ACME) locus (P = 0.02). These data suggest that inherent organism characteristics may explain the link between elevated vancomycin MICs and poor outcomes in patients with SAB, regardless of the antibiotic treatment received. A consideration of clonal specificity should be included in future research when attempting to ascertain treatment effects or clinical outcomes. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
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- 2014
32. The silver lining of disposable sporicidal privacy curtains in an intensive care unit.
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Sloane T., Gillespie E.E., Stuart R.L., Kotsanas D., Wijesooriya W.R.P.L.I., Sloane T., Gillespie E.E., Stuart R.L., Kotsanas D., and Wijesooriya W.R.P.L.I.
- Abstract
Background The environment is a well-known source of health care-acquired infection. Because of the known risk of contamination, patient privacy curtains require frequent changes to decrease the risk of spread from patients to curtain and visa versa. Methods Fourteen disposable sporicidal privacy curtains were tested from December 2012 to June 2013 while hanging in a busy intensive care unit. Significant bacterial pathogens were identified and total bacteria enumerated as colony-forming units. Antimicrobial activity of curtain swatches was also tested against a range of bacteria in the laboratory. Measurements were recorded as zone of inhibition and contact inhibition. A cost analysis to replace standard curtains with disposable sporicidal curtains was also undertaken. Results Cultures grew low numbers of skin and environmental microorganisms with no methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, or Clostridium difficile detected. Vancomycin-resistant enterococci were recovered in very low numbers from 2 curtains where vancomycin-resistant enterococci-infected patients had been located. Privacy curtains demonstrated antimicrobial activity against C difficile and 13 additional bacterial pathogens. Conclusion We conclude that disposable sporicidal privacy curtains are cost-effective and best replaced at 6 months in a high-risk area such as an intensive care unit. © 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
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- 2014
33. Recombinations in staphylococcal cassette chromosome mec elements compromise the molecular detection of methicillin resistance in Staphylococcus aureus
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Hill-Cawthorne, Grant A., Hudson, Lyndsey O., El Ghany, Moataz Fouad Abd, Piepenburg, Olaf, Nair, Mridul, Dodgson, Andrew, Forrest, Matthew S., Clark, Taane G., Pain, Arnab, Hill-Cawthorne, Grant A., Hudson, Lyndsey O., El Ghany, Moataz Fouad Abd, Piepenburg, Olaf, Nair, Mridul, Dodgson, Andrew, Forrest, Matthew S., Clark, Taane G., and Pain, Arnab
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Clinical laboratories are increasingly using molecular tests for methicillin-resistant Staphylococcus aureus (MRSA) screening. However, primers have to be targeted to a variable chromosomal region, the staphylococcal cassette chromosome mec (SCCmec). We initially screened 726 MRSA isolates from a single UK hospital trust by recombinase polymerase amplification (RPA), a novel, isothermal alternative to PCR. Undetected isolates were further characterised using multilocus sequence, spa typing and whole genome sequencing. 96% of our tested phenotypically MRSA isolates contained one of the six orfX-SCCmec junctions our RPA test and commercially available molecular tests target. However 30 isolates could not be detected. Sequencing of 24 of these isolates demonstrated recombinations within the SCCmec element with novel insertions that interfered with the RPA, preventing identification as MRSA. This result suggests that clinical laboratories cannot rely solely upon molecular assays to reliably detect all methicillin-resistance. The presence of significant recombinations in the SCCmec element, where the majority of assays target their primers, suggests that there will continue to be isolates that escape identification. We caution that dependence on amplification-based molecular assays will continue to result in failure to diagnose a small proportion (?4%) of MRSA isolates, unless the true level of SCCmec natural diversity is determined by whole genome sequencing of a large collection of MRSA isolates. © 2014 Hill-Cawthorne et al.
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- 2014
34. Inhibition of methicillin resistant Staphylococcus aureus by a plasma needle
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Miletić, Maja, Miletić, Maja, Vuković, Dragana, Zivanović, Irena, Dakić, Ivana, Soldatović, Ivan, Maletić, Dejan, Lazović, Saša, Malović, Gordana, Petrović, Zoran Lj., Puač, Nevena, Miletić, Maja, Miletić, Maja, Vuković, Dragana, Zivanović, Irena, Dakić, Ivana, Soldatović, Ivan, Maletić, Dejan, Lazović, Saša, Malović, Gordana, Petrović, Zoran Lj., and Puač, Nevena
- Abstract
In numerous recent papers plasma chemistry of non equilibrium plasma sources operating at atmospheric pressure has been linked to plasma medical effects including sterilization. In this paper we present a study of the effectiveness of an atmospheric pressure plasma source, known as plasma needle, in inhibition of the growth of biofilm produced by methicillin resistant Staphylococcus aureus (MRSA). Even at the lowest powers the biofilms formed by inoculi of MRSA of 10(4) and 10(5) CFU have been strongly affected by plasma and growth in biofilms was inhibited. The eradication of the already formed biofilm was not achieved and it is required to go to more effective sources.
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- 2014
35. Changes over time in the distribution of dominant clonal complexes of methicillin-resistant Staphylococcus aureus in Medellín, Colombia
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Ocampo, Ana M., Vélez, Lázaro A., Robledo, Jaime, Jiménez, Judy Natalia, Ocampo, Ana M., Vélez, Lázaro A., Robledo, Jaime, and Jiménez, Judy Natalia
- Abstract
Introduction: Part of the success of methicillin-resistant Staphylococcus aureus (MRSA) as a pathogen responds to the rapid spread of pandemic lineages with diverse virulence and antimicrobial susceptibility profiles. In Colombia, several healthcare-associated MRSA (HA-MRSA) clones have been found, including the pediatric clone (CC5-ST5-SCCmecIV), the Brazilian clone (CC8-ST239-SCCmecIII), and the Chilean/Cordobés clone (CC5-ST5-SCCmecI). Moreover, the community-associated MRSA (CA-MRSA) clone USA300 has been reported as causing hospital-acquired infections.Objective: To describe the changes over time in the distribution of MRSA clones from a university hospital in Medellín collected at two time points a decade apart.Materials and methods: A total of 398 MRSA strains were analyzed. Of these, 67 strains were collected in 1994, while the remaining 331 strains were collected between 2008 and 2010. Species identification and methicillin resistance were confirmed by detection of nuc and mecA genes, respectively. Molecular characterization included spa typing, SCCmec typing, PFGE and MLST.Results: Analysis of the MRSA strains collected in 1994 revealed that they belonged to a single clone, the CC5-SCCmecIV, whereas among the isolates from 2008-2010, two dominant clones were identified: CC8-SCCmecIVc, which included spa types t008 and t1610 and is closely related to the USA 300 clone, and CC5-SCCmecI (spa type t149), related to the Chilean clone. The ST5-SCCmecIV clone from 1994 was not detected.Conclusions: This study identifies temporal dynamics in MRSA clone diversity, and highlights the importance of local surveillance and dissemination of results, especially in countries like Colombia where MRSA is prevalent and knowledge regarding its epidemiology is still insufficient., Introducción. Parte del éxito de Staphylococcus aureus resistente a la meticilina (SARM) como patógeno se debe a la rápida diseminación de linajes pandémicos con perfiles variables de virulencia y sensibilidad antimicrobiana. En Colombia se han identificado clones asociados al hospital como el pediátrico (CC5-ST5-SCCmecIV), el brasilero (CC8-ST239-SCCmecIII) y el chileno/cordobés (CC5-ST5-SCCmecI). Asimismo, se describió el USA300 (CC8-ST8-SCCmecIV), tradicionalmente asociado a la comunidad, causante de infecciones hospitalarias.Objetivo. Describir el comportamiento en el tiempo de los clones de SARM provenientes de un hospital universitario de Medellín en aislamientos recolectados con una década de diferencia.Materiales y métodos. Se analizaron 398 aislamientos de SARM, 67 recolectados en 1994 y 331 recolectados entre 2008 y 2010. La identificación y la sensibilidad a la meticilina se confirmaron mediante los genes nuc y mecA. La caracterización molecular incluyó la tipificación de spa, SCCmec, la electroforesis en gel de campo pulsado (Pulsed Field Gel Electrophoresis, PFGE), y la tipificación por secuenciación de locus múltiples (Multilocus Sequence Typing, MLST).Resultados. Al analizar los aislamientos de SARM de 1994 se encontró que pertenecían a un único linaje, el CC5-SCCmecIV, mientras que los aislamientos de 2008 a 2010 presentaron dos linajes dominantes: el CC8-SCCmecIVc, con cepas de los tipos spa t008 y t1610, estrechamente relacionadas con el clon USA 300, y el CC5-SCCmecI, con las de tipo spa t149, relacionadas con el clon chileno; no se detectaron cepas del linaje encontrado en 1994.Conclusiones. En este estudio se demuestra una dinámica en el tiempo de las cepas de S. aureus, y se señala la importancia de la vigilancia local y la difusión de los resultados, sobre todo en países como el nuestro, donde SARM es prevalente y la comprensión de su epidemiología es limitada.
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- 2014
36. Universal decolonization was better than MRSA screening and isolation for preventing nosocomial ICU infections.
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Decker, Brooke K, Decker, Brooke K, Palmore, Tara N, Decker, Brooke K, Decker, Brooke K, and Palmore, Tara N
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- 2013
37. Targeted decolonization to prevent ICU infections.
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Huang, Susan S, Huang, Susan S, Septimus, Edward, Platt, Richard, Huang, Susan S, Huang, Susan S, Septimus, Edward, and Platt, Richard
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- 2013
38. Estimated burden of methicillin-resistant Staphylococcus aureus in California hospitals after changes to administrative codes, 2005-2010.
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Tehrani, David M, Tehrani, David M, Cao, Chenghua, Kwark, Homin, Huang, Susan S, Tehrani, David M, Tehrani, David M, Cao, Chenghua, Kwark, Homin, and Huang, Susan S
- Abstract
We assess the impact of revised International Classification of Diseases, Ninth Revision, codes on methicillin-resistant Staphylococcus aureus burden in California hospitals. Codes were rapidly adopted, demonstrating new capture of colonization and continued relatively stable capture of infections. Nevertheless, despite new colonization codes, coded data demonstrated poor retention between serial hospitalizations.
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- 2013
39. Identifying antibiotic-resistant bacteria in hospitalized patients: what is the role of active-surveillance cultures?
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Sandora, Thomas J, Sandora, Thomas J, Dolan, Susan A, Harbarth, Stephan, Huang, Susan S, McAdam, Alexander J, Milstone, Aaron M, Sandora, Thomas J, Sandora, Thomas J, Dolan, Susan A, Harbarth, Stephan, Huang, Susan S, McAdam, Alexander J, and Milstone, Aaron M
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- 2013
40. The economic burden of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
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Lee, BY, Lee, BY, Singh, A, David, MZ, Bartsch, SM, Slayton, RB, Huang, SS, Zimmer, SM, Potter, MA, Macal, CM, Lauderdale, DS, Miller, LG, Daum, RS, Lee, BY, Lee, BY, Singh, A, David, MZ, Bartsch, SM, Slayton, RB, Huang, SS, Zimmer, SM, Potter, MA, Macal, CM, Lauderdale, DS, Miller, LG, and Daum, RS
- Abstract
The economic impact of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) remains unclear. We developed an economic simulation model to quantify the costs associated with CA-MRSA infection from the societal and third-party payer perspectives. A single CA-MRSA case costs third-party payers $2277-$3200 and society $7070-$20 489, depending on patient age. In the United States (US), CA-MRSA imposes an annual burden of $478 million to 2.2 billion on third-party payers and $1.4-13.8 billion on society, depending on the CA-MRSA definitions and incidences. The US jail system and Army may be experiencing annual total costs of $7-11 million ($6-10 million direct medical costs) and $15-36 million ($14-32 million direct costs), respectively. Hospitalization rates and mortality are important cost drivers. CA-MRSA confers a substantial economic burden on third-party payers and society, with CA-MRSA-attributable productivity losses being major contributors to the total societal economic burden. Although decreasing transmission and infection incidence would decrease costs, even if transmission were to continue at present levels, early identification and appropriate treatment of CA-MRSA infections before they progress could save considerable costs.
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- 2013
41. Predicting high prevalence of community methicillin-resistant Staphylococcus aureus strains in nursing homes.
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Murphy, Courtney R, Murphy, Courtney R, Hudson, Lyndsey O, Spratt, Brian G, Quan, Victor, Kim, Diane, Peterson, Ellena, Tan, Grace, Evans, Kaye, Meyers, Hildy, Cheung, Michele, Lee, Bruce Y, Mukamel, Dana B, Enright, Mark C, Whealon, Matthew, Huang, Susan S, Murphy, Courtney R, Murphy, Courtney R, Hudson, Lyndsey O, Spratt, Brian G, Quan, Victor, Kim, Diane, Peterson, Ellena, Tan, Grace, Evans, Kaye, Meyers, Hildy, Cheung, Michele, Lee, Bruce Y, Mukamel, Dana B, Enright, Mark C, Whealon, Matthew, and Huang, Susan S
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We assessed characteristics associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) carriage among residents of 22 nursing homes. Of MRSA-positive swabs, 25% (208/824) were positive for CA-MRSA. Median facility CA-MRSA percentage was 22% (range, 0%-44%). In multivariate models, carriage was associated with age less than 65 years (odds ratio, 1.2; P<.001) and Hispanic ethnicity (odds ratio, 1.2; P=.006). Interventions are needed to target CA-MRSA.
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- 2013
42. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California.
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Hudson, Lyndsey O, Hudson, Lyndsey O, Reynolds, Courtney, Spratt, Brian G, Enright, Mark C, Quan, Victor, Kim, Diane, Hannah, Paul, Mikhail, Lydia, Alexander, Richard, Moore, Douglas F, Godoy, Daniel, Bishop, Cynthia J, Huang, Susan S, Hudson, Lyndsey O, Hudson, Lyndsey O, Reynolds, Courtney, Spratt, Brian G, Enright, Mark C, Quan, Victor, Kim, Diane, Hannah, Paul, Mikhail, Lydia, Alexander, Richard, Moore, Douglas F, Godoy, Daniel, Bishop, Cynthia J, and Huang, Susan S
- Abstract
Nursing homes represent a unique and important methicillin-resistant Staphylococcus aureus (MRSA) reservoir. Not only are strains imported from hospitals and the community, strains can be transported back into these settings from nursing homes. Since MRSA bacteria are prevalent in nursing homes and yet relatively poorly studied in this setting, a multicenter, regional assessment of the frequency and diversity of MRSA in the nursing home reservoir was carried out and compared to that of the MRSA from hospitals in the same region. The prospective study collected MRSA from nasal swabbing of residents of 26 nursing homes in Orange County, California, and characterized each isolate by spa typing. A total of 837 MRSA isolates were collected from the nursing homes. Estimates of admission prevalence and point prevalence of MRSA were 16% and 26%, respectively. The spa type genetic diversity was heterogeneous between nursing homes and significantly higher overall (77%) than the diversity in Orange County hospitals (72%). MRSA burden in nursing homes appears largely due to importation from hospitals. As seen in Orange County hospitals, USA300 (sequence type 8 [ST8]/t008), USA100 (ST5/t002), and a USA100 variant (ST5/t242) were the dominant MRSA clones in Orange County nursing homes, representing 83% of all isolates, although the USA100 variant was predominant in nursing homes, whereas USA300 was predominant in hospitals. Control strategies tailored to the complex problem of MRSA transmission and infection in nursing homes are needed in order to minimize the impact of this unique reservoir on the overall regional MRSA burden.
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- 2013
43. The potential regional impact of contact precaution use in nursing homes to control methicillin-resistant Staphylococcus aureus.
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Lee, Bruce Y, Lee, Bruce Y, Singh, Ashima, Bartsch, Sarah M, Wong, Kim F, Kim, Diane S, Avery, Taliser R, Brown, Shawn T, Murphy, Courtney R, Yilmaz, S Levent, Huang, Susan S, Lee, Bruce Y, Lee, Bruce Y, Singh, Ashima, Bartsch, Sarah M, Wong, Kim F, Kim, Diane S, Avery, Taliser R, Brown, Shawn T, Murphy, Courtney R, Yilmaz, S Levent, and Huang, Susan S
- Abstract
ObjectiveImplementation of contact precautions in nursing homes to prevent methicillin-resistant Staphylococcus aureus (MRSA) transmission could cost time and effort and may have wide-ranging effects throughout multiple health facilities. Computational modeling could forecast the potential effects and guide policy making.DesignOur multihospital computational agent-based model, Regional Healthcare Ecosystem Analyst (RHEA).SettingAll hospitals and nursing homes in Orange County, California.MethodsOur simulation model compared the following 3 contact precaution strategies: (1) no contact precautions applied to any nursing home residents, (2) contact precautions applied to those with clinically apparent MRSA infections, and (3) contact precautions applied to all known MRSA carriers as determined by MRSA screening performed by hospitals.ResultsOur model demonstrated that contact precautions for patients with clinically apparent MRSA infections in nursing homes resulted in a median 0.4% (range, 0%-1.6%) relative decrease in MRSA prevalence in nursing homes (with 50% adherence) but had no effect on hospital MRSA prevalence, even 5 years after initiation. Implementation of contact precautions (with 50% adherence) in nursing homes for all known MRSA carriers was associated with a median 14.2% (range, 2.1%-21.8%) relative decrease in MRSA prevalence in nursing homes and a 2.3% decrease (range, 0%-7.1%) in hospitals 1 year after implementation. Benefits accrued over time and increased with increasing compliance.ConclusionsOur modeling study demonstrated the substantial benefits of extending contact precautions in nursing homes from just those residents with clinically apparent infection to all MRSA carriers, which suggests the benefits of hospitals and nursing homes sharing and coordinating information on MRSA surveillance and carriage status.
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- 2013
44. The Regional Healthcare Ecosystem Analyst (RHEA): a simulation modeling tool to assist infectious disease control in a health system.
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Lee, Bruce Y, Lee, Bruce Y, Wong, Kim F, Bartsch, Sarah M, Yilmaz, S Levent, Avery, Taliser R, Brown, Shawn T, Song, Yeohan, Singh, Ashima, Kim, Diane S, Huang, Susan S, Lee, Bruce Y, Lee, Bruce Y, Wong, Kim F, Bartsch, Sarah M, Yilmaz, S Levent, Avery, Taliser R, Brown, Shawn T, Song, Yeohan, Singh, Ashima, Kim, Diane S, and Huang, Susan S
- Abstract
ObjectiveAs healthcare systems continue to expand and interconnect with each other through patient sharing, administrators, policy makers, infection control specialists, and other decision makers may have to take account of the entire healthcare 'ecosystem' in infection control.Materials and methodsWe developed a software tool, the Regional Healthcare Ecosystem Analyst (RHEA), that can accept user-inputted data to rapidly create a detailed agent-based simulation model (ABM) of the healthcare ecosystem (ie, all healthcare facilities, their adjoining community, and patient flow among the facilities) of any region to better understand the spread and control of infectious diseases.ResultsTo demonstrate RHEA's capabilities, we fed extensive data from Orange County, California, USA, into RHEA to create an ABM of a healthcare ecosystem and simulate the spread and control of methicillin-resistant Staphylococcus aureus. Various experiments explored the effects of changing different parameters (eg, degree of transmission, length of stay, and bed capacity).DiscussionOur model emphasizes how individual healthcare facilities are components of integrated and dynamic networks connected via patient movement and how occurrences in one healthcare facility may affect many other healthcare facilities.ConclusionsA decision maker can utilize RHEA to generate a detailed ABM of any healthcare system of interest, which in turn can serve as a virtual laboratory to test different policies and interventions.
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- 2013
45. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission.
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McKinnell, James A, McKinnell, James A, Miller, Loren G, Eells, Samantha J, Cui, Eric, Huang, Susan S, McKinnell, James A, McKinnell, James A, Miller, Loren G, Eells, Samantha J, Cui, Eric, and Huang, Susan S
- Abstract
ObjectiveScreening for methicillin-resistant Staphylococcus aureus (MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.DesignWe searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.ResultsWe reviewed 4,381 abstracts; 29 articles met inclusion criteria (n = 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3-4.7]; P < .01), nursing home exposure (OR, 3.8 [95% CI, 2.3-6.3]; P < .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2-15.1]; Clostridium difficile infection: OR, 3.4 [95% CI, 2.2-5.3]; vancomycin-resistant Enterococci carriage: OR, 3.1 [95% CI, 2.5-4.0]; P < .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure; P < .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6-1.8]; P = .87).ConclusionsMRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention progr
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- 2013
46. Quantifying the impact of extranasal testing of body sites for methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission.
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McKinnell, James A, McKinnell, James A, Huang, Susan S, Eells, Samantha J, Cui, Eric, Miller, Loren G, McKinnell, James A, McKinnell, James A, Huang, Susan S, Eells, Samantha J, Cui, Eric, and Miller, Loren G
- Abstract
ObjectiveMethicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-associated infections. Recent legislative mandates require nares screening for MRSA at hospital and intensive care unit (ICU) admission in many states. However, MRSA colonization at extranasal sites is increasingly recognized. We conducted a systematic review of the literature to identify the yield of extranasal testing for MRSA.DesignWe searched MEDLINE from January 1966 through January 2012 for articles comparing nasal and extranasal screening for MRSA colonization. Studies were categorized by population tested, specifically those admitted to ICUs and those admitted to hospitals with a high prevalence (6% or greater) or low prevalence (less than 6%) of MRSA carriers. Data were extracted using a standardized instrument.ResultsWe reviewed 4,381 abstracts and 735 articles. Twenty-three articles met the criteria for analysis ((n = 39,479 patients). Extranasal MRSA screening increased the yield by approximately one-third over nares alone. The yield was similar at ICU admission (weighted average, 33%; range, 9%-69%) and hospital admission in high-prevalence (weighted average, 37%; range, 9%-86%) and low-prevalence (weighted average, 50%; range, 0%-150%) populations. For comparisons between individual extranasal sites, testing the oropharynx increased MRSA detection by 21% over nares alone; rectum, by 20%; wounds, by 17%; and axilla, by 7%.ConclusionsExtranasal MRSA screening at hospital or ICU admission in adults will increase MRSA detection by one-third compared with nares screening alone. Findings were consistent among subpopulations examined. Extranasal testing may be a valuable strategy for outbreak control or in settings of persistent disease, particularly when combined with decolonization or enhanced infection prevention protocols.
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- 2013
47. Targeted versus universal decolonization to prevent ICU infection.
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Huang, Susan S, Huang, Susan S, Septimus, Edward, Kleinman, Ken, Moody, Julia, Hickok, Jason, Avery, Taliser R, Lankiewicz, Julie, Gombosev, Adrijana, Terpstra, Leah, Hartford, Fallon, Hayden, Mary K, Jernigan, John A, Weinstein, Robert A, Fraser, Victoria J, Haffenreffer, Katherine, Cui, Eric, Kaganov, Rebecca E, Lolans, Karen, Perlin, Jonathan B, Platt, Richard, CDC Prevention Epicenters Program, AHRQ DECIDE Network and Healthcare-Associated Infections Program, Huang, Susan S, Huang, Susan S, Septimus, Edward, Kleinman, Ken, Moody, Julia, Hickok, Jason, Avery, Taliser R, Lankiewicz, Julie, Gombosev, Adrijana, Terpstra, Leah, Hartford, Fallon, Hayden, Mary K, Jernigan, John A, Weinstein, Robert A, Fraser, Victoria J, Haffenreffer, Katherine, Cui, Eric, Kaganov, Rebecca E, Lolans, Karen, Perlin, Jonathan B, Platt, Richard, CDC Prevention Epicenters Program, and AHRQ DECIDE Network and Healthcare-Associated Infections Program
- Abstract
BackgroundBoth targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA).MethodsWe conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital.ResultsA total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstr
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- 2013
48. Infection prevention practices in adult intensive care units in a large community hospital system after implementing strategies to reduce health care-associated, methicillin-resistant Staphylococcus aureus infections.
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Moody, Julia, Moody, Julia, Septimus, Edward, Hickok, Jason, Huang, Susan S, Platt, Richard, Gombosev, Adrijana, Terpstra, Leah, Avery, Taliser, Lankiewicz, Julie, Perlin, Jonathan B, Moody, Julia, Moody, Julia, Septimus, Edward, Hickok, Jason, Huang, Susan S, Platt, Richard, Gombosev, Adrijana, Terpstra, Leah, Avery, Taliser, Lankiewicz, Julie, and Perlin, Jonathan B
- Abstract
BackgroundA range of strategies and approaches have been developed for preventing health care-associated infections. Understanding the variation in practices among facilities is necessary to improve compliance with existing programs and aid the implementation of new interventions.MethodsIn 2009, HCA Inc administered an electronic survey to measure compliance with evidence-based infection prevention practices as well as identify variation in products or methods, such as use of special approach technology for central vascular catheters and ventilator care. Responding adult intensive care units (ICUs) were those considering participation in a clinical trial to reduce health care-associated infections.ResultsResponses from 99 ICUs in 55 hospitals indicated that many evidenced-based practices were used consistently, including methicillin-resistant Staphylococcus aureus (MRSA) screening and use of contact precautions for MRSA-positive patients. Other practices exhibited wide variability including discontinuation of precautions and use of antimicrobial technology or chlorhexidine patches for central vascular catheters. MRSA decolonization was not a predominant practice in ICUs.ConclusionIn this large, community-based health care system, there was substantial variation in the products and methods to reduce health care-associated infections. Despite system-wide emphasis on basic practices as a precursor to adding special approach technologies, this survey showed that these technologies were commonplace, including in facilities where improvement in basic practices was needed.
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- 2013
49. What is nosocomial? Large variation in hospital choice of numerators and denominators affects rates of hospital-onset methicillin-resistant Staphylococcus aureus.
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Datta, Rupak, Datta, Rupak, Kuo King, Melissa, Kim, Diane, Nguyen, Christopher, Elkins, Kristen, Gombosev, Adrijana, Avery, Taliser R, Meyers, Hildy, Cheung, Michele, Huang, Susan S, Datta, Rupak, Datta, Rupak, Kuo King, Melissa, Kim, Diane, Nguyen, Christopher, Elkins, Kristen, Gombosev, Adrijana, Avery, Taliser R, Meyers, Hildy, Cheung, Michele, and Huang, Susan S
- Abstract
We calculated hospital-onset methicillin-resistant Staphylococcus aureus (HO-MRSA) rates for Orange County, California, hospitals using survey and state data. Numerators were variably defined as HO-MRSA occurring more than 48 hours (37%), more than 2 days (30%), and more than 3 days (33%) postadmission. Survey-reported denominators differed from state-reported patient-days. Numerator and denominator choices substantially impacted HO-MRSA rates.
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- 2012
50. Simulation shows hospitals that cooperate on infection control obtain better results than hospitals acting alone.
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Lee, Bruce Y, Lee, Bruce Y, Bartsch, Sarah M, Wong, Kim F, Yilmaz, S Levent, Avery, Taliser R, Singh, Ashima, Song, Yeohan, Kim, Diane S, Brown, Shawn T, Potter, Margaret A, Platt, Richard, Huang, Susan S, Lee, Bruce Y, Lee, Bruce Y, Bartsch, Sarah M, Wong, Kim F, Yilmaz, S Levent, Avery, Taliser R, Singh, Ashima, Song, Yeohan, Kim, Diane S, Brown, Shawn T, Potter, Margaret A, Platt, Richard, and Huang, Susan S
- Abstract
Efforts to control life-threatening infections, such as with methicillin-resistant Staphylococcus aureus (MRSA), can be complicated when patients are transferred from one hospital to another. Using a detailed computer simulation model of all hospitals in Orange County, California, we explored the effects when combinations of hospitals tested all patients at admission for MRSA and adopted procedures to limit transmission among patients who tested positive. Called "contact isolation," these procedures specify precautions for health care workers interacting with an infected patient, such as wearing gloves and gowns. Our simulation demonstrated that each hospital's decision to test for MRSA and implement contact isolation procedures could affect the MRSA prevalence in all other hospitals. Thus, our study makes the case that further cooperation among hospitals--which is already reflected in a few limited collaborative infection control efforts under way--could help individual hospitals achieve better infection control than they could achieve on their own.
- Published
- 2012
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