scholarly journals Trends in methicillin-resistant Staphylococcus aureus bloodstream infections using statewide population-based surveillance and hospital discharge data, Connecticut, 2010–2018

2020 ◽  
Vol 41 (6) ◽  
pp. 734-736
Author(s):  
Ashley N Rose ◽  
Paula Clogher ◽  
Kelly M Hatfield ◽  
Runa H Gokhale ◽  
Isaac See ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Population Based ◽  
Hospital Discharge Data ◽  
Discharge Data ◽  
Methicillin Resistant ◽  
Identification Methods

AbstractWe compared methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) captured by culture-based surveillance and MRSA septicemia hospitalizations captured by administrative coding using statewide hospital discharge data in Connecticut from 2010 to 2018. Observed discrepancies between identification methods suggest administrative coding is inappropriate for assessing trends in MRSA BSIs.

scholarly journals Trends in Incidence of Methicillin-resistant Staphylococcus aureus Bloodstream Infections Differ by Strain Type and Healthcare Exposure, United States, 2005–2013

2019 ◽  
Vol 70 (1) ◽  
pp. 19-25 ◽  
Author(s):  
Isaac See ◽  
Yi Mu ◽  
Valerie Albrecht ◽  
Maria Karlsson ◽  
Ghinwa Dumyati ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Population Based ◽  
Emerging Infections ◽  
Methicillin Resistant ◽  
Central Lines ◽  
Strain Type ◽  
Healthcare Associated ◽  
Community Onset

Abstract Background Previous reports suggested that US methicillin-resistant Staphylococcus aureus (MRSA) strain epidemiology has changed since the rise of USA300 MRSA. We describe invasive MRSA trends by strain type. Methods Data came from 5 Centers for Disease Control and Prevention Emerging Infections Program sites conducting population-based surveillance and collecting isolates for invasive MRSA (ie, from normally sterile body sites), 2005–2013. MRSA bloodstream infection (BSI) incidence per 100 000 population was stratified by strain type and epidemiologic classification of healthcare exposures. Invasive USA100 vs USA300 case characteristics from 2013 were compared through logistic regression. Results From 2005 to 2013, USA100 incidence decreased most notably for hospital-onset (6.1 vs 0.9/100 000 persons, P < .0001) and healthcare-associated, community-onset (10.7 vs 4.9/100 000 persons, P < .0001) BSIs. USA300 incidence for hospital-onset BSIs also decreased (1.5 vs 0.6/100 000 persons, P < .0001). However, USA300 incidence did not significantly change for healthcare-associated, community-onset (3.9 vs 3.3/100 000 persons, P = .05) or community-associated BSIs (2.5 vs 2.4/100 000 persons, P = .19). Invasive MRSA was less likely to be USA300 in patients who were older (adjusted odds ratio [aOR], 0.97 per year [95% confidence interval {CI}, .96–.98]), previously hospitalized (aOR, 0.36 [95% CI, .24–.54]), or had central lines (aOR, 0.44 [95% CI, .27–.74]), and associated with USA300 in people who inject drugs (aOR, 4.58 [95% CI, 1.16–17.95]). Conclusions Most of the decline in MRSA BSIs was from decreases in USA100 BSI incidence. Prevention of USA300 MRSA BSIs in the community will be needed to further reduce burden from MRSA BSIs.

scholarly journals Antibiotic Resistance, spa Typing and Clonal Analysis of Methicillin-Resistant Staphylococcus aureus (MRSA) Isolates from Blood of Patients Hospitalized in the Czech Republic

Antibiotics ◽  
2021 ◽  
Vol 10 (4) ◽  
pp. 395
Author(s):  
Katarina Pomorska ◽  
Vladislav Jakubu ◽  
Lucia Malisova ◽  
Marta Fridrichova ◽  
Martin Musilek ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Czech Republic ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Spa Typing ◽  
The Czech Republic ◽  
Methicillin Resistant ◽  
Mrsa Strains ◽  
Spa Types ◽  
Repeat Pattern

Staphylococcus aureus is one of the major causes of bloodstream infections. The aim of our study was to characterize methicillin-resistant Staphylococcus aureus (MRSA) isolates from blood of patients hospitalized in the Czech Republic between 2016 and 2018. All MRSA strains were tested for antibiotic susceptibility, analyzed by spa typing and clustered using a Based Upon Repeat Pattern (BURP) algorithm. The representative isolates of the four most common spa types and representative isolates of all spa clonal complexes were further typed by multilocus sequence typing (MLST) and staphylococcal cassette chromosome mec (SCCmec) typing. The majority of MRSA strains were resistant to ciprofloxacin (94%), erythromycin (95.5%) and clindamycin (95.6%). Among the 618 strains analyzed, 52 different spa types were detected. BURP analysis divided them into six different clusters. The most common spa types were t003, t586, t014 and t002, all belonging to the CC5 (clonal complex). CC5 was the most abundant MLST CC of our study, comprising of 91.7% (n = 565) of spa-typeable isolates. Other CCs present in our study were CC398, CC22, CC8, CC45 and CC97. To our knowledge, this is the biggest nationwide study aimed at typing MRSA blood isolates from the Czech Republic.

scholarly journals 286. Exploratory Cost-Effectiveness Analysis for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infections: Are Daptomycin and Linezolid Favored over Vancomycin and Other Antibiotics?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S143-S144
Author(s):  
Michelle Vu ◽  
Kenneth Smith ◽  
Sherrie L Aspinall ◽  
Cornelius J Clancy ◽  
Deanna Buehrle
Keyword(s):  
Staphylococcus Aureus ◽  
Cost Effectiveness ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Bloodstream Infections ◽  
Sensitivity Analyses ◽  
Drug Event ◽  
Base Case ◽  
Health Administration ◽  
Research Support ◽  
Methicillin Resistant

Abstract Background Methicillin-resistant Staphylococcus aureus bloodstream infections (MRSAB) cause significant mortality and often require extended antibiotic therapy. Vancomycin, the most common initial MRSAB treatment, carries significant monitoring burden and nephrotoxicity risks. We compared cost-effectiveness of vancomycin and other antibiotic regimens as MRSAB treatment. Methods We estimated cost-effectiveness of intravenous antibiotics (vancomycin, daptomycin, linezolid, ceftaroline/daptomycin, dalbavancin) for Veterans Health Administration (VA) patients with MRSAB using an exploratory decision-tree model. Primary effectiveness outcome was composite of microbiological failure and adverse drug event (ADE)-related discontinuation at 7-days. Results In base-case analyses, linezolid and daptomycin were less expensive and had fewer treatment failures than other regimens at 4 and 6-weeks. Compared to linezolid, daptomycin incremental cost-effectiveness ratios were ~$45,000 (4-weeks) and ~$61,000 (6-weeks) per composite failure avoided, respectively. In one-way sensitivity analyses, daptomycin (4-weeks) was favored over linezolid if linezolid microbiological failure or ADE-related discontinuation rates were >14.8% (base case: 14.0%) or >14.3% (base case: 14.0%), respectively, assuming a willingness to pay (WTP) threshold of $40,000/ composite treatment failure avoided. Vancomycin was favored if its microbiological failure risk was < 16.4% (base case: 27.2%). In two-way sensitivity analyses, daptomycin was favored if linezolid microbiological failure and ADE-related discontinuation rates were >19% and > 16%, respectively. Linezolid, daptomycin and vancomycin were favored in 47%, 39%, and 11% of 4-week probabilistic iterations, respectively, at $40,000 WTP. Conclusion Daptomycin or linezolid are likely less expensive and more effective than vancomycin or other initial regimens for MRSAB. More data are needed to support safety of linezolid in MRSAB patients. Disclosures Cornelius J. Clancy, MD, Astellas (Consultant, Grant/Research Support)Cidara (Consultant, Research Grant or Support)Melinta (Grant/Research Support)Merck (Consultant, Grant/Research Support)Needham Associates (Consultant)Qpex (Consultant)Scynexis (Consultant)Shionogi (Consultant)

scholarly journals The Incidence, Characteristics, and Outcomes of Community and Hospital-Associated S. aureus Disease in Fulton County, Georgia

2020 ◽  
Vol 41 (S1) ◽  
pp. s81-s82
Author(s):  
Andrew Webster ◽  
Scott Fridkin ◽  
Susan Ray
Keyword(s):  
Hospital Discharge ◽  
Population Based ◽  
Incidence Rates ◽  
Outcome Data ◽  
Hospital Discharge Data ◽  
Invasive Infection ◽  
Emerging Infections ◽  
Inpatient Hospitalization ◽  
Discharge Data ◽  
Total Treatment

Background: Due to reliance on hospital discharge data for case identification, the burden of noninvasive and community-acquired S. aureus disease is often underestimated. To determine the full burden of S. aureus infections, we utilized population-based surveillance in a large urban county. Methods: The Georgia Emerging Infections Program (GA EIP) conducted CDC-funded, population-based surveillance by finding cases of S. aureus infections in 8 counties around Atlanta in 2017. Cases were residents with S. aureus isolated from either a normally sterile site in a 30-day period (invasive cases) or another site in a 14-day period (noninvasive cases). Medical records (all invasive and 1:4 sample of noninvasive cases) among Fulton County residents were abstracted for clinical, treatment, and outcome data. Cases treated were mapped to standard therapeutic site codes. Noninvasive specimens were reviewed and attributed to an invasive case if both occurred within 2 weeks. Incidence rates were calculated using 2017 census population and using a weight-adjusted cohort to account for sampling. Results: In total, 1,186 noninvasive (1:4 sample) and 529 invasive cases of S. aureus in Fulton county were reviewed. Only 35 of 1,186 (2.9%) noninvasive cases were temporally linked to invasive cases, resulting in 5,133 cases after extrapolation (529 invasive, 4,604 noninvasive). All invasive cases and 3,776 of 4,604 noninvasive cases (82%) were treated (4,305 total). Treatment was highest in skin (90%) and abscess (97%), lowest in urine (62%) and sputum (60%), and consisted of antibacterial agents alone (65%) or in addition to drainage procedures (35%). Overall, 41% of all cases were hospitalized, 12% required ICU admission, and 2.7% died, almost exclusively with bloodstream and pulmonary infections. Attribution of noninvasive infection was most often outside healthcare settings (87%); only 341 (7.9%) were hospital-onset cases; however, 34% of cases had had healthcare exposure in the preceding year, most often inpatient hospitalization (75%) or recent surgery (35%). Estimated countywide incidence was 414 per 100,000 (130 for MRSA and 284 for MSSA), invasive infection was 50 per 100,000. Among treated cases, 57% were SSTI, and the proportion of cases caused by MRSA was ~33% but varied slightly by therapeutic site (Fig. 1). Conclusions: The incidence of treated S. aureus infection in our large urban county is estimated to be 414 per 100,000 persons, which exceeds previously estimated rates based on hospital discharge data. Only 12% of treated infections were invasive, and <1 in 10 were hospital onset. Also, two-thirds of treated disease cases were MSSA; most were SSTIs.Funding: Proprietary Organization: Pfizer.Disclosures: Scott Fridkin, consulting fee - vaccine industry (spouse).

scholarly journals Multicenter Cohort Study of Ceftaroline versus Daptomycin for Treatment of Methicillin-Resistant Staphylococcus aureus Bloodstream Infection

2021 ◽  
Author(s):  
Evan J Zasowski ◽  
Trang D Trinh ◽  
Kimberly C Claeys ◽  
Abdalhamid M Lagnf ◽  
Sahil Bhatia ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Treatment Failure ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Study Drug ◽  
Bloodstream Infections ◽  
Risk Difference ◽  
Multicenter Cohort Study ◽  
Methicillin Resistant ◽  
Composite Failure

Abstract Background Observational data suggest ceftaroline may be effective for methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSI) but comparative data with standard of care are limited. This analysis compares the outcomes of MRSA BSI treated with ceftaroline or daptomycin. Methods Multicenter, retrospective, observational cohort study of adult patients with MRSA BSI from 2010 to 2017. Patients treated with ≥ 72 hours of ceftaroline or daptomycin were included. Those clearing BSI before study drug and those with a pneumonia source were excluded. The primary outcome was composite treatment failure, defined as 30-day mortality, BSI duration ≥ 7 days on study drug, and 60-day MRSA BSI recurrence. Inverse probability of treatment weighted risk difference in composite failure between daptomycin and ceftaroline groups was computed and 15% non-inferiority margin applied. Results Two hundred seventy patients were included; 83 ceftaroline and 187 daptomycin. Ceftaroline was non-inferior to daptomycin with respect to composite failure [39% daptomycin, 32.5% ceftaroline; weighted risk difference (95% CI) 7.0% (-5.0 – 19.0%)]. No differences between treatment groups was observed for 30-day mortality or other secondary efficacy outcomes. Creatine phosphokinase elevation was significantly more common among daptomycin patients (5.3% vs 0%, P = 0.034). Rash was significantly more common among ceftaroline patients (10.8 vs 1.1%, P = 0.001). Conclusions No difference in treatment failure or mortality was observed between MRSA BSI treated with ceftaroline or daptomycin. These data support future study of ceftaroline as a primary MRSA BSI treatment and current use of ceftaroline when an alternative to vancomycin and daptomycin is required.

Post-discharge decolonization of patients harboring methicillin-resistant Staphylococcus aureus (MRSA) USA300 strains: secondary analysis of the CLEAR Trial

2021 ◽  
pp. 1-4
Author(s):  
Gabrielle M. Gussin ◽  
Lauren Heim ◽  
Thomas Tjoa ◽  
James A. McKinnell ◽  
Loren G. Miller ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Discharge ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Secondary Analysis ◽  
Post Discharge ◽  
Methicillin Resistant ◽  
Usa300 Strain ◽  
Strain Type ◽  
Trial Participants

Abstract The CLEAR Trial recently found that decolonization reduced infections and hospitalizations in MRSA carriers in the year following hospital discharge. In this secondary analysis, we explored whether decolonization had a similar benefit in the subgroup of trial participants who harbored USA300, using two different definitions for the USA300 strain-type.

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