scholarly journals Development and Validation of a Clinical Prediction Rule to Predict Transmission of Methicillin-Resistant Staphylococcus aureus in Nursing Homes

2018 ◽  
Vol 188 (1) ◽  
pp. 214-221
Author(s):  
Sarah S Jackson ◽  
Alison D Lydecker ◽  
Laurence S Magder ◽  
Mary-Claire Roghmann
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Homes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Nursing Home Residents ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Veterans Affairs ◽  
Clinical Prediction ◽  
Contact Precautions ◽  
Mrsa Colonization

Abstract The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents is high. Health-care workers (HCWs) often serve as a vector in MRSA transmission. The ability to identify residents who are likely to transmit MRSA to HCWs’ hands and clothing during clinical care is important so that infection control measures, such as Contact Precautions, can be employed. Using data on demographic and clinical characteristics collected from residents of community nursing homes in Maryland and Michigan between 2012 and 2014, we developed a clinical prediction rule predicting the probability of MRSA transmission to HCWs’ gowns. We externally validated this model in a cohort of Department of Veterans Affairs nursing home residents from 7 states between 2012 and 2016. The prediction model, which included sex, race, resident dependency on HCWs for care, the presence of any medical device, diabetes mellitus, and chronic skin breakdown, showed good performance (C statistic = 0.70; sensitivity = 76%, specificity = 49%) in the development set. The decision curve analysis indicated that this model has greater clinical utility than use of a nares surveillance culture for MRSA colonization, which is current clinical practice for placing hospital inpatients on Contact Precautions. The prediction rule demonstrated less utility in the validation cohort, suggesting that a separate rule should be developed for residents of Veterans Affairs nursing homes.

scholarly journals What Is the Primary Driver of Preoperative Vancomycin Use? It’s Not Methicillin-resistant Staphylococcus aureus—or Allergy

2020 ◽  
Vol 71 (10) ◽  
pp. 2732-2735
Author(s):  
Judith M Strymish ◽  
William O’ Brien ◽  
Kamal Itani ◽  
Kalpana Gupta ◽  
Westyn Branch-Elliman
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Veterans Affairs ◽  
Common Reason ◽  
Surgical Prophylaxis ◽  
Surgical Specialty ◽  
Methicillin Resistant ◽  
Primary Driver ◽  
Mrsa Colonization

Abstract Factors driving vancomycin surgical prophylaxis are poorly understood. In a national Veterans Affairs cohort with manually validated data, surgical specialty (cardiac, orthopedics) and perception of high facility methicillin-resistant Staphylococcus aureus (MRSA) prevalence—not MRSA colonization—were the primary drivers of prescribing. A β-lactam allergy was the second most common reason. These data may inform perioperative stewardship.

Risk Factors for Methicillin-Resistant Staphylococcus Aureus Carriage in Residents of German Nursing Homes

2002 ◽  
Vol 23 (9) ◽  
pp. 511-515 ◽  
Author(s):  
H. von Baum ◽  
C. Schmidt ◽  
D. Svoboda ◽  
O. Bock-Hensley ◽  
Constanze Wendt
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Nursing Home ◽  
Nursing Homes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Significant Risk ◽  
Nursing Home Residents ◽  
Medium Size ◽  
Prevalence Survey ◽  
Methicillin Resistant

Objectives:To determine the prevalence of and the risk factors for methicillin-resistant Staphylococcus aureus (MRSA) carriage in nursing home residents in the Rhine-Neckar region of southern Germany.Design:Point-prevalence survey.Setting:Forty-seven nursing homes in the region.Participants:All residents of the approached nursing homes who agreed to participate.Methods:After informed consent was obtained, all participants had their nares swabbed, some personal data collected, or both. All swabs were examined for growth of MRSA All S. aureus isolates underwent oxacillin susceptibility testing and polymerase chain reaction for demonstration of the meek gene. All MRSA isolates were typed using pulsed-field gel electrophoresis after digestion with SmaI.Results:Swabs from 3,236 nursing home residents yielded 36 MRSA strains, contributing to a prevalence rate of 1.1%. Significant risk factors for MRSA carriage in the multivariate analysis were the presence of wounds or urinary catheters, limited mobility, admission to a hospital during the preceding 3 months, or stay in a medium-size nursing home. One predominant MRSA strain could be detected in 30 of the 36 MRSA carriers.Conclusions:The prevalence of MRSA in German nursing homes is still low. These residents seemed to acquire their MRSA in the hospital and transfer it to their nursing home. Apart from well-known risk factors for the acquisition of MRSA we identified the size of the nursing home as an independent risk factor. This might be due to an increased use of antimicrobials in nursing homes of a certain size.

scholarly journals Derivation and validation of clinical prediction rules for reduced vancomycin susceptibility in Staphylococcus aureus bacteraemia

2012 ◽  
Vol 141 (1) ◽  
pp. 165-173 ◽  
Author(s):  
J. H. HAN ◽  
W. B. BILKER ◽  
P. H. EDELSTEIN ◽  
K. B. MASCITTI ◽  
E. LAUTENBACH
Keyword(s):  
Staphylococcus Aureus ◽  
Methicillin Resistance ◽  
Prediction Rule ◽  
Clinical Prediction Rule ◽  
Clinical Prediction ◽  
Broth Microdilution ◽  
Healthcare Associated Infection ◽  
Final Model ◽  
Individualized Management ◽  
Healthcare Associated

SUMMARYReduced vancomycin susceptibility (RVS) may lead to poor clinical outcomes in Staphylococcus aureus bacteraemia. We conducted a cohort study of 392 patients with S. aureus bacteraemia within a university health system. The association between RVS, as defined by both Etest [vancomycin minimum inhibitory concentration (MIC) >1·0 μg/ml] and broth microdilution (vancomycin MIC ⩾1·0 μg/ml), and patient and clinical variables were evaluated to create separate predictive models for RVS. In total, 134 (34·2%) and 73 (18·6%) patients had S. aureus isolates with RVS by Etest and broth microdilution, respectively. The final model for RVS by Etest included methicillin resistance [odds ratio (OR) 1·51, 95% confidence interval (CI) 0·97–2·34], non-white race (OR 0·67, 95% CI 0·42–1·07), healthcare-associated infection (OR 0·56, 95% CI 0·32–0·96), and receipt of any antimicrobial therapy ⩽30 days prior to the culture date (OR 3·06, 95% CI 1·72–5·44). The final model for RVS by broth microdilution included methicillin resistance (OR 2·45, 95% CI 1·42–4·24), admission through the emergency department (OR 0·54, 95% CI 0·32–0·92), presence of an intravascular device (OR 2·24, 95% CI 1·30–3·86), and malignancy (OR 0·51, 95% CI 0·26–1·00). The availability of an easy and rapid clinical prediction rule for early identification of RVS can be used to help guide the timely and individualized management of these serious infections.

scholarly journals Risk Factors for Persistent Methicillin-Resistant Staphylococcus aureus Colonization in Children with Multiple Intensive Care Unit Admissions

2013 ◽  
Vol 34 (7) ◽  
pp. 748-750 ◽  
Author(s):  
Victor O. Popoola ◽  
Pranita Tamma ◽  
Nicholas G. Reich ◽  
Trish M. Perl ◽  
Aaron M. Milstone
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Mrsa Colonization

We studied methicillin-resistant Staphylococcus aureus (MRSA)-colonized children with multiple intensive care unit (ICU) admissions to assess the persistence of MRSA colonization. Our data found that children with more than 1 year between ICU admissions had a higher prevalence of MRSA colonization than the overall ICU population, which supports empirical contact precautions for children with previous MRSA colonization.

Discontinuation of Contact Precautions for Patients No Longer Colonized with Methicillin-Resistant Staphylococcus aureus

2010 ◽  
Vol 31 (05) ◽  
pp. 541-543 ◽  
Author(s):  
Holenarasipur R. Vikram ◽  
Diane G. Dumigan ◽  
Cynthia Kohan ◽  
Nancy L. Havill ◽  
Allison Tauman ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Hospital Readmission ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Number Of Patients ◽  
Mrsa Colonization ◽  
Positive Results

To reduce the number of patients with known methicillin-resistant Staphylococcus aureus (MRSA) colonization who are repeatedly placed in isolation on hospital readmission, we screened patients who had no positive results for MRSA culture in the previous 6 months. Twenty-one (21%) of 98 patients were no longer colonized and were removed from contact precautions.

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