Role of Healthcare Workers in Outbreaks of Methicillin-ResistantStaphylococcus aureus: A 10-Year Evaluation From a Dutch University Hospital

AbstractBackground and Objective:The benefit of screening healthcare workers (HCWs) at risk for methicillin-resistantStaphylococcus aureus(MRSA) carriage and furloughing MRSA-positive HCWs to prevent spread to patients is controversial. We evaluated our MRSA program for HCWs between 1992 and 2002.Setting:A university medical center in the Netherlands, where methicillin resistance has been kept below 0.5% of all nosocomial S.aureusinfections using active surveillance cultures and isolation of colonized patients.Design:HCWs caring for MRSA-positive patients or patients in foreign hospitals were screened for MRSA. MRSA-positive HCWs had additional cultures, temporary exclusion from patient-related work, assessment of risk factors for persisting carriage, decolonization therapy with mupirocin intranasally and chlorhexidine baths for skin and hair, and follow-up cultures.Results:Fifty-nine HCWs were colonized with MRSA. Seven of 840 screened employees contracted MRSA in foreign hospitals; 36 acquired MRSA after contact with MRSA-positive patients despite isolation precautions (attack rate per outbreak varied from less than 1% to 15%). Our hospital experienced 17 MRSA outbreaks, including 13 episodes in which HCWs were involved. HCWs were index cases of at least 4 outbreaks. In 8 outbreaks, HCWs acquired MRSA after caring for MRSA-positive patients despite isolation precautions.Conclusion:Postexposure screening of HCWs allowed early detection of MRSA carriage and prevention of subsequent transmission to patients. Where the MRSA prevalence is higher, the role of HCWs may be greater. In such settings, an adapted version of our program could help prevent dissemination.

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Impact of BNT162b2 vaccination and isolation on SARS-CoV-2 transmission in Israeli households: an observational study

10.1101/2021.07.12.21260377 ◽

2021 ◽

Author(s):

Maylis Layan ◽

Mayan Gilboa ◽

Tal Gonen ◽

Miki Goldenfeld ◽

Lilac Meltzer ◽

...

Keyword(s):

Healthcare Workers ◽

Data Augmentation ◽

Medical Center ◽

Credible Interval ◽

Control Measures ◽

Risk Of Infection ◽

Household Transmission ◽

Index Cases

Background Massive vaccination rollouts against SARS-CoV-2 infections have facilitated the easing of control measures in countries like Israel. While several studies have characterized the effectiveness of vaccines against severe forms of COVID-19 or SARS-CoV-2 infection, estimates of their impact on transmissibility remain limited. Here, we evaluated the role of vaccination and isolation on SARS-CoV-2 transmission within Israeli households. Methods From December 2020 to April 2021, confirmed cases were identified among healthcare workers of the Sheba Medical Centre and their family members. Households were recruited and followed up with repeated PCR for a minimum of ten days after case confirmation. Symptoms and vaccination information were collected at the end of follow-up. We developed a data augmentation Bayesian framework to ascertain how age, isolation and BNT162b2 vaccination with more than 7 days after the 2nd dose impacted household transmission of SARS-CoV-2. Findings 210 households with 215 index cases were enrolled. 269 out of 687 (39%) household contacts developed a SARS-CoV-2 infection. Of those, 170 (63%) developed symptoms. Children below 12 years old were less susceptible than adults/teenagers (Relative Risk RR=0.50, 95% Credible Interval CI 0.32-0.79). Vaccination reduced the risk of infection among adults/teenagers (RR=0.19, 95% CI 0.07-0.40). Isolation reduced the risk of infection of unvaccinated adult/teenager (RR=0.11, 95% CI 0.05-0.19) and child contacts (RR=0.16, 95% CI 0.07-0.31) compared to unvaccinated adults/teenagers that did not isolate. Infectivity was significantly reduced in vaccinated cases (RR=0.22, 95% CI 0.06-0.70). Interpretation Within households, vaccination reduces both the risk of infection and of transmission if infected. When contacts were not vaccinated, isolation also led to important reductions in the risk of transmission. Vaccinated contacts might reduce their risk of infection if they isolate, although this requires confirmation with additional data. Funding Sheba Medical Center.

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Methicillin-ResistantStaphylococcus AureusCarriage Among Patients After Hospital Discharge

Infection Control and Hospital Epidemiology ◽

10.1086/502592 ◽

2005 ◽

Vol 26 (7) ◽

pp. 629-633 ◽

Cited By ~ 31

Author(s):

Menno R. Vriens ◽

Hetty E. M. Blok ◽

Ada C. M. Gigengack-Baars ◽

Ellen M. Mascini ◽

Chris van der Werken ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Hospital Discharge ◽

Medical Center ◽

Eradication Therapy ◽

Infect Control Hosp ◽

The University ◽

Mrsa Colonization

AbstractBackground and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)

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Fatality of Staphylococcus aureus infections in a Greek university hospital: role of inappropriate empiric treatment, methicillin resistance, and toxin genes’ presence

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-019-03742-5 ◽

2019 ◽

Vol 39 (3) ◽

pp. 443-450 ◽

Cited By ~ 1

Author(s):

Ioanna Katsarou ◽

Nefeli-Marina Paraskevopoulou ◽

Matthaios Papadimitriou-Olivgeris ◽

Nikolaos Giormezis ◽

Maria Militsopoulou ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistance ◽

University Hospital ◽

Empiric Treatment ◽

Toxin Genes

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Postcranioplasty seizures following decompressive craniectomy and seizure prophylaxis: a retrospective analysis at a single institution

Journal of Neurosurgery ◽

10.3171/2018.4.jns172519 ◽

2019 ◽

Vol 131 (3) ◽

pp. 936-940 ◽

Cited By ~ 1

Author(s):

Mun-Chun Yeap ◽

Ching-Chang Chen ◽

Zhuo-Hao Liu ◽

Po-Chuan Hsieh ◽

Cheng-Chi Lee ◽

...

Keyword(s):

Risk Factors ◽

Medical Center ◽

Multivariable Analysis ◽

Seizure Prophylaxis ◽

High Incidence ◽

Prophylactic Use ◽

Early Seizures ◽

New Onset

OBJECTIVECranioplasty is a relatively simple and less invasive intervention, but it is associated with a high incidence of postoperative seizures. The incidence of, and the risk factors for, such seizures and the effect of prophylactic antiepileptic drugs (AEDs) have not been well studied. The authors’ aim was to evaluate the risk factors that predispose patients to postcranioplasty seizures and to examine the role of seizure prophylaxis in cranioplasty.METHODSThe records of patients who had undergone cranioplasty at the authors’ medical center between 2009 and 2014 with at last 2 years of follow-up were retrospectively reviewed. Demographic and clinical characteristics, the occurrence of postoperative seizures, and postoperative complications were analyzed.RESULTSAmong the 583 patients eligible for inclusion in the study, 247 had preexisting seizures or used AEDs before the cranioplasty and 336 had no seizures prior to cranioplasty. Of these 336 patients, 89 (26.5%) had new-onset seizures following cranioplasty. Prophylactic AEDs were administered to 56 patients for 1 week after cranioplasty. No early seizures occurred in these patients, and this finding was statistically significant (p = 0.012). Liver cirrhosis, intraoperative blood loss, and shunt-dependent hydrocephalus were risk factors for postcranioplasty seizures in the multivariable analysis.CONCLUSIONSCranioplasty is associated with a high incidence of postoperative seizures. The prophylactic use of AEDs can reduce the occurrence of early seizures.

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Psychological Resilience Provides No Independent Protection From Suicidal Risk

Crisis ◽

10.1027/0227-5910/a000364 ◽

2016 ◽

Vol 37 (2) ◽

pp. 130-139 ◽

Cited By ~ 9

Author(s):

Danica W. Y. Liu ◽

A. Kate Fairweather-Schmidt ◽

Richard Burns ◽

Rachel M. Roberts ◽

Kaarin J. Anstey

Keyword(s):

Risk Factors ◽

Well Being ◽

Current Status ◽

Psychological Resilience ◽

Cross Sectional ◽

Life Project ◽

Resilience Factors ◽

First Time

Abstract. Background: Little is known about the role of resilience in the likelihood of suicidal ideation (SI) over time. Aims: We examined the association between resilience and SI in a young-adult cohort over 4 years. Our objectives were to determine whether resilience was associated with SI at follow-up or, conversely, whether SI was associated with lowered resilience at follow-up. Method: Participants were selected from the Personality and Total Health (PATH) Through Life Project from Canberra and Queanbeyan, Australia, aged 28–32 years at the first time point and 32–36 at the second. Multinomial, linear, and binary regression analyses explored the association between resilience and SI over two time points. Models were adjusted for suicidality risk factors. Results: While unadjusted analyses identified associations between resilience and SI, these effects were fully explained by the inclusion of other suicidality risk factors. Conclusion: Despite strong cross-sectional associations, resilience and SI appear to be unrelated in a longitudinal context, once risk/resilience factors are controlled for. As independent indicators of psychological well-being, suicidality and resilience are essential if current status is to be captured. However, the addition of other factors (e.g., support, mastery) makes this association tenuous. Consequently, resilience per se may not be protective of SI.

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A Narrative Review of Early Oral Stepdown Therapy for the Treatment of Uncomplicated Staphylococcus aureus Bacteremia: Yay or Nay?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa151 ◽

2020 ◽

Vol 7 (6) ◽

Author(s):

Michael Dagher ◽

Vance G Fowler ◽

Patty W Wright ◽

Milner B Staub

Keyword(s):

Staphylococcus Aureus ◽

Hospital Readmission ◽

Potential Role ◽

Review Article ◽

Narrative Review ◽

Oral Antibiotics ◽

Staphylococcus Aureus Bacteremia ◽

Complete Treatment

Abstract Historically, intravenous (IV) antibiotics have been the cornerstone of treatment for uncomplicated Staphylococcus aureus bacteremia (SAB). However, IV antibiotics are expensive, increase the rates of hospital readmission, and can be associated with catheter-related complications. As a result, the potential role of oral antibiotics in the treatment of uncomplicated SAB has become a subject of interest. This narrative review article aims to summarize key arguments for and against the use of oral antibiotics to complete treatment of uncomplicated SAB and evaluates the available evidence for specific oral regimens. We conclude that evidence suggests that oral step-down therapy can be an alternative for select patients who meet the criteria for uncomplicated SAB and will comply with medical treatment and outpatient follow-up. Of the currently studied regimens discussed in this article, linezolid has the most support, followed by fluoroquinolone plus rifampin.

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Abstract W P21: Should We Perform Thrombectomy In Patients With Wake-up Strokes? A Case Series Using Ct Perfusion For Patient Selection

Stroke ◽

10.1161/str.46.suppl_1.wp21 ◽

2015 ◽

Vol 46 (suppl_1) ◽

Author(s):

Gabriel Vidal ◽

James Milburn ◽

Garrett Bennett ◽

Vivek Sabharwal ◽

Mustafa Al Hasan

Keyword(s):

Risk Factors ◽

Ct Perfusion ◽

Medical Center ◽

Case Series ◽

Stroke Severity ◽

Vessel Occlusion ◽

Single Center Experience ◽

Aspiration Technique ◽

Group 2

Background and objectives: Approximately 25% of patients who present with acute ischemic stroke are wake-up strokes. These patients are often not treated with IV thrombolytics because of unclear onset of symptoms. Little data exists on endovascular therapy as acute treatment for this population, particularly with an aspiration technique. The objective of this study is to compare outcomes of patients who presented with wake-up strokes due to large vessel occlusion treated with neuroendovascular procedures versus those who received conservative treatment, based on a 2-year (2012-2013), single center experience at Ochsner Medical Center in New Orleans, LA. Method: 24 consecutive patients, who presented with wake-up strokes, were outside the IV tPA window, and had both CTA confirmed intracranial LVO and CT-perfusion data upon arrival to our institution were retrospectively studied. Patients with hemorrhages, tandem lesions, or high-grade carotid stenosis were excluded from this analysis. Decision to perform endovascular treatment was made by the vascular neurologist and neuro-interventionalist based on stroke severity and CTA/perfusion data. Patients in group 1 (n = 8) underwent endovascular revascularization procedures; patients in group 2 (n = 16) were treated conservatively (medical management alone). Presentation NIHSS, risk factors, mortality, discharge NIHSS, discharge mRS, and follow up mRS were compared. Results: There were no statistical differences in patient population regarding age, gender, and risk factors. There was no statistical difference in their initial NIHSS (16.8 vs. 21.8, p=0.05162), or mortality (0% vs 21%, pr=0.262). The two groups were statistically different in their discharge NIHSS (7.25 vs 21.81, p<0.00045), discharge mRS (2 vs 5, p<0.00001), clinic follow up mRS (1.37 vs 4.94, p<0.00001), and good outcome at discharge (mRS 0-2)(75% vs 0%, pr<0.0002). Conclusion: Patients with wake-up strokes, LVO, and favorable CT-perfusion data who underwent neuroendovascular reperfusion treatment had significantly better outcomes in our population, despite similar stroke severity at presentation. This suggests that with careful selection, neuroendovascular therapy for wake-up strokes may lead to improved outcomes.

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Methicillin-resistant Staphylococcus aureus bloodstream infection: risk factors and clinical outcome in non-intensive-care units

Revista da Sociedade Brasileira de Medicina Tropical ◽

10.1590/s0037-86822012000200010 ◽

2012 ◽

Vol 45 (2) ◽

pp. 189-193 ◽

Cited By ~ 4

Author(s):

Karinne Spirandelli Carvalho Naves ◽

Natália Vaz da Trindade ◽

Paulo Pinto Gontijo Filho

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Bloodstream Infection ◽

Antimicrobial Agents ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistance ◽

Diffusion Method ◽

Disk Diffusion Method ◽

Methicillin Resistant ◽

Staphylococcus Aureus Bloodstream Infection

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is spread out in hospitals across different regions of the world and is regarded as the major agent of nosocomial infections, causing infections such as skin and soft tissue pneumonia and sepsis. The aim of this study was to identify risk factors for methicillin-resistance in Staphylococcus aureus bloodstream infection (BSI) and the predictive factors for death. METHODS: A retrospective cohort of fifty-one patients presenting bacteraemia due to S. aureus between September 2006 and September 2008 was analysed. Staphylococcu aureus samples were obtained from blood cultures performed by clinical hospital microbiology laboratory from the Uberlândia Federal University. Methicillinresistance was determined by growth on oxacillin screen agar and antimicrobial susceptibility by means of the disk diffusion method. RESULTS: We found similar numbers of MRSA (56.8%) and methicillin-susceptible Staphylococcus aureus (MSSA) (43.2%) infections, and the overall hospital mortality ratio was 47%, predominantly in MRSA group (70.8% vs. 29.2%) (p=0.05). Age (p=0.02) was significantly higher in MRSA patients as also was the use of central venous catheter (p=0.02). The use of two or more antimicrobial agents (p=0.03) and the length of hospital stay prior to bacteraemia superior to seven days (p=0.006) were associated with mortality. High odds ratio value was observed in cardiopathy as comorbidity. CONCLUSIONS: Despite several risk factors associated with MRSA and MSSA infection, the use of two or more antimicrobial agents was the unique independent variable associated with mortality.

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