Efficacy of Pre-Operative MRSA Screening in Otolaryngology

Objective To examine the efficacy of pre-operative Staphylococcus aureus screening by nasal swab on post-operative Methicillin-resistant Staphylococcus aureus (MRSA) infection rates in surgical patients undergoing varied otolaryngological procedures. Methods Retrospective review of MRSA colonization and infection rates in surgical otolaryngology patients at a single institution. MRSA infection rates in unscreened patients undergoing procedures during a one-year period were compared to infection rates in patients undergoing pre-operative Staphylococcus aureus screening in an 11-month time frame. Patients colonized with Staphylococcus aureus were treated with Mupirocin and Chlorhexidine prior to the procedure. Results Records of 420 patients undergoing varied otolaryngological procedures were evaluated. In the 241 patients without pre-operative screening, 9 patients had Staphylococcus aureus-infected wounds. There were two (0.83%) post-operative MRSA surgical site infections. Out of 179 patients followed after screening was initiated, 24 patients (13.4%) were colonized with Staphylococcus aureus and underwent preoperative treatment. There were no MRSA infections in the post-operative period. Conclusions Early results demonstrate the potential benefit of pre-operative Staphylococcus aureus screening in reducing the MRSA infection rate. Screening and treatment of MRSA colonized patients pre-operatively reduces infectious complications and should be considered in otolaryngology surgical practice.

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Surveillance and Control of Methicillin-Resistant Staphylococcus aureus Infections in French Hospitals

Infection Control and Hospital Epidemiology ◽

10.1086/501844 ◽

2001 ◽

Vol 22 (11) ◽

pp. 677-682 ◽

Cited By ~ 24

Author(s):

Didier Lepelletier ◽

Hervé Richet

Keyword(s):

Staphylococcus Aureus ◽

Representative Sample ◽

Public Hospitals ◽

Infection Rates ◽

Surveillance Programs ◽

Mrsa Infection ◽

Data Surveillance ◽

Resistance Rates ◽

And Control ◽

Mrsa Colonization

AbstractObjective:To assess the way French hospitals conduct surveillance for, and control infections caused by, methicillin-resis-tant Staphylococcus aureus (MRSA), and to evaluate the incidence of these infections.Design:Retrospective analysis of sample surveillance data.Setting:Representative sample of French hospitals.Participants:Representative sample of 38 French public hospitals.Methods:Hospitals were selected randomly in 1996, taking into account their location and number of beds. Administrative data, surveillance denominators used, antimicrobial resistance rates, and infection control practices were analyzed for the period 1990 to 1995. The same 38 centers were contacted 3 years later, in 1998, to reassess their surveillance and control activities.Results:French hospitals were slow to implement MRSA surveillance programs; only 5% had such programs in 1990, when the median incidence per admission (0.37%) and per patient-days (0.04%) of MRSA infections was already high. Despite the implementation of surveillance programs in 66% of French hospitals in 1995 and 87% in 1998, the MRSA infection rates remained stable from 1990 to 1995 and increased from 1995 to 1998. The proportion of French hospitals having a policy for the transfer of MRSA-infected patients to other hospitals increased from 47% in 1995 to 61% in 1998, whereas screening for MRSA colonization (42%-53%) and isolation for colonized or infected patients (87%-89%) remained stable.Conclusions:This first national survey showed that French hospitals probably were not optimally prepared to control and prevent MRSA infections, since they were slow to respond to the growing problem.

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Utility of Methicillin-Resistant Staphylococcus aureus Nares Screening in Hospitalized Children with Acute Infectious Disease Syndromes

Antibiotics ◽

10.3390/antibiotics10121434 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1434

Author(s):

Ashley Sands ◽

Nicole Mulvey ◽

Denise Iacono ◽

Jane Cerise ◽

Stefan H. F. Hagmann

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Hospitalized Children ◽

Methicillin Resistant ◽

Osteoarticular Infections ◽

Clinical Culture ◽

Acute Infectious Disease ◽

Mrsa Infection ◽

Age Range ◽

Mrsa Colonization

Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses.

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MRSA – ‘Bug-Bear’ of a Surgical Practice: Reducing the Incidence of MRSA Surgical Site Infections

Annals of The Royal College of Surgeons of England ◽

10.1308/003588406x94841 ◽

2006 ◽

Vol 88 (2) ◽

pp. 222-223 ◽

Cited By ~ 14

Author(s):

Andrea Guyot ◽

Graham Layer

Keyword(s):

Staphylococcus Aureus ◽

Surgical Site Infection ◽

Orthopaedic Surgery ◽

Methicillin Resistant Staphylococcus Aureus ◽

Surgical Site Infections ◽

Site Infection ◽

Infection Rates ◽

Methicillin Resistant ◽

Surgical Practice ◽

Department Of Health

Adverse publicity (the ‘superbug') has demonstrated that the problem of MRSA (methicillin-resistant Staphylococcus aureus) is prevalent in many of the country's most prestigious hospitals. The results of the mandatory UK Department of Health (DH) surveillance for early surgical site infections in orthopaedic surgery (SSIS) have been published recently for the period April 2004 to March 2005 when 41,242 operations were studied (< http://www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsStatistic > 28 October 2005). Infection rates were generally and gratifyingly low but 48% of surgical site infections were caused by Staph. aureus and of those 68% were MRSA. The following article will discuss the aetiology and prevention of MRSA surgical site infection.

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Colonization With Methicillin-Resistant Staphylococcus aureus in ICU Patients Morbidity, Mortality, and Glycopeptide Use

Infection Control and Hospital Epidemiology ◽

10.1086/501846 ◽

2001 ◽

Vol 22 (11) ◽

pp. 687-692 ◽

Cited By ~ 80

Author(s):

Maité Garrouste-Orgeas ◽

Jean-Francois Timsit ◽

Hatem Kallel ◽

Adel Ben Ali ◽

Marie Francoise Dumay ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Tertiary Care ◽

Icu Mortality ◽

Icu Patients ◽

Methicillin Resistant ◽

Saps Ii ◽

Icu Stay ◽

Mrsa Infection ◽

The Impact ◽

Mrsa Colonization

Abstract Objective: To determine the impact of methicillin-resis-tant Staphylococcus aureus (MRSA) colonization on the occurrence of S aureus infections (methicillin-resistant and methicillin-suscep-tible), the use of glycopeptides, and outcome among intensive care unit (ICU) patients. Design: Prospective observational cohort survey. Setting: A medical-surgical ICU with 10 single-bed rooms in a 460-bed, tertiary-care, university-affiliated hospital. Patients: A total of 1,044 ICU patients were followed for the detection of MRSA colonization from July 1, 1995, to July, 1 1998. Methods: MRSA colonization was detected using nasal samples in all patients plus wound samples in surgical patients within 48 hours of admission or within the first 48 hours of ICU stay and weekly thereafter. MRSA infections were defined using Centers for Disease Control and Prevention standard definitions, except for ventilator-associated pneumonia and catheter-related infections, which were defined by quantitative distal culture samples. Results: One thousand forty-four patients (70% medical patients) were included in the analysis. Mean age was 61±18 years; mean Simplified Acute Physiologic Score (SAPS) II was 36.4±20; and median ICU stay was 4 (range, 1-193) days. Two hundred thirty-one patients (22%) died in the ICU. Fifty-four patients (5.1%) were colonized with MRSA on admission, and 52 (4.9%) of 1,044 acquired MRSA colonization in the ICU. Thirty-five patients developed a total of 42 S aureus infections (32 MRSA, 10 methi-cillin-susceptible). After factors associated with the development of an S aureus infection were adjusted for in a multivariate Cox model (SAPS II >36: hazard ratio [HR], 1.64; P=.09; male gender: HR, 2.2; P=.05), MRSA colonization increased the risk of S aureus infection (HR, 3.84; P=.0003). MRSA colonization did not influence ICU mortality (HR, 1.01; P=.94). Glycopeptides were used in 11.4% of the patients (119/1,044) for a median duration of 5 days. For patients with no colonization, MRSA colonization on admission, and ICU-acquired MRSA colonization, respectively, glycopeptide use per 1,000 hospital days was 37.7, 235.2, and 118.3 days. MRSA colonization per se increased by 3.3-fold the use of glycopeptides in MRSA-colonized patients, even when an MRSA infection was not demonstrated, compared to non-colonized patients. Conclusions: In our unit, MRSA colonization greatly increased the risk of S aureus infection and of glycopeptide use in colonized and non-colonized patients, without influencing ICU mortality. MRSA colonization influenced glycopeptide use even if an MRSA infection was not demonstrated; thus, an MRSA control program is warranted to decrease vancomycin use and to limit glycopeptide resistance in gram-positive cocci.

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

Epidemiology and Infection ◽

10.1017/s0950268813000228 ◽

2013 ◽

Vol 141 (11) ◽

pp. 2392-2402 ◽

Cited By ~ 12

Author(s):

G. N. DELORENZE ◽

M. A. HORBERG ◽

M. J. SILVERBERG ◽

A. TSAI ◽

C. P. QUESENBERRY ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Health Plan ◽

Methicillin Resistant Staphylococcus Aureus ◽

Incidence Rates ◽

Infected Group ◽

Rapid Rise ◽

Infection Rates ◽

Methicillin Resistant ◽

Mrsa Infection

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

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Bacterial Epidemiology of Surgical Site Infections after Open Fractures of the Lower Limb: A Retrospective Cohort Study

Antibiotics ◽

10.3390/antibiotics10121513 ◽

2021 ◽

Vol 10 (12) ◽

pp. 1513

Author(s):

Tracie Joyner Youbong ◽

Astrid De Pontfarcy ◽

Maxence Rouyer ◽

Alessio Strazzula ◽

Catherine Chakvetadze ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Cohort Study ◽

Lower Limb ◽

Surgical Site Infections ◽

Enterobacter Cloacae ◽

Infectious Complications ◽

Open Fractures ◽

University Hospital ◽

Limb Fracture ◽

Group 3

Open lower limb fractures are common injuries, and the occurrence of infectious complications after open fractures is a usual problem. The rate of surgical site infections (SSIs) and the nature and resistance of the germs responsible for SSIs remain poorly described. Our aim was to describe the bacterial epidemiology of SSIs after surgical management of an open lower limb fracture. We conducted a retrospective monocentric cohort study from 1 January 2012 to 31 December 2020 based on the analysis of inpatient records in a non-university hospital of Ile de France region. All patients who underwent surgery for an open lower limb fracture were included. A total of 149 patients were included. In our population, 19 (12.7%) patients developed an SSI. Of these 19 patients, the sample was polymicrobial in 9 (47.4%) patients. In 9 (45%) cases, the samples identified a group 3 enterobacteria, Enterobacter cloacae being the main one in 7 (36.9%) cases. Staphylococci were identified in 11 patients, with Staphylococcus aureus in 9 (47.4%). All Staphylococcus aureus were susceptible to methicillin, and all enterobacteria were susceptible to C3G. Among all SSI, 10 (58.8%) contained at least one germ resistant to amoxicillin/clavulanic acid (AMC). The SSIs rate was 12.7%. The main pathogens identified were Enterobacter cloacae and Staphylococcus aureus. The presence of early SSI caused by group 3 Enterobacteriaceae renders current antibiotic prophylaxis protocols inadequate with AMC in half the cases.

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Staphylococcus aureus Decolonization Protocol Decreases Surgical Site Infections for Total Joint Replacement

Arthritis ◽

10.1155/2010/924518 ◽

2010 ◽

Vol 2010 ◽

pp. 1-4 ◽

Cited By ~ 34

Author(s):

Scott Hadley ◽

Igor Immerman ◽

Lorraine Hutzler ◽

James Slover ◽

Joseph Bosco

Keyword(s):

Staphylococcus Aureus ◽

Treatment Group ◽

Total Joint Replacement ◽

Surgical Site Infections ◽

Control Group ◽

Positive Trend ◽

Perioperative Prophylaxis ◽

Nasal Mupirocin ◽

Hip Arthroplasties ◽

Mrsa Colonization

We investigated the effects of implementation of an institution-wide screening and decolonization protocol on the rates of deep surgical site infections (SSIs) in patients undergoing primary knee and hip arthroplasties. 2058 patients were enrolled in this study: 1644 patients in the treatment group and 414 in the control group. The treatment group attended preoperative admission testing (PAT) clinic where they were screened for MSSA and MRSA colonization. All patients were provided a 5-day course of nasal mupirocin and a single preoperative chlorhexidine shower. Additionally, patients colonized with MRSA received Vancomycin perioperative prophylaxis. The control group did not attend PAT nor receive mupirocin treatment and received either Ancef or Clindamycin for perioperative antibiotic prophylaxis. There were a total of 6 deep infections in the control group (1.45%) and 21 in the treatment group (1.28%); this represented a decrease of 13% () in the treatment versus control group. This decrease represented a positive trend in favor of staphylococcus screening, decolonization with mupirocin, and perioperative Vancomycin for known MRSA carriers.

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Efficacy of Skin and Nasal Povidone-Iodine Preparation against Mupirocin-Resistant Methicillin-Resistant Staphylococcus aureus and S. aureus within the Anterior Nares

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.04624-14 ◽

2015 ◽

Vol 59 (5) ◽

pp. 2765-2773 ◽

Cited By ~ 29

Author(s):

Michele J. Anderson ◽

Maren L. David ◽

Matt Scholz ◽

Sally J. Bull ◽

Dan Morse ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Human Skin ◽

Povidone Iodine ◽

Human Subjects ◽

Surgical Site Infections ◽

Attractive Alternative ◽

Methicillin Resistant ◽

Content Type ◽

Nasal Swabs ◽

Mrsa Infection

ABSTRACTMupirocin decolonization of nasalStaphylococcus aureusprior to surgery decreases surgical-site infections; however, treatment requires 5 days, compliance is low, and resistance occurs. In 2010, 3M Company introduced povidone-iodine (PVP-I)-based skin and nasal antiseptic (Skin and Nasal Prep [SNP]). SNP has rapid, broad-spectrum antimicrobial activity. We tested SNP's efficacy using full-thickness tissue (porcine mucosal [PM] and human skin) explant models and human subjects. Prior to or following infection with methicillin-resistantStaphylococcus aureus(MRSA) (mupirocin sensitive and resistant), explants were treated with Betadine ophthalmic preparation (Bet), SNP, or mupirocin (Bactroban nasal ointment [BN]) or left untreated. One hour posttreatment, explants were washed with phosphate-buffered saline (PBS) plus 2% mucin. One, 6, or 12 h later, bacteria were recovered and enumerated. Alternatively, following baseline sampling, human subjects applied two consecutive applications of SNP or saline to their anterior nares. One, 6, and 12 h after application of the preparation (postprep), nasal swabs were obtained, andS. aureuswas enumerated. We observed that treatment of infected PM or human skin explants with SNP resulted in >2.0 log10CFU reduction in MRSA, regardless of mupirocin sensitivity, which was significantly different from the values for BN- and Bet-treated explants and untreated controls 1 h, 6 h, and 12 h after being washed with PBS plus mucin. Swabbing the anterior nares of human subjects with SNP significantly reduced residentS. aureuscompared to saline 1, 6, and 12 h postprep. Finally, pretreatment of PM explants with SNP, followed by a mucin rinse prior to infection, completely prevented MRSA infection. We conclude that SNP may be an attractive alternative for reducing the bioburden of anterior nares prior to surgery.

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Effect of Targeted Surveillance for Control of Methicillin-ResistantStaphylococcus aureusin a Community Hospital System

Infection Control and Hospital Epidemiology ◽

10.1086/500372 ◽

2006 ◽

Vol 27 (3) ◽

pp. 233-238 ◽

Cited By ~ 47

Author(s):

Timothy E. West ◽

Cile Guerry ◽

Mary Hiott ◽

Nancy Morrow ◽

Katherine Ward ◽

...

Keyword(s):

South Carolina ◽

Community Hospital ◽

Tertiary Care ◽

Surgical Site Infections ◽

Cost Effective ◽

Hospital System ◽

Contact Isolation ◽

Mrsa Infection ◽

The Cost ◽

Mrsa Colonization

Objective.To examine the cost associated with targeted surveillance for methicillin-resistantStaphylococcus aureus(MRSA) and the effect of such surveillance on the rate of nosocomial MRSA infection in a community hospital system.Design.A before-and-after study comparing the rate of MRSA infection before (BES) and after (AES) the initiation of expanded surveillance. Cost-effectiveness was calculated as the difference between the cost savings associated with preventing nosocomial MRSA bacteremias and surgical site infections AES and the cost of MRSA cultures and contact isolation for patients colonized with MRSA.Setting and Participants.Patients in a 400-bed tertiary-care facility (Roper Hospital) and a 180-bed suburban hospital (St. Francis Hospital), both in Charleston, South Carolina.Interventions.Beginning in September 2001, patients were screened for MRSA colonization upon admission to the intensive care unit and weekly thereafter. In July 2002, surveillance was expanded to include targeted screening of patients admitted to general wards who were at risk of MRSA colonization. Colonized patients were placed in contact isolation.Results.The mean rate of nosocomial MRSA infection decreased at Roper (0.76 cases per 1,000 patient-days BES and 0.45 per 1000 patient-days AES;P= .05) and at St. Francis (0.73 cases per 1,000 patient-days BES and 0.57 cases per 1000 patient-days AES;P= .35). Surveillance was cost-effective, preventing 13 nosocomial MRSA bacteremias and 9 surgical site infections, for a savings of $1,545,762.Conclusions.Targeted surveillance for MRSA colonization was cost-effective and provided substantial benefits by reducing the rate of nosocomial MRSA infections in a community hospital system.

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