Multicenter, Prospective Surveillance Study of Staphylococcus aureus Nasal Colonization in 28 Italian Intensive Care Units: The ISABEL Study

2011 ◽  
Vol 32 (2) ◽  
pp. 193-197 ◽  
Author(s):  
Pierluigi Viale ◽  
Giovanni Gesu ◽  
Gaetano Privitera ◽  
Biagio Allaria ◽  
Nicola Petrosillo ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Invasive Disease ◽  
Invasive Infection ◽  
Icu Admission ◽  
Increased Risk ◽  
Mrsa Colonization ◽  
The Relationship ◽  
Colonization Status

The role of methicillin-resistant Staphylococcus aureus (MRSA) colonization as a predictor of invasive disease in intensive care unit (ICU) patients was established many years ago. The role of mefhicillin-susceptible Staphylococcus aureus (MSSA) colonization is more debated, although in a recent report patients who were carriers of MRSA or MSSA at ICU admission were found to be at increased risk. Whether carriage at ICU admission involves a higher risk of invasive infection than carriage acquired during an ICU stay has not been established. We report the results of a study aimed at estimating the frequency of S. aureus (MRSA and MSSA) colonization at admission and at discharge in patients admitted to several ICUs in Italy and at estimating the relationship between colonization status and infection by S. aureus.

scholarly journals 855. Significance of Invasive Infections due to Methicillin Sensitive Staphylococcus aureus in the neonatal population

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S468-S468
Author(s):  
Mariawy Riollano ◽  
Deena Altman ◽  
shanna kowalsky ◽  
Stephanie Pan
Keyword(s):  
Staphylococcus Aureus ◽  
Clinical Characteristics ◽  
Invasive Disease ◽  
Control Measures ◽  
Invasive Infection ◽  
Single Center ◽  
Infection Control Measures ◽  
Invasive Infections ◽  
Mrsa Colonization ◽  
Neonatal Population

Abstract Background Staphylococcus aureus is a well-known cause of hospital acquired infections. Methicillin resistant staphylococcus aureus (MRSA) colonization is a recognized risk factor for invasive infections. The neonatal population in the intensive care unit (NICU) is particularly vulnerable to these types of infections, resulting in high mortality and morbidity. However, only scant data is available to establish the risk for invasive disease in patients with Methicillin sensitive staphylococcus aureus (MSSA). As a result, surveillance and prevention strategies are only address for MRSA colonization. Here, we describe the clinical characteristics of S. aureus colonized patients identified in late 2018 during transmission events in a single center NICU. As a result of the targeted surveillance investigation for MRSA infection control measures, S. aureus colonization was stratified, and we were able to compare the differences in invasive disease between MRSA and MSSA. Methods This is a retrospective chart review of the 47 colonized patients identified during October 2018- January 2019 SA transmission events in single center NICU. Risk factors, clinical characteristics, and the hospital course of these cases, including the proportion of invasive illness were reviewed. Results We found that most clinical characteristic, risk factors, and hospital course were the same between MRSA and MSSA colonized infants (p values > 0.05). Additionally, there was no difference in the proportion of invasive infection between MRSA and MSSA colonized patients (p value > 0.05). The type of invasive infections identified were SSTI, bacteremia, and osteomyelitis. Conclusion The proportion of invasive infection was the same in MSSA and MRSA colonized patients. This data provides us with supportive material for future recommendations of infection control measures for MSSA colonized patients. Disclosures All Authors: No reported disclosures

scholarly journals A Systematic Literature Review and Meta-Analysis of Factors Associated with Methicillin-ResistantStaphylococcus aureusColonization at Time of Hospital or Intensive Care Unit Admission

2013 ◽  
Vol 34 (10) ◽  
pp. 1077-1086 ◽  
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Samantha J. Eells ◽  
Eric Cui ◽  
Susan S. Huang
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
High Risk ◽  
Hospital Admission ◽  
Systematic Evaluation ◽  
Factors Associated ◽  
Icu Admission ◽  
Increased Risk ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Screening for methicillin-resistantStaphylococcus aureus(MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.Design.We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.Results.We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n= 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3–4.7];P<.01), nursing home exposure (OR, 3.8 [95% CI, 2.3–6.3];P< .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2–15.1];Clostridium difficileinfection: OR, 3.4 [95% CI, 2.2–5.3]; vancomycin-resistantEnterococcicarriage: OR, 3.1 [95% CI, 2.5–4.0];P< .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure;P< .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6–1.8];P= .87).Conclusions.MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.

scholarly journals Effectiveness of an Alcohol-Based Nasal Antiseptic in Reducing MRSA Bacteremia in an Adult Intensive Care Population

2020 ◽  
Vol 41 (S1) ◽  
pp. s206-s206
Author(s):  
Lauren Reeves ◽  
Lisa Barton ◽  
Michelle Nash ◽  
Jennifer Williams ◽  
Don Guimera ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Tertiary Care ◽  
Effective Alternative ◽  
Invasive Infection ◽  
Patient Acuity ◽  
Admission Rates ◽  
Increased Risk ◽  
Similar Patient ◽  
Baseline Incidence

Background: Hospitalized patients are at an increased risk of invasive infection with Staphylococcus aureus when colonized with the bacteria on admission. Rates of methicillin-resistant Staphylococcus aureus (MRSA) bacteremia are directly correlated with overall patient acuity, placing patients in intensive care areas at greatest risk. Universal decolonization with nasal antibiotic ointments has been shown to reduce the incidence of invasive MRSA in critically ill patients; however, debate remains regarding the long-term efficacy of this strategy and the possibility of developing antimicrobial resistance. An alcohol-based nasal antimicrobial may be an effective alternative. This study evaluated the effectiveness of a twice daily alcohol-based product in reducing the rate of MRSA bacteremia in an academic tertiary-care adult intensive care setting. Methods: Our study was an observational design with retrospective and prospective cohorts each consisting of 61 critical care beds. The baseline incidence of MRSA bacteremia was determined from a 7-month period preceding the implementation of the nasal antimicrobial. At implementation, each admission received an electronic order for an alcohol-based nasal antiseptic that was applied twice daily during the intensive care stay. The primary outcome was the incidence of MRSA bacteremia in each group. MRSA bacteremia was defined by the CDC NHSN criteria after review by an infection prevention nurse. The 2 test was used to compare the rates between the 2 groups, and P < .005 was considered significant. Results: The study periods contained similar patient days, with 12,475 in the retrospective group and 12,733 in the prospective group. The rate of MRSA bacteremia in the retrospective cohort was 0.2404 compared to 0 in the prospective cohort. This rate change was statistically significant, with P < .0001. Conclusions: The alcohol-based nasal antiseptic was effective in reducing healthcare-onset MRSA bacteremia in this intensive care population. This approach may be a safe and effective alternative to nasal antibiotic ointment that avoids antibiotic resistance risks.Funding: NoneDisclosures: None

scholarly journals Methicillin-resistant Staphylococcus aureus nasal colonization and infection in an intensive care unit of a university hospital in China

2018 ◽  
Vol 46 (9) ◽  
pp. 3698-3708 ◽  
Author(s):  
Fu Qiao ◽  
Wenzhi Huang ◽  
Lin Cai ◽  
Zhiyong Zong ◽  
Weijia Yin
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Mainland China ◽  
Methicillin Resistant ◽  
Icu Admission ◽  
Icu Stay ◽  
Nasal Swabs ◽  
Mrsa Colonization

Objective This study was performed to determine the prevalence and risk factors associated with nasal methicillin-resistant Staphylococcus aureus (MRSA) colonization upon intensive care unit (ICU) admission and during the ICU stay in mainland China. Methods A prospective observational study was performed in a 50-bed general ICU of a 4300-bed teaching hospital in China from 2011 to 2013. Nasal swabs for MRSA detection were obtained upon ICU admission and at discharge for patients having stayed in the ICU for longer than 3 days. Results In total, 115 patients (4.1%; 95% confidence interval [CI], 3.4–4.9) were already colonized with MRSA on ICU admission, and another 185 patients (10.7%; 95% CI, 9.3–12.2) acquired MRSA during their ICU stay. Development of an MRSA infection was significantly more likely in patients with than without MRSA colonization on ICU admission (odds ratio [OR], 2.8; 95% CI, 1.1–7.3). Patients who acquired MRSA had significantly prolonged lengths of stay in the ICU (23.3 days) and higher hospital bills (135,171 RMB; about 19,590 USD) than those who tested negative for MRSA. Conclusion The MRSA colonization rate among ICU patients in mainland China is high. Patients with MRSA-positive nasal swabs are more likely to develop MRSA infections.

scholarly journals 1772. Vancomycin-Resistant Enterococcus Alters the Gastrointestinal Microbiome in Critically Ill Patients

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S66-S66
Author(s):  
Edward Cuaresma ◽  
Monica Laszkowska ◽  
Stephania Stump ◽  
Dagmara Moscoso ◽  
David Chong ◽  
...  
Keyword(s):  
Critically Ill ◽  
Relative Abundance ◽  
Critically Ill Patients ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Icu Admission ◽  
Increased Risk ◽  
Rectal Colonization ◽  
The Relationship ◽  
Colonization Status

Abstract Background In critically ill patients, rectal colonization with VRE is associated with an increased risk for nosocomial infection or death. In mice, fecal transplantation of Blautia producta directly inhibits VRE growth and leads to clearance of VRE. We performed a prospective, intensive care unit (ICU)-based study to evaluate the relationship between B. producta and VRE. We also sought to determine the relationship between VRE, MRSA, and other common MDR bacteria. Methods This study included 97 adults newly admitted to the ICU between February 2015 and June 2016. Rectal swabs were obtained at time of ICU admission and 72 hours later. VRE rectal colonization status was determined categorically for each sample by culture on selective media. Specimens were also cultured for methicillin-resistant Staphylococcus aureus (MRSA) and for MDR Gram-negatives, defined as those with nonsusceptibility to 3 or more antibiotic classes. 16S rRNA gene sequencing was performed and the relative abundance was calculated for B. producta. Differentially abundant bacteria taxa between VRE positive and VRE negative specimens were assessed using linear discriminant analysis effect size (LefSe) analysis. Results Among the 97 patients, 7 (7.2%) were colonized with VRE at the time of ICU admission and 3 (3.3%) of the remaining patients became colonized 72 hours later. The microbiome composition differed significantly when accounting for VRE colonization status. The relative abundance of B. producta was 140-fold higher in VRE-negative compared with VRE-positive samples (0.0012% vs. 8.48 × 10–6%, P = 0.03). On LefSe analysis, there was also significantly lower differential abundance of B. producta when VRE was present (LDA score 4.65). The presence of VRE in culture was significantly associated with the co-presence of MRSA (23.5% co-colonized if VRE positive vs. 8.4% if VRE negative, P = 0.046) but not with the copresence of MDR Gram-negative bacteria (29.4% if cocolonized if VRE positive vs. 34.3% if VRE negative, P = 0.68). Conclusion In this ICU cohort, rectal colonization with VRE was inversely associated with the putatively protective organism B. producta. VRE was associated with rectal co-colonization with MRSA but not with MDR Gram-negative bacteria. B. producta may have promise as a probiotic designed to prevent VRE colonization. Disclosures All authors: No reported disclosures.

Clinical and Economic Impact of Methicillin-Resistant Staphylococcus aureus Colonization or Infection on Neonates in Intensive Care Units

2010 ◽  
Vol 31 (2) ◽  
pp. 177-182 ◽  
Author(s):  
Xiaoyan Song ◽  
Eli Perencevich ◽  
Joseph Campos ◽  
Billie L. Short ◽  
Nalini Singh
Keyword(s):  
Staphylococcus Aureus ◽  
Cohort Study ◽  
Intensive Care ◽  
Length Of Stay ◽  
Economic Impact ◽  
Mortality Risk ◽  
Hospital Charges ◽  
Methicillin Resistant ◽  
Control Subjects ◽  
Mrsa Colonization

Objective.The rising incidence and mortality of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in children has become a great concern. This study aimed to determine the clinical and economic impact of MRSA colonization or infection on infants and to measure excess mortality, length of stay, and hospital charges attributable to MRSA.Design.This is a retrospective cohort study.Setting and Patients.The study included infants admitted to a level III-IV neonatal intensive care unit from September 1, 2004, through March 31, 2008.Methods.A time-dependent proportional hazard model was used to analyze the association between MRSA colonization or infection and mortality. The relationships between MRSA colonization or infection and length of stay and between MRSA colonization or infection and hospital charges were assessed using a matched cohort study design.Results.Of 2,280 infants, 191 (8.4%) had MRSA colonization or infection. Of 132 MRSA isolates with antibiotic susceptibility results, 106 were resistant to clindamycin and/or trimethoprim-sulfamethoxazole, thus representing a noncommunity phenotype. The mortality rate was 17.8% for patients with MRSA colonization or infection and 11.5% for control subjects. Neither MRSA colonization (hazard ratio [HR], 0.9 [95% confidence interval {CI}, 0.5-1.5]; P > .05) nor infection (HR, 1.2 [95% CI, 0.7-1.9]; P > .05) was associated with increased mortality risk. Infection caused by MRSA strains that were resistant to clindamycin and/or trimethoprim-sulfamethoxazole increased the mortality risk by 40% (HR, 1.4 [95% CI, 0.9-2.2]; P > .05), compared with the mortality risk of control subjects, but the increase was not statistically significant. MRSA infection independently increased length of stay by 40 days (95% CI, 34.2—45.6; P < .001) and was associated with an extra charge of $164,301 (95% CI, $158,712-$169,889; P < .001).Conclusions.MRSA colonization or infection in infants is associated with significant morbidity and financial burden but is not independently associated with increased mortality.

scholarly journals Low 25-Hydroxyvitamin D Levels on Admission to the Intensive Care Unit May Predispose COVID-19 Pneumonia Patients to a Higher 28-Day Mortality Risk: A Pilot Study on a Greek ICU Cohort

Nutrients ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3773
Author(s):  
Alice G. Vassiliou ◽  
Edison Jahaj ◽  
Maria Pratikaki ◽  
Stylianos E. Orfanos ◽  
Ioanna Dimopoulou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Vitamin D ◽  
Intensive Care ◽  
Critically Ill ◽  
Mortality Risk ◽  
Rank Test ◽  
Icu Admission ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D

We aimed to examine whether low intensive care unit (ICU) admission 25-hydroxyvitamin D (25(OH)D) levels are associated with worse outcomes of COVID-19 pneumonia. This was a prospective observational study of SARS-CoV2 positive critically ill patients treated in a multidisciplinary ICU. Thirty (30) Greek patients were included, in whom 25(OH)D was measured on ICU admission. Eighty (80%) percent of patients had vitamin D deficiency, and the remaining insufficiency. Based on 25(OH)D levels, patients were stratified in two groups: higher and lower than the median value of the cohort (15.2 ng/mL). The two groups did not differ in their demographic or clinical characteristics. All patients who died within 28 days belonged to the low vitamin D group. Survival analysis showed that the low vitamin D group had a higher 28-day survival absence probability (log-rank test, p = 0.01). Critically ill COVID-19 patients who died in the ICU within 28 days appeared to have lower ICU admission 25(OH)D levels compared to survivors. When the cohort was divided at the median 25(OH)D value, the low vitamin D group had an increased risk of 28-day mortality. It seems plausible, therefore, that low 25(OH)D levels may predispose COVID-19 patients to an increased 28-day mortality risk.

Role of vitamin D and sFlt-1/PlGF ratio in the development of early- and late-onset preeclampsia

2015 ◽  
Vol 53 (7) ◽  
Author(s):  
Indira Álvarez-Fernández ◽  
Belén Prieto ◽  
Verónica Rodríguez ◽  
Yolanda Ruano ◽  
Ana I. Escudero ◽  
...  
Keyword(s):  
Vitamin D ◽  
Late Onset ◽  
Tertiary Care ◽  
Care Hospital ◽  
Hydroxyvitamin D ◽  
Increased Risk ◽  
25 Hydroxyvitamin D ◽  
The Relationship ◽  
Plgf Ratio

AbstractThe imbalanced production of placental biomarkers and vitamin D deficiency have been proposed as risk factors for the development of preeclampsia (PE). However, little is known about the relationship between them and their role in early- versus late-onset PE. The objectives were to assess the role of 25-hydroxyvitamin D [25(OH)D] concentrations and the soluble fms-like tyrosine kinase 1 (sFlt-1) to placental growth factor (PlGF) ratio in the development of early- and late-onset PE; and to evaluate the relationship between 25(OH)D and the biomarkers.A retrospective, full-blinded cohort study was conducted at the Obstetric Emergency Service of a tertiary care hospital. Pregnant women (n=257) attending obstetric triage with suspicion of PE were included. sFlt-1, PlGF and 25(OH)D concentrations were measured by electrochemoluminescence (ECLIA) immunoassay and pregnancy outcome (development of PE) was registered from patients records.PE women showed lower 25(OH)D concentrations at clinical presentation than non-PE women (median: 35.0 nmol/L and 39.6 nmol/L, respectively; p=0.027). Women with 25(OH)D levels <50 nmol/L experienced an increased risk of developing late-onset PE [odds ratio (OR) 4.6, 95% confidence interval (CI) 1.4–15], but no association was found for early-onset PE. However, a sFlt-1/PlGF ratio above the corresponding cutpoints increased the risk of developing both early- and late-onset PE [ORs 58 (95% CI 11–312) and 12 (95% CI 5.0–27), respectively]. No association was found between 25(OH)D levels and sFlt-1/PlGF ratio.Low vitamin D status in women with suspected late-onset PE increases the risk of imminent development of the disease.

Factors Associated with Risk and Prognosis of Intensive Care Unit Admission in Patients with Acute Myeloid Leukemia: A Danish Nationwide Cohort Study

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4783-4783
Author(s):  
Cecilie Velsoe Maeng ◽  
Christian Fynbo Christiansen ◽  
Kathleen Dori Liu ◽  
Lene Sofie Granfeldt Oestgaard
Keyword(s):  
Intensive Care ◽  
High Risk ◽  
Myeloid Leukemia ◽  
Risk Group ◽  
Remission Induction ◽  
First Year ◽  
Icu Patients ◽  
Icu Admission ◽  
Increased Risk ◽  
Acute Myeloid

Significance Patients with acute myeloid leukemia (AML) are at high risk of critical illness requiring admission to the intensive care unit (ICU) due to both disease- and treatment-related complications. A better understanding of risk factors for ICU admission and prognosis may help with prevention of life-threatening complications and informed decision-making when treating AML patients. Methods This study included all adult Danish AML patients, who received remission-induction chemotherapy alone or in combination with allogeneic stem cell transplantation from 2005 to 2016. The cohort was identified using the Danish Acute Leukemia Registry (DNLR) and information on ICU admission was obtained from the Danish Intensive Care Database. We examined risk of ICU admission within 1 and 3 years of diagnosis considering competing risk of death and investigated a number of possible risk factors for ICU admission. We computed 1-, 3-, and 5-year mortality from time of ICU admission and in the matched non-ICU comparison group using a risk set matching (1:1) on time since diagnosis, sex, and age. Finally, we used the pseudo-value approach to compute the relative risk (RR) of death in the ICU admitted cohort compared to the matched cohort. We adjusted for ECOG/WHO performance status (PS), year of diagnosis, cytogenetic risk group, number of comorbidities, and secondary/therapy-related AML. Results A total of 1383 AML patients were included in the study. The median follow-up time was 1.65 (IQR: 0.60-4.36) years. The risk of ICU admission within 1 year of AML diagnosis was 22.7%, and the risk within 3 years was 28.1%. Median time to ICU was 59 (IQR: 15-272) days. Male sex was associated with increased risk of ICU admission after 1 year (adjusted RR: 1.26, 95% CI: 1.01-1.57) and PS >1 was associated with an increased risk after both 1 year (adjusted RR: 1.74, 95% CI: 1.33-1.30) and 3 years (adjusted RR: 1.54, 95% CI: 1.22-1.96). Other factors listed in Table 1 (age, comorbidity, cytogenetic risk group, secondary or therapy-related AML, and year of diagnosis) were not associated with increased risk of ICU admission. In AML patients admitted to the ICU, the 1-year mortality from time of ICU admission was 69.2%, compared to a 1-year mortality rate of 31.0% in the matched non-ICU patients (adjusted RR: 3.25, 95% CI: 2.56-4.12). Long-term mortality was increased in ICU patients; 3-year mortality was 82.1% compared to 49.7% (adjusted RR: 2.43, 95% CI: 1.97-3.01), and the 5-year mortality was 83.1% compared to 60.6%, (adjusted RR: 2.12, 95% CI: 1.70-2.66). Conclusion In this national population-based cohort study, more than one fourth of AML patients treated with remission-induction chemotherapy were admitted to an ICU within 3 years of diagnosis with the majority of ICU admissions occurring within the first year. ICU admission was associated with high mortality, especially within the first year after admission. The risk of mortality decreased over time but remained increased 3 and 5 years after admission compared to the matched cohort. Early monitoring and management of high-risk patients may be effective in preventing ICU admissions and PS may serve as a possible tool to identify patients at high risk of ICU admission. Disclosures No relevant conflicts of interest to declare.

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