Development of a Prediction Rule for Methicillin-ResistantStaphylococcus aureusand Vancomycin-ResistantEnterococcusCarriage in a Veterans Affairs Medical Center Population

2008 ◽  
Vol 29 (10) ◽  
pp. 969-971 ◽  
Author(s):  
Stefan Riedel ◽  
Diana Von Stein ◽  
Kelly Richardson ◽  
Joann Page ◽  
Sara Miller ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Admission ◽  
Medical Center ◽  
Prediction Rule ◽  
Veterans Affairs ◽  
Methicillin Resistant ◽  
History Of ◽  
Vancomycin Resistant

A history of hospital admission in the prior year was the most sensitive predictor of methicillin-resistantStaphylococcus aureusor vancomycin-resistantEnterococcuscolonization at admission to a Veterans Affairs Medical Center (VAMC) but missed more than one-third of carriers and required screening more than one-half of admitted patients.

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.

Perception vs Reality: Methicillin-Resistant Staphylococcus aureus Carriage Among Healthcare Workers at a Veterans Affairs Medical Center

2015 ◽  
Vol 37 (1) ◽  
pp. 110-112 ◽  
Author(s):  
Nora E. Colburn ◽  
Jennifer Cadnum ◽  
Elizabeth Flannery ◽  
Shelley Chang ◽  
Curtis J. Donskey ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Healthcare Workers ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Medical Center ◽  
Veterans Affairs ◽  
Infect Control Hosp ◽  
Prevalence Study ◽  
Methicillin Resistant ◽  
Knowledge Deficit

In a prevalence study of 209 healthcare workers, 18 (8.6%) and 13 (6.2%) carried methicillin-resistant Staphylococcus aureus in their nares or on their hands, respectively. However, 100 (62%) of 162 workers completing an associated survey believed themselves to be colonized, revealing a knowledge deficit about methicillin-resistant Staphylococcus aureus epidemiology.Infect. Control Hosp. Epidemiol. 2015;37(1):110–112

scholarly journals In VitroActivity of Retapamulin and Antimicrobial Susceptibility Patterns in a Longitudinal Collection of Methicillin-Resistant Staphylococcus aureus Isolates from a Veterans Affairs Medical Center

2015 ◽  
Vol 60 (3) ◽  
pp. 1298-1303 ◽  
Author(s):  
Amanda T. Harrington ◽  
Jennifer A. Black ◽  
Jill E. Clarridge
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Agents ◽  
Medical Center ◽  
Alternative Therapy ◽  
Puget Sound ◽  
Veterans Affairs ◽  
Methicillin Resistant ◽  
Vancomycin Mics ◽  
Level Resistance

Mupirocin is a topical antimicrobial used to decolonize patients who carry methicillin-resistantStaphylococcus aureus(MRSA), and the topical agent retapamulin may be a potential alternative therapy. The goal of this study was to determine thein vitroactivity of retapamulin as well as a panel of 15 antimicrobial agents, including mupirocin, for 403 MRSA isolates collected longitudinally from a naive population at the Veterans Affairs Puget Sound Health Care System. The MICs for retapamulin had a unimodal distribution, ranging from 0.008 to 0.5 μg/ml. One isolate had an MIC of >16 μg/ml, was also resistant to clindamycin and erythromycin, and was recovered from the nares of a patient undergoing hemodialysis. Twenty-four isolates (6%) and 11 isolates (3%) demonstrated low-level resistance (MICs of 8 to 64 μg/ml) and high-level resistance (MICs of ≥512 μg/ml), respectively, to mupirocin. Isolates were recovered from 10 patients both before and after mupirocin therapy. Of those, isolates from 2 patients demonstrated MIC changes postmupirocin therapy; in both cases, however, strain typing demonstrated that the pre- and postmupirocin strains were different. A total of 386 isolates (96%) had vancomycin MICs of ≤1.0 μg/ml; 340 isolates (84%) were resistant to levofloxacin, 18 isolates (4.5%) were resistant to trimethoprim-sulfamethoxazole, and 135 isolates (33%) had elevated MICs of 4 μg/ml for linezolid. The baseline levels of resistance were low for mupirocin (9%) and even lower for retapamulin (0.25%) Although the use of mupirocin is currently the standard therapy for decolonization practices, the activity of retapamulin warrants its consideration as an alternative therapy in MRSA decolonization regimens.

scholarly journals Resource Burden Associated with Contact Precautions for Methicillin-Resistant Staphylococcus aureus and Vancomycin-Resistant Enterococcus: The Patient Access Managers' Perspective

2012 ◽  
Vol 33 (8) ◽  
pp. 849-852 ◽  
Author(s):  
Erica S. Shenoy ◽  
Rochelle P. Walensky ◽  
Hang Lee ◽  
Benjamin Orcutt ◽  
David C. Hooper
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Vancomycin Resistant Enterococcus ◽  
Patient Access ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Factors Influencing ◽  
History Of ◽  
Vancomycin Resistant ◽  
The Impact

We surveyed patient access managers on the impact of contact precautions (CP) for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE) on time to bed assignment, and we investigated the factors influencing infection control policies allowing for discontinuation of CP. The majority of respondents reported an increase in time to bed assignment for patients with a history of MRSA and/or VRE infection or colonization.

Mupirocin-Resistant, Methicillin-Resistant Staphylococcus aureus: Does Mupirocin Remain Effective?

2003 ◽  
Vol 24 (5) ◽  
pp. 342-346 ◽  
Author(s):  
Elaine S. Walker ◽  
Jose E. Vasquez ◽  
Roy Dula ◽  
Hollie Bullock ◽  
Felix A. Sarubbi
Keyword(s):  
Staphylococcus Aureus ◽  
Medical Center ◽  
Dna Typing ◽  
Veterans Affairs ◽  
Post Treatment ◽  
Methicillin Resistant ◽  
Control Programs ◽  
Dna Pattern ◽  
Mupirocin Ointment ◽  
High Level

AbstractObjective:To determine the efficacy of mupirocin ointment in reducing nasal colonization with mupirocin-susceptible, methicillin-resistant Staphylococcus aureus (MS MRSA) as well as mupirocin-resistant MRSA (MR MRSA).Design:Prospective evaluation in which patients colonized with MRSA were treated twice daily with 2% topical mupirocin ointment for 5 days.Setting:James H. Quillen Veterans' Affairs Medical Center.Patients:Forty hospitalized patients with two anterior nares cultures positive for MRSA within a 7-day period.Methods:Treated patients had post-treatment cultures at day 3 and weeks 1,2, and 4. Isolates underwent mupirocin-susceptibility testing and DNA typing. MRSA clearance and type turnover were assessed for isolates that were mupirocin-susceptible, low-level (LL) MR MRSA and high-level (HL) MR MRSA.Results:Post-treatment nares cultures on day 3 were negative for 78.5%, 80%, and 27.7% of patients with MS MRSA, LL-MR MRSA, and HL-MR MRSA, respectively. Sustained culture negativity at 1 to 4 weeks was more common in the MS MRSA group (91%) than in the LL-MR MRSA group (25%) or the HL-MR MRSA group (25%). Positive post-treatment cultures usually showed the same DNA pattern relative to baseline. Plasmid curing of 18 HL-MR MRSA resulted in 15 MS MRSA and 3 LL-MR MRSA.Conclusions:Mupirocin was effective in eradicating MS MRSA, but strains of MR MRSA often persisted after treatment. This appeared to reflect treatment failure rather than exogenous recolonization. MR MRSA is now more prevalent and it is appropriate to sample MRSA populations for mupirocin susceptibility prior to incorporating mupirocin into infection control programs.

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