scholarly journals STOP-BSI: Reducing Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Oncology Patients

2020 ◽  
Vol 41 (S1) ◽  
pp. s391-s391
Author(s):  
Mylinh Yun ◽  
Jay Varkey ◽  
Renee Spinke ◽  
Marie Ayers ◽  
Christina Bell ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Povidone Iodine ◽  
Medical Center ◽  
Academic Medical Center ◽  
Bloodstream Infections ◽  
Nurse Specialist ◽  
Oncology Patients ◽  
Improvement Project ◽  
Methicillin Resistant ◽  
Oncology Unit

Background: Hospital-acquired methicillin-resistant Staphylococcus aureus bloodstream infections (MRSA BSIs) are associated with serious morbidity and mortality in immunocompromised patients. Of all MRSA BSIs at our academic medical center, 63% occurred in the oncology units. A multidisciplinary team was formed to address the improvement opportunity: the clinical nurse specialist, hospital epidemiologist, unit leaders, nurse champions and representatives from infection prevention, pharmacy and information technology. The goal was to decrease the incidence of hospital-onset MRSA BSI in the oncology wards by 10 infections in 2016 by implementing daily chlorohexidine (CHG) bathing and weekly nasal povidone-iodine antisepsis in July 2016. Methods: The strategically targeting oncology with povidone-iodine nasal antisepsis and bathing with CHG Staph reduction initiative (STOP-BSI) was a quality improvement project consisting of daily CHG baths for all oncology patients and nasal povidone-iodine on admission and weekly thereafter. Nurses and patient care technicians were trained on how to administer CHG treatments. Education was also provided to patients on how to use CHG bath wipes to self-administer the nasal antisepsis. Education resources were created to help answer concerns of the staff, patient, or family, and an escalation process was developed for treatment refusal. CHG bath audits were performed to measure compliance and to identify barriers to the process. Results: By the end of 2016, the number of infections decreased by 5 on the oncology units. The number of infections continued to decrease each year. The bone marrow transplant (BMT) unit decreased from 8 infections in 2015 to 3 in 2018. The hematology oncology unit infections decreased from 5 infections in 2015 to 0 in 2018. The medical oncology unit infections decreased from 2 infections in 2015 to 0 in 2018. The CLABSI rates per 1,000 line days trended downward after some time. Conclusions: Implementing daily CHG baths and weekly povidone-iodine nasal antisepsis reduced the number of MRSA BSI infections in the oncology population. The CLABSI rates decreased after barriers to the process were removed.Funding: NoneDisclosures: None

scholarly journals Blurred molecular epidemiological lines between the two dominant methicillin-resistant Staphylococcus aureus clones

2018 ◽  
Author(s):  
Amy C. Dupper ◽  
Mitchell J. Sullivan ◽  
Kieran I. Chacko ◽  
Aaron Mishkin ◽  
Brianne Ciferri ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
Medical Center ◽  
Data Extraction ◽  
Age Groups ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Peripheral Intravenous Catheter ◽  
Life Threatening ◽  
Healthcare Associated

AbstractBackgroundMethicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening infections in both community and hospital settings and is a leading cause of healthcare-associated infections (HAIs). We sought to describe the molecular epidemiological landscape of patients with MRSA bloodstream infections (BSIs) at an urban medical center by evaluating the clinical characteristics associated with the two dominant endemic clones.MethodsComprehensive clinical data extraction from the electronic health records of 227 hospitalized patients ≥18 years old with MRSA BSI over a 33-month period in New York City were collected. The descriptive epidemiology and mortality associated with the two dominant clones was compared using logistic regression.ResultsMolecular analysis revealed that 91% of all single-patient MRSA BSIs were due to two equally represented genotypes, clonal complex (CC) 5 (N=117) and CC8 (N=110). MRSA BSIs were associated with a 90-day mortality of 27%. CC8 caused disease more frequently in younger age groups (56 ± 17 vs 67 ± 17 years old; p<0.001) and in non-White race (OR=3.45 95% CI [1.51-7.87]; p=0.003), with few other major distinguishing features. Morbidity and mortality also did not differ significantly between the two clones. CC8 caused BSIs more frequently in the setting of peripheral intravenous catheters (OR=5.96; 95% CI [1.51-23.50]; p=0.01).ConclusionThe clinical features distinguishing dominant MRSA clones continue to converge. The association of CC8 with peripheral intravenous catheter infections underscores the importance of classical community clones causing hospital-onset infections. Ongoing monitoring and analysis of the dynamic epidemiology of this endemic pathogen is crucial to inform management to prevent disease.

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

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

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

scholarly journals 2249. Impact of Minimum Inhibitory Concentration on Clinical Outcomes of Daptomycin for VRE Bloodstream Infection Among Neutropenic Oncology Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S769-S769
Author(s):  
Elisabeth Caulder ◽  
Elizabeth Palavecino ◽  
James Beardsley ◽  
James Johnson ◽  
Vera Luther ◽  
...  
Keyword(s):  
Bloodstream Infection ◽  
Clinical Success ◽  
Medical Center ◽  
Academic Medical Center ◽  
Charlson Comorbidity Index Score ◽  
Multivariable Logistic Regression Analysis ◽  
Oncology Patients ◽  
Oncology Unit ◽  
Record Review ◽  
The Impact

Abstract Background Vancomycin-resistant Enterococcus (VRE) bloodstream infection (BSI) is a significant cause of morbidity and mortality in immunocompromised patients. This study aimed to assess the impact of daptomycin (DAP) MIC on outcomes of treatment for VRE BSI in neutropenic oncology patients. Methods This was a retrospective, observational, single-center, cohort study at an academic medical center. Included: age ≥ 18, neutropenia, admitted to oncology unit, and DAP for VRE BSI. Excluded: death within 24 hours after initiation of DAP, polymicrobial BSI, and linezolid use for > 48 hours before DAP initiation. Patients with VRE BSI 2008–2018 were identified using a report from the micro lab. Data were collected by electronic medical record review. The primary outcome of the study was clinical success, defined as culture sterilization, hypotension resolution, defervescence, and no need to change DAP due to persistent signs/symptoms of infection. Patients were analyzed according to DAP MIC ≤ 2 vs. ≥ 4 mg/L. Multivariable logistic regression analysis was performed to identify factors associated with clinical success. Results 44 patients met study criteria (MIC ≤ 2, n = 26; MIC ≥ 4, n = 18). Mean age was 58 years, 59% were male, and median ANC was 0. Median Charlson Comorbidity Index Score and Pitt Bacteremia Score (Pitt) were 5 and 1, respectively. 34% required ICU admission. More patients achieved clinical success with MIC ≤ 2 (88% vs. 56%; P = 0.03). Time to success (2.4 vs. 4 days, P = 0.02) and time to culture sterilization (2.2 vs. 2.9 days, P = 0.24) were shorter with MIC ≤ 2. Mortality was similar between groups (31% vs. 33%). Time to culture sterilization (P = 0.008), neutropenia resolution (P = 0.02), MIC group (P = 0.096), and Pitt (P = 0.52) were included in the multivariable model. Conclusion DAP MIC should be considered when choosing therapy for VRE BSI among neutropenic oncology patients, particularly those expected to have prolonged neutropenia and those with persistently positive cultures. Disclosures All authors: No reported disclosures.

scholarly journals Standardized Treatment and Assessment Pathway Improves Mortality in Adults with Methicillin-resistant Staphylococcus aureus Bacteremia: STAPH-Study

2021 ◽  
Author(s):  
Sara Alosaimy ◽  
Abdalhamid M Lagnf ◽  
Taylor Morrisette ◽  
Sarah C J Jorgensen ◽  
Trang D Trinh ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Infectious Diseases ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Bloodstream Infections ◽  
Clinical Implementation ◽  
Methicillin Resistant ◽  
Confounding Variables ◽  
Early Use

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) management remains challenging for clinicians. Numerous in vitro studies report synergy when vancomycin (VAN)/daptomycin (DAP) were combined with beta-lactams (BL), which has led to clinical implementation of these combinations. While shorter durations of bacteremia have often been reported, there has been no significant impact on mortality. Methods The Detroit Medical Center (DMC) developed and implemented a clinical pathway algorithm for MRSA BSI treatment in 2016 that included the early use of BL combination therapy with standard-of-care (VAN or DAP) and a mandatory infectious diseases consultation. This was a retrospective, quasi-experimental study at the DMC between 2013-2020. Multivariable logistic regression was used to assess the independent association between pathway implementation and 30-day mortality while adjusting for confounding variables. Results Overall, 813 adult patients treated for MRSA BSI were evaluated. Compared to pre-pathway (PRE) patients (n=379), those treated post-pathway (POST) (n=434) had a significant reduction in 30-day and 90-day mortality; 9.7% in POST vs. 15.6% in PRE (p=0.011) and 12.2% in POST vs. 19.0% in PRE (p=0.007), respectively. The incidence of acute kidney injury (AKI) was higher in the PRE compared to POST; 9.6% vs. 7.2% (p=0.282), respectively. After adjusting for confounding variables including infectious diseases consult, POST was independently associated with a reduction in 30-day mortality (adjusted odds ratio [aOR], 0.608; 95% confidence interval [CI], 0.375-0.986). Conclusions Implementation of a MRSA BSI treatment pathway with early use of BL reduced mortality with no increased in AKI. Further prospective evaluation of this pathway approach is warranted.

Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia

2003 ◽  
Vol 24 (6) ◽  
pp. 431-435 ◽  
Author(s):  
Leonard B. Johnson ◽  
Arti Bhan ◽  
Joan Pawlak ◽  
Odette Manzor ◽  
Louis D. Saravolatz
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Electric Fields ◽  
Medical Center ◽  
Academic Medical Center ◽  
Care Facility ◽  
Retrospective Case ◽  
Term Care ◽  
Methicillin Resistant ◽  
Community Onset

AbstractObjectives:To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.Design:Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.Setting:A 600-bed urban academic medical center.Patients:Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.Results:The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.Conclusions:Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.

scholarly journals Blurred Molecular Epidemiological Lines Between the Two Dominant Methicillin-Resistant Staphylococcus aureus Clones

2019 ◽  
Vol 6 (9) ◽  
Author(s):  
Amy C Dupper ◽  
Mitchell J Sullivan ◽  
Kieran I Chacko ◽  
Aaron Mishkin ◽  
Brianne Ciferri ◽  
...  
Keyword(s):  
New York ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Age Groups ◽  
Bloodstream Infections ◽  
Methicillin Resistant ◽  
Peripheral Intravenous Catheter ◽  
Life Threatening ◽  
Catheter Infections

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) causes life-threatening infections in both community and hospital settings and is a leading cause of health care–associated infections (HAIs). We sought to describe the molecular epidemiological landscape of patients with MRSA bloodstream infections (BSIs) at an urban medical center by evaluating the clinical characteristics associated with the two dominant endemic clones. Methods Comprehensive clinical data from the electronic health records of 227 hospitalized patients ≥18 years old with MRSA BSI over a 33-month period in New York City were collected. The descriptive epidemiology and mortality associated with the two dominant clones were compared using logistic regression. Results Molecular analysis revealed that 91% of all single-patient MRSA BSIs were due to two equally represented genotypes, clonal complex (CC) 5 (n = 117) and CC8 (n = 110). MRSA BSIs were associated with a 90-day mortality rate of 27%. CC8 caused disease more frequently in younger age groups (56 ± 17 vs 67 ± 17 years old; P &lt; .001) and in those of nonwhite race (odds ratio [OR], 3.45; 95% confidence interval [CI], 1.51–7.87; P = .003), with few other major distinguishing features. Morbidity and mortality also did not differ significantly between the two clones. CC8 caused BSIs more frequently in the setting of peripheral intravenous catheters (OR, 5.96; 95% CI, 1.51–23.50; P = .01). Conclusions The clinical features distinguishing dominant MRSA clones continue to converge. The association of CC8 with peripheral intravenous catheter infections underscores the importance of classical community clones causing hospital-onset infections. Ongoing monitoring and analysis of the dynamic epidemiology of this endemic pathogen are crucial to inform management and prevent disease.

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