scholarly journals Effectiveness of Methicillin-Resistant Staphylococcus aureus (MRSA) Nasal Screening for Reduction of Vancomycin Use for Pneumonia

2020 ◽  
Vol 41 (S1) ◽  
pp. s470-s471
Author(s):  
Shannon Snellgrove ◽  
Matthew Brown ◽  
Seth Edwards ◽  
Sixto Leal ◽  
Allen Bryan ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Screening Tool ◽  
Hemodynamic Instability ◽  
Exclusion Criteria ◽  
Methicillin Resistant ◽  
Screening Questionnaire ◽  
Days Of Therapy ◽  
Antibiotic Coverage

Background: Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been a well-established risk for developing MRSA pneumonia. In previous studies, the MRSA nasal screening test has shown an excellent negative predictive value (NPV) for MRSA pneumonia in patients without exclusion criteria such as mechanical ventilation, hemodynamic instability, cavitary lesions, and underlying pulmonary disease. MRSA nasal screening can be used as a stewardship tool to de-escalate broad antibiotic coverage, such as vancomycin. Objective: The purpose of this study was to determine whether implementation of a MRSA nasal screening questionnaire improves de-escalation of vancomycin for patients with pneumonia. Methods: A retrospective review was performed on 250 patients from October 2018 to January 2019 who received MRSA nasal screening due to their prescriber choosing only “respiratory” on the vancomycin dosing consult form. Data obtained included demographics and clinical outcomes. Statistical analyses were performed, and P < .05 was considered significant. Results: Of the 250 patients screened, only 19 patients (8%) were positive for MRSA. Moreover, 40% of patients met exclusion criteria. In 149 patients without exclusion criteria, the MRSA nasal swab had a 98% NPV. Although not statistically significant, vancomycin days of therapy (DOT) based on MRSA nasal swab result was 1 day shorter in those with negative swabs (3.49 days negative vs 4.58 days positive; P = .22). Vancomycin DOT was significantly reduced in pneumonia patients without exclusion criteria (3.17 days “no” vs 4.17 days “yes”; P = .037). Conclusions: The implementation of an electronic MRSA nasal screening questionnaire resulted in reduced vancomycin DOT in pneumonia patients at UAB Hospital. The MRSA nasal swab is an effective screening tool for antibiotic de-escalation based on its 98% NPV for MRSA pneumonia if utilized in the correct patient population.Funding: NoneDisclosures: Rachael Anne Lee reports a speaker honoraria from Prime Education, LLC.

COMMUNITY ACQUIRED METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS HAND INFECTIONS: A SOUTH PACIFIC PERSPECTIVE — CHARACTERISTICS AND IMPLICATIONS FOR ANTIBIOTIC COVERAGE

Hand Surgery ◽  
2012 ◽  
Vol 17 (03) ◽  
pp. 317-324 ◽  
Author(s):  
Derek Buchanan ◽  
Wolfgang Heiss-Dunlop ◽  
Jon A. Mathy
Keyword(s):  
Staphylococcus Aureus ◽  
Antibiotic Treatment ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
The United States ◽  
Control Group ◽  
Methicillin Resistant ◽  
Empiric Treatment ◽  
Sensitivity Data ◽  
Culture Positive ◽  
Antibiotic Coverage

Purpose: Community acquired methicillin resistant Staphylococcus aureus (CA-MRSA) infections are reported to be increasing worldwide. In the United States when rates exceed 15% empiric treatment is suggested. The aim of our study was to determine local rates and treatment of CA-MRSA within our region. Methods: Nine hundred and forty-two patients were admitted to our service during a six-year period with culture-positive hand infections identified from operative cultures at the time of surgery. Results: Sixty-six (7.0%) patients had CA-MRSA positive cultures identified. Thirty-two (48.5%) patients were noted to have remained on antibiotic treatment that did not reflect their MRSA positive status after cultures returned. Despite this, re-admission and re-operation rates were low and comparable to our non-MRSA control group. Conclusions: Within our CA-MRSA group, current rates do not support automatic empiric treatment for CA-MRSA. Based on sensitivity data, co-trimoxazole and intravenous vancomycin are appropriate and effective antibiotic treatment within our region. Our data supports the importance of drainage of pyogenic infections in helping to resolve complicated hand infections.

scholarly journals Screening for Methicillin-Resistant Staphylococcus aureus Colonization Using Sponges

2015 ◽  
Vol 36 (1) ◽  
pp. 28-33 ◽  
Author(s):  
Chang-Seop Lee ◽  
Bianca Montalmont ◽  
Jessica A. O’Hara ◽  
Alveena Syed ◽  
Charma Chaussard ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Type Ii ◽  
Chain Reaction ◽  
Methicillin Resistant ◽  
Nasal Swabs ◽  
Positive Specimen ◽  
Mrsa Infection ◽  
Polymerase Chain

OBJECTIVENasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection.DESIGNHospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR).PATIENTSA total of 105 MRSA patients were included in the study.RESULTSAt least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites.CONCLUSIONScreening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.Infect Control Hosp Epidemiol 2014;36(1): 28–33

Clinical Outcomes of Linezolid vs Vancomycin in Methicillin-Resistant Staphylococcus aureus Ventilator-Associated Pneumonia

2011 ◽  
Vol 26 (6) ◽  
pp. 385-391 ◽  
Author(s):  
Jeannie D. Chan ◽  
Tam N. Pham ◽  
Jenny Wong ◽  
Michelle Hessel ◽  
Joseph Cuschieri ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Cure ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Signs And Symptoms ◽  
Ventilator Associated Pneumonia ◽  
Vancomycin Therapy ◽  
Methicillin Resistant ◽  
Treatment Standard ◽  
Primary Endpoints ◽  
Days Of Therapy

Background: Vancomycin has been the treatment standard for methicillin-resistant Staphylococcus aureus (MRSA) infections, but clinical efficacy is limited. We report outcomes of a cohort with MRSA ventilator-associated pneumonia (VAP) treated with vancomycin vs linezolid. Methods: Retrospective analysis of 113 participants with MRSA VAP confirmed by bronchoscopy who have been initiated on therapy with either vancomycin or linezolid within 24 hours after bronchoscopy and completed ≥7 days of therapy during their hospitalization from July 2003 to June 2007. The primary endpoints were hospital survival and clinical cure, defined as resolution of signs and symptoms of VAP or microbiological eradication after completion of therapy along with clinical pulmonary infection score (CPIS) ≤6 at day 7 of therapy. Results: At hospital discharge, 23/27 (85.2%) of linezolid and 72/86 (83.7%) of vancomycin recipients had survived ( P = .672). In comparison to linezolid recipients, the adjusted odds ratio (OR) for survival was 0.72 (95% confidence interval [CI]: 0.16-3.27) with vancomycin therapy. Clinical cure was achieved in 24/27 (88.9%) of linezolid and 63/86 (73.3%) of vancomycin recipients ( P = .066). Compared to linezolid recipients, the adjusted OR for clinical cure was 0.24 (95% CI: 0.05-1.10) with vancomycin therapy. Survival and clinical cure did not differ significantly between vancomycin recipients with trough level ≥15 and <15 μg/mL, respectively. Conclusions: Our results suggested no survival benefit but a trend toward higher cure rate with linezolid therapy. The optimal treatment of MRSA VAP requires further study through randomized, controlled trials.

scholarly journals Efficacy of Telavancin in a Rabbit Model of Aortic Valve Endocarditis Due to Methicillin-Resistant Staphylococcus aureus or Vancomycin-Intermediate Staphylococcus aureus

2005 ◽  
Vol 49 (8) ◽  
pp. 3163-3165 ◽  
Author(s):  
Andres G. Madrigal ◽  
Li Basuino ◽  
Henry F. Chambers
Keyword(s):  
Staphylococcus Aureus ◽  
Aortic Valve ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
No Reduction ◽  
Rabbit Model ◽  
Daily Regimen ◽  
Methicillin Resistant ◽  
Days Of Therapy ◽  
Time Kill

ABSTRACT The activities of telavancin and vancomycin were compared in vitro and in the rabbit model of aortic valve endocarditis against a methicillin-resistant Staphylococcus aureus strain, COL, and a vancomycin-intermediate S. aureus (VISA) strain, HIP 5836. Telavancin was bactericidal in time-kill studies at a concentration of 5 μg/ml against both COL and HIP5836. Vancomycin was bacteriostatic at 5 μg/ml and bactericidal at 10 μg/ml against COL and was bacteriostatic at 10 μg/ml against VISA strain HIP 5836. Compared to untreated controls, a twice-daily regimen of 30 mg/kg of telavancin reduced mean aortic valve vegetation titers of the COL strain by 4.7 log10 CFU/g after 4 days of therapy and sterilized 6/11 vegetations compared to 3.4 log10 CFU/g with 3/10 vegetations sterilized for a regimen of twice-daily vancomycin, 30 mg/kg; these differences were not statistically significant. Telavancin was significantly more effective than vancomycin in the VISA model, producing a 5.5 log10 CFU/g reduction versus no reduction in CFU with vancomycin. In experiments comparing 2-day regimens of telavancin at 30 mg/kg and 50 mg/kg twice daily, organisms were rapidly eliminated from vegetations, but the effect was not different between the two doses. These results suggest that telavancin may be an effective treatment for endocarditis and other serious staphylococcal infections accompanied by bacteremia, including infections caused by staphylococci not susceptible to vancomycin.

scholarly journals Prevalence of Staphylococcus aureus and MRSA among Medical students: a literature review

2021 ◽  
Vol 10 (11) ◽  
pp. e347101119536
Author(s):  
Amanda de Souza Lemos ◽  
Ana Carolina Mello Fontoura de Souza ◽  
Bruna Karas ◽  
Camilla Mattia Calixto ◽  
Celine Iris Meijerink ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Students ◽  
Literature Review ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Studies ◽  
Methicillin Resistant ◽  
Hospital Environments ◽  
And Staphylococcus Aureus

Objective: The aim was to analyze the results of studies about the prevalence of Staphylococcus aureus and methicillin-resistant S. aureus among medical students. Methodology: A literature review was carried out from August to November 2020, being selected 19 articles from the Pubmed and “Biblioteca Virtual de Saúde” databases, using the descriptors “Methicillin-Resistant Staphylococcus aureus” and “Students, Medical”. Studies from the last 10 years that target medical students and samples collected by nasal swab were included. Results: Several studies have confirmed the hypothesis that, as students advanced in the academic years and, consequently, raised their exposure to hospital environments, colonization by methicillin-sensitive and resistant Staphylococcus aureus increased. However, some studies were divergent, not finding significant values ​​for this association. The prevalences found also varied according to the place and country surveyed. Conclusion: In general, the greater the exposure to hospital environments, the higher the rate of colonization of students by methicillin-resistant Staphylococcus aureus and Staphylococcus aureus.

scholarly journals Methicillin-resistant Staphylococcus aureus colonization among healthcare workers in Oman

2021 ◽  
Vol 15 (10) ◽  
pp. 1426-1435
Author(s):  
Loay Al Wahaibi ◽  
Rajaa Al Sudairi ◽  
Abdullah Balkhair ◽  
Huda Al-Awaisi ◽  
Mohamed Mabruk
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Healthcare Workers ◽  
Nasal Swab ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Aureus Strain ◽  
Nasal Colonization ◽  
Methicillin Resistant ◽  
Associated Risk Factors ◽  
Mrsa Colonization

Introduction: Methicillin-Resistant Staphylococcus aureus (MRSA) is a S. aureus strain characterized by resistance to cloxacillin. Healthcare workers (HCWs), are recognized for their heightened risk for MRSA acquisition and possibly for MRSA nosocomial transmission. This cross-sectional study aimed to determine the prevalence and the associated risk factors of MRSA colonization among healthcare workers at Sultan Qaboos University Hospital (SQUH) in Oman. Methodology: A total of 200 nasal swab samples were collected from the healthcare workers at SQUH during the period October 2nd 2018 to January 7th 2019. All nasal swab samples were examined microbiologically for the presence of MRSA using the standard method and the results were confirmed by detection of the mecA product (PBP2a). Data on associated risk factors for MRSA colonization was collected and analyzed. Results: Forty-one of the 200 screened healthcare workers (20.5%) were found to have nasal carriage of Staphylococcus aureus of which 63.4% were Methicillin Sensitive and 36.6% were Methicillin-Resistant (MRSA). Methicillin-Resistant Staphylococcus aureus (MRSA) was isolated from fifteen of the 200 screened healthcare workers giving a prevalence rate of nasal colonization with MRSA of 7.5%. We found no statistical association between healthcare worker MRSA nasal colonization and age, gender, HCWs specialty, hand hygiene practices, skin condition, previous MRSA infection, and previous exposure to antibiotics. Conclusions: Identification of the prevalence and the associated risk factors of MRSA colonization in healthcare workers mandates continuous surveillance and the implementation of all possible preventive measures to reduce re-occurrences.

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