scholarly journals The rise of methicillin resistant Staphylococcus aureus: now the dominant cause of skin and soft tissue infection in Central Australia

2017 ◽  
Vol 145 (13) ◽  
pp. 2817-2826 ◽  
Author(s):  
E. MACMORRAN ◽  
S. HARCH ◽  
E ATHAN ◽  
S LANE ◽  
S TONG ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Treatment Outcomes ◽  
Univariate Analysis ◽  
Methicillin Resistant ◽  
Dominant Phenotype ◽  
Mrsa Infection ◽  
Central Australia ◽  
Healthcare Associated ◽  
Community Onset

SUMMARYThis study aimed to examine the epidemiology and treatment outcomes of community-onset purulent staphylococcal skin and soft tissue infections (SSTI) in Central Australia. We performed a prospective observational study of patients hospitalised with community-onset purulent staphylococcal SSTI (n = 160). Indigenous patients accounted for 78% of cases. Patients were predominantly young adults; however, there were high rates of co-morbid disease. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was the dominant phenotype, accounting for 60% of cases. Hospitalisation during the preceding 6 months, and haemodialysis dependence were significant predictors of CA-MRSA infection on univariate analysis. Clinical presentation and treatment outcomes were found to be comparable for methicillin-susceptible S. aureus (MSSA) and methicillin-resistant cases. All MRSA isolates were characterised as non-multi-resistant, with this term used interchangeably with CA-MRSA in this analysis. We did not find an association between receipt of an active antimicrobial agent within the first 48 h, and progression of infection; need for further surgical debridement; unplanned General Practitioner or hospital re-presentation; or need for further antibiotics. At least one adverse outcome was experienced by 39% of patients. Clindamycin resistance was common, while rates of trimethoprim–sulfamethoxazole resistance were low. This study suggested the possibility of healthcare-associated transmission of CA-MRSA. This is the first Australian report of CA-MRSA superseding MSSA as the cause of community onset staphylococcal SSTI.

scholarly journals 469. Contributions of Infections among Persons Who Inject Drugs to the Changing Incidence of Healthcare-Associated, Community-Onset Methicillin-Resistant Staphylococcus aureus Infections, 2009–2017

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S229-S230
Author(s):  
Kelly A Jackson ◽  
Runa Hatti Gokhale ◽  
Joelle Nadle ◽  
Susan Petit ◽  
Susan Ray ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Care Facility ◽  
Term Care ◽  
Persons Who Inject Drugs ◽  
Methicillin Resistant ◽  
Long Term Care Facility ◽  
Active Population ◽  
Healthcare Associated ◽  
Community Onset

Abstract Background Recently, overall reductions for invasive MRSA infections (isolation from a normally sterile site) have slowed. Healthcare-associated community-onset (HACO) invasive methicillin-resistant Staphylococcus aureus (MRSA) infections are those with recent healthcare exposures who develop MRSA infection outside acute care hospitals, and account for most invasive MRSA infections. HACO incidence decreased 6.6% per year during 2005–2008; the contribution of persons who inject drugs (PWID) to HACO incidence has not been reported. Methods We identified invasive MRSA infections using active, population- and laboratory-based surveillance data during 2009–2017 from 25 counties in 7 sites (CA, CT, GA, MD, MN, NY, TN). Cases were HACO if culture was obtained from an outpatient, or ≤3 days after hospitalization in a patient with ≥1 of the following healthcare exposures (HEs): hospitalization, surgery, dialysis, or residence in a long-term care facility (LTCF) in the past year; or central vascular catheter ≤2 days before culture. We calculated incidence (per census population) overall, for PWID cases and others, and for cases associated with each HE. For each HE, we calculated the proportion of overall incidence increase for PWID and others. Results HACO MRSA incidence declined overall from 2009 to 2016 but increased from 2016 to 2017 overall (8%), for both PWID (63%) and others (5%) (figure). For both PWID and non-PWID, incidence from 2016 to 2017 increased by 0.5 cases/100,000 population; 91% of the increase in PWID occurred in cases with a past year hospitalization while 78% of the increase in cases not associated with injection drug use (IDU) occurred in cases with past year LTCF residence. Past year LTCF residence was less common among PWID (16%) then among other cases (38%, P < 0.01). Conclusion After years of declines, HACO MRSA incidence increased equally in 2017 for cases associated with IDU and in cases unrelated to IDU. Increases in PWID-associated cases account for half the overall increase, indicating that efforts to reduce HACO MRSA should address PWID risk factors as these infections may be due to self-injection. In addition, increases not related to PWID, if sustained, would be a reversal of historic trends and require further investigation into causes. Disclosures All authors: No reported disclosures.

Evaluation of International Classification of Diseases, Ninth Revision, Clinical Modification Codes for Reporting Methicillin-Resistant Staphylococcus aureus Infections at a Hospital in Illinois

2010 ◽  
Vol 31 (05) ◽  
pp. 463-468 ◽  
Author(s):  
Melissa K. Schaefer ◽  
Katherine Ellingson ◽  
Craig Conover ◽  
Alicia E. Genisca ◽  
Donna Currie ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
International Classification Of Diseases ◽  
International Classification ◽  
Care Hospital ◽  
Methicillin Resistant ◽  
Diagnosis Codes ◽  
Classification Of Diseases ◽  
Mrsa Infection ◽  
Healthcare Associated

Background. States, including Illinois, have passed legislation mandating the use of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for reporting healthcare-associated infections, such as methicillin-resistant Staphylococcus aureus (MRSA). Objective. To evaluate the sensitivity of ICD-9-CM code combinations for detection of MRSA infection and to understand implications for reporting. Methods. We reviewed discharge and microbiology databases from July through August of 2005, 2006, and 2007 for ICD-9-CM codes or microbiology results suggesting MRSA infection at a tertiary care hospital near Chicago, Illinois. Medical records were reviewed to confirm MRSA infection. Time from admission to first positive MRSA culture result was evaluated to identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code combinations for detecting confirmed MRSA infections was calculated using all codes present in the discharge record (up to 15); the effect of reviewing only 9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid Services, was also evaluated. The sensitivity of the combination of diagnosis codes for detection of HO-MRSA infections was compared with that for community-onset MRSA (CO-MRSA) infections. Results. We identified 571 potential MRSA infections with the use of screening criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31% if only 9 diagnoses were reviewed (P &lt; .001). The sensitivity of code combinations was 33% for HO-MRSA infections compared with 62% for CO-MRSA infections (P &lt; .001). Conclusions. Limiting analysis to 9 diagnosis codes resulted in low sensitivity. Furthermore, code combinations were better at revealing CO-MRSA infections than HO-MRSA infections. These limitations could compromise the validity of ICD-9-CM codes for interfacility comparisons and for reporting of healthcare-associated MRSA infections.

scholarly journals Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in a Canadian emergency department

CJEM ◽  
2009 ◽  
Vol 11 (05) ◽  
pp. 430-438 ◽  
Author(s):  
Robert Stenstrom ◽  
Eric Grafstein ◽  
Marc Romney ◽  
John Fahimi ◽  
Devin Harris ◽  
...  
Keyword(s):  
Risk Factors ◽  
Emergency Department ◽  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Soft Tissue Infection ◽  
Tissue Infection ◽  
Methicillin Resistant ◽  
Period Prevalence ◽  
Monthly Period ◽  
Mrsa Infection

ABSTRACT Objective: We sought to estimate the period prevalence of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infection (SSTI) and evaluate risk factors for MRSA SSTI in an emergency department (ED) population. Methods: We carried out a cohort study with a nested case–control design. Patients presenting to our ED with a wound culture and a discharge diagnosis of SSTI between January 2003 and September 2004 were dichotomized as MRSA positive or negative. Fifty patients with MRSA SSTI matched by calendar time to 100 controls with MRSA-negative SSTI had risk factors assessed using multivariate conditional logistic regression. Results: Period prevalence of MRSA SSTI was 54.8% (95% confidence interval [CI] 50.2%–59.4%). The monthly period prevalence increased from 21% in January 2003 to 68% in September 2004 (p &lt; 0.01). Risk factors for MRSA SSTI were injection drug use (IDU) (odds ratio [OR] 4.6, 95% CI 1.4–16.1), previous MRSA infection and colonization (OR 6.4, 95% CI 2.1–19.8), antibiotics in 8 weeks preceding index visit (OR 2.6, 95% CI 1.2–8.1), diabetes mellitus (OR 4.1, 95% CI 1.4–12.1), abscess (OR 5.6, 95% CI 1.8–17.1) and admission to hospital in previous 12 months (OR 2.6, 95% CI 1.1–11.2). Conclusion: The period prevalence of MRSA SSTI between January 2003 and September 2004 was 54.8% at our institution. There was a marked increase in the monthly period prevalence from the beginning to the end of the study. Risk factors are IDU, previous MRSA infection and colonization, prescriptions for antibiotics in previous 8 weeks and admission to hospital in the preceding 12 months. On the basis of local prevalence and risk factor patterns, emergency physicians should consider MRSA as a causative agent for SSTI.

Risk factors for methicillin-resistant Staphylococcus aureus skin and soft tissue infection in MRSA-colonized patients discharged from a Veterans Affairs hospital

2015 ◽  
Vol 144 (3) ◽  
pp. 647-651 ◽  
Author(s):  
J. CADENA ◽  
A. M. RICHARDSON ◽  
C. R. FREI
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Statistical Tests ◽  
Multivariable Analysis ◽  
High Risk Population ◽  
Care Hospital ◽  
Post Discharge ◽  
Methicillin Resistant ◽  
Mrsa Infection

SUMMARYCurrently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.

Methicillin-ResistantStaphylococcus aureusin Canadian Aboriginal People

2006 ◽  
Vol 27 (2) ◽  
pp. 204-207 ◽  
Author(s):  
Marianna Ofner-Agostini ◽  
Andrew E. Simor ◽  
Michael Mulvey ◽  
Elizabeth Bryce ◽  
Mark Loeb ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Soft Tissue ◽  
Clinical Features ◽  
Patient Population ◽  
Genetic Background ◽  
Aboriginal People ◽  
Methicillin Resistant ◽  
Aboriginal Population ◽  
Mrsa Infection

We describe 279 hospitalized Canadian aboriginals in whom methicillin-resistantStaphylococcus aureus(MRSA) was detected. They were identified in 38 Canadian hospitals from 1995 through 2002. Compared with nonaboriginals, aboriginals were more likely to be younger than 18 years of age (OR, 1.8;P<.0001), to have had an MRSA infection (OR, 3.8;P<.0001), and to have had MRSA isolated from specimens of skin or soft tissue (OR, 4.1;P= .016). The clinical features of MRSA infection in aboriginals are distinct from those in the general patient population with MRSA infection in Canadian hospitals, and the genetic background of MRSA isolates from aboriginals also varies from that of strains from the non-aboriginal population.

Identifying the Risk Factors for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection among Patients Colonized with MRSA on Admission

2012 ◽  
Vol 33 (12) ◽  
pp. 1219-1225 ◽  
Author(s):  
Yuriko Fukuta ◽  
Candace A. Cunningham ◽  
Patricia L. Harris ◽  
Marilyn M. Wagener ◽  
Robert R. Muder
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Univariate Analysis ◽  
Significant Risk ◽  
Prior History ◽  
Methicillin Resistant ◽  
Control Subjects ◽  
History Of ◽  
Mrsa Infection ◽  
Hospital Acquired

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospital-acquired infections. MRSA-colonized inpatients who may benefit from undergoing decolonization have not been identified.Objective.To identify risk factors for MRSA infection among patients who are colonized with MRSA at hospital admission.Design.A case-control study.Setting.A 146-bed Veterans Affairs hospital.Participants.Case patients were those patients admitted from January 2003 to August 2011 who were found to be colonized with MRSA on admission and then developed MRSA infection. Control subjects were those patients admitted during the same period who were found to be colonized with MRSA on admission but who did not develop MRSA infection.Methods.A retrospective review.Results.A total of 75 case patients and 150 control subjects were identified. A stay in the intensive care unit (ICU) was the significant risk factor in univariate analysis (P<.001). Prior history of MRSA (P = .03), transfer from a nursing home (P = .002), experiencing respiratory failure (P<.001), and receipt of transfusion (P = .001) remained significant variables in multivariate analysis. Prior history of MRSA colonization or infection (P = .02), difficulty swallowing (P = .04), presence of an open wound (P = .002), and placement of a central line (P = .02) were identified as risk factors for developing MRSA infection for patients in the ICU. Duration of hospitalization, readmission rate, and mortality rate were significantly higher in case patients than in control subjects (P< .001, .001, and <.001, respectively).Conclusions.MRSA-colonized patients admitted to the ICU or admitted from nursing homes have a high risk of developing MRSA infection. These patients may benefit from undergoing decolonization.

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