scholarly journals Public Health Importance of Invasive Methicillin-sensitive Staphylococcus aureus Infections: Surveillance in 8 US Counties, 2016

2019 ◽  
Author(s):  
Kelly A Jackson ◽  
Runa H Gokhale ◽  
Joelle Nadle ◽  
Susan M Ray ◽  
Ghinwa Dumyati ◽  
...  
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Infection Control ◽  
Care Facility ◽  
Public Health Problem ◽  
The United States ◽  
Multivariate Logistic Regression Model ◽  
Public Health Importance ◽  
Term Care ◽  
Healthcare Associated

Abstract Background Public health and infection control prevention and surveillance efforts in the United States have primarily focused on methicillin-resistant Staphylococcus aureus (MRSA). We describe the public health importance of methicillin-susceptible S. aureus (MSSA) in selected communities. Methods We analyzed Emerging Infections Program surveillance data for invasive S. aureus (SA) infections (isolated from a normally sterile body site) in 8 counties in 5 states during 2016. Cases were considered healthcare-associated if culture was obtained >3 days after hospital admission; if associated with dialysis, hospitalization, surgery, or long-term care facility (LTCF) residence within 1 year prior; or if a central venous catheter was present ≤2 days prior. Incidence per 100 000 census population was calculated, and a multivariate logistic regression model with random intercepts was used to compare MSSA risk factors with those of MRSA. Results Invasive MSSA incidence (31.3/100 000) was 1.8 times higher than MRSA (17.5/100 000). Persons with MSSA were more likely than those with MRSA to have no underlying medical conditions (adjusted odds ratio [aOR], 2.06; 95% confidence interval [CI], 1.26–3.39) and less likely to have prior hospitalization (aOR, 0.70; 95% CI, 0.60–0.82) or LTCF residence (aOR, 0.37; 95% CI, 0.29–0.47). MSSA accounted for 59.7% of healthcare-associated cases and 60.1% of deaths. Conclusions Although MRSA tended to be more closely associated with healthcare exposures, invasive MSSA is a substantial public health problem in the areas studied. Public health and infection control prevention efforts should consider MSSA prevention in addition to MRSA.

scholarly journals 2462. Public Health Response to Contain the First Outbreak of New Delhi Metallo-β-Lactamase-Producing Klebsiella pneumoniae in Minnesota

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S852-S852
Author(s):  
Brittany VonBank ◽  
Sean O’Malley ◽  
Paula Snippes Vagnone ◽  
Mary Ellen Bennett ◽  
Tammy Hale ◽  
...  
Keyword(s):  
Public Health ◽  
United States ◽  
Infection Control ◽  
Care Facility ◽  
The United States ◽  
New Delhi ◽  
Surveillance Culture ◽  
Public Health Response ◽  
Term Care ◽  
Health Response

Abstract Background Carbapenem-resistant Enterobacteriaceae (CRE) producing the New Delhi-metallo-β-lactamase (NDM) carbapenemase are uncommon in the United States but are a serious threat for untreatable antibiotic-resistant infections. In Minnesota (MN), NDM-CRE is typically associated with receipt of healthcare abroad. We describe the public health response to contain the first outbreak of NDM-CRE in MN. Methods CRE is reportable, with isolate submission to the MN Department of Health (MDH) for MALDI-TOF identification, phenotypic carbapenemase production testing, and PCR for carbapenemase genes. On December 24, 2018, MDH identified a case of NDM-K. pneumoniae in a long-term care facility (LTCF) without travel. MDH initiated an investigation. We defined a case as having NDM-K. pneumoniae matching the outbreak PFGE pattern from a clinical or surveillance culture. Cases were identified through surveillance, point prevalence survey (PPS) rectal swab colonization testing, and PFGE at MDH. MDH collected a healthcare exposure history for all cases. A containment response occurred in any facility where a case received healthcare in the 30 days prior. Results Nine cases of clonal NDM-K. pneumoniae with specimen collection dates between December 24, 2018 and March 26, 2019 were identified; 8 were residents of LTCF A and 1 was a roommate in LTCF B of a former LTCF A resident. PPS testing of 260 healthcare contacts occurred in 6 facilities, including LTCF A, LTCF B, and 4 acute care hospitals (ACH) that accepted LTCF A transfers; 7/9 cases were identified through PPS and 2/9 cases were identified through CRE surveillance. One case from LTCF A was identified in an ACH, but PPS did not identify transmission in ACHs. MDH conducted on-site infection control assessments in 2 LTCFs, identified numerous infection control (IC) lapses at LTCF A, and provided telephone IC consultation to 4 ACHs. Conclusion Surveillance and PPS uncovered an outbreak of NDM CRE in 2 LTCFs. Patient transfers led to a regional public health response lasting several months that included IC consultation and additional PPS. Intervention to coordinate containment responses among interconnected healthcare facilities is critical to containing the spread of novel resistance mechanisms in the United States. Disclosures All authors: No reported disclosures.

scholarly journals 972. Asymptomatic Carriage of Clostridiodes difficile and Risk of Subsequent Infection

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S38-S38
Author(s):  
Katrina Espiritu ◽  
Michael Vernon ◽  
Donna Schora ◽  
Lance Peterson ◽  
Kamaljit Singh
Keyword(s):  
Care Facility ◽  
The United States ◽  
Term Care ◽  
Asymptomatic Carriers ◽  
Long Term Care Facility ◽  
Patient Demographics ◽  
Asymptomatic Carriage ◽  
Admission Screening ◽  
History Of ◽  
Healthcare Associated

Abstract Background C. difficile is one of the most common healthcare-associated infections in the United States. Studies of patients with asymptomatic carriage of toxigenic C. difficile have reported conflicting results on the risk of subsequent C. difficile infection (CDI). Older studies suggest that the risk was low and colonization may be protective. Subsequent studies indicate that asymptomatic carriers have a 6-fold greater risk of developing CDI. The aims of our study were to assess the burden of asymptomatic C. difficile carriage and risk of subsequent CDI. Methods Adult inpatients at NorthShore University HealthSystem, Illinois hospitals between August 1, 2017 and February 28, 2018 were eligible for the study. Focused admission screening of patients at high risk of C. difficile carriage was performed: (1) history of CDI or colonization, (2) prior hospitalization past 2 months, or (3) admission from a long-term care facility. A rectal swab was collected and tested using the cobas® Cdif Test (Roche) real-time PCR. The development of hospital onset CDI (HO-CDI) in colonized patients was monitored prospectively for at least 2 months. HO-CDI testing of colonized patients was performed using the Cepheid GeneXpert RT-PCR. HO-CDI was defined as patients hospitalized for at least 72 hours with 3 or more episodes of diarrhea/24 hours, in the absence of other potential causes of diarrhea. Patient demographics were collected using a standardized form and data analyzed using VassarStats. Results There were 6,104 patients enrolled in the study and 528 (8.7%) were positive on admission for toxigenic C. difficile carriage. The mean age of colonized patients was 75.5 years (range 24–103) and 56.4% (298 patients) were females. Of 528 colonized patients, 21 (4%) had a positive CDI test. A total of 7 patients (1.3%) developed HO-CDI. Mean time to positive HO-CDI was 46.1 days (range 5–120 days). Of 5,576 patients that were negative for C difficile carriage on admission, 14 (0.3%) patients developed HO-CDI. The relative risk of HO-CDI was 5.28 (95% CI: 2.14–13.03, P = 0.05). Conclusion We found that 8.7% of at-risk admissions were asymptomatic toxigenic C. difficile carriers. While only 1.3% developed HO-CDI, asymptomatic carriers had a 5 times higher risk of subsequent CDI compared with non-carriers. Disclosures All authors: No reported disclosures.

scholarly journals The first isolation of Panton-Valentine leukocidin (PVL) positive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in Russia

2007 ◽  
Vol 12 (11) ◽  
Author(s):  
T Baranovich ◽  
V Potapov ◽  
T Yamamoto
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Public Health Problem ◽  
The United States ◽  
Important Public Health Problem ◽  
Methicillin Resistant ◽  
Important Public Health ◽  
Panton Valentine Leukocidin ◽  
Valentine Leukocidin

Since the first report of pediatric deaths in 1997-1999 in the United States, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) has become an increasingly important public health problem worldwide.

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.

scholarly journals Multifacility Outbreak of NDM/OXA-23–Producing Acinetobacter baumannii in California, 2020–2021

2021 ◽  
Vol 1 (S1) ◽  
pp. s79-s79
Author(s):  
Diana Holden ◽  
Tisha Mitsunaga ◽  
Denise Sanford ◽  
Tanya Fryer ◽  
June Nash ◽  
...  
Keyword(s):  
Public Health ◽  
Antibiotic Resistance ◽  
Infection Control ◽  
Acinetobacter Baumannii ◽  
The United States ◽  
Infection Prevention And Control ◽  
Care Hospital ◽  
Public Health Response ◽  
Term Care ◽  
Healthcare Network

Background: NDM/OXA-23 carbapenemase-producing Acinetobacter baumannii isolates have been reported worldwide, but rarely in the United States. A California acute-care hospital (ACH) A identified 3 patients with pan-nonsusceptible A. baumannii during May–June 2020, prompting a public health investigation to prevent further transmission among the regional healthcare network. Methods: A clinical isolate was defined as NDM/OXA-23–producing A. baumannii from a patient at ACH A or B, or an epidemiologically linked patient identified through colonization screening during May 2020–January 2021. ACHs A and B are sentinel sites for carbapenem-resistant A. baumannii surveillance through the Antibiotic Resistance Laboratory Network (AR Lab Network), where isolates are tested for carbapenemase genes. The California Department of Public Health with 3 local health departments conducted an epidemiological investigation, contact tracing, colonization screening, and whole-genome sequencing (WGS). Results: In total, 11 cases were identified during May 2020–January 2021, including 3 cases at ACH A during May–June 2020, and 8 additional cases during November 2020–January 2021: 5 at ACH A, 1 at ACH B, and 2 at skilled nursing facility (SNF) A. Isolates from ACHs A and B were identified through testing at the AR Lab Network. Of the 11 patients (including the index patient), 4 had exposure at SNF A, where 2 cases were identified through colonization screening. Screening conducted at ACH A and 5 other long-term care facilities (LTCFs) identified no additional cases. WGS results for the first 8 cases identified showed 2–13 single-nucleotide polymorphism differences. Antibiotic resistance genes for all isolates sequenced included NDM-1 and OXA-23. On-site assessments related to a COVID-19 outbreak conducted at ACH A identified infection control gaps. Conclusions: Hospital participation in public health laboratory surveillance allows early detection of novel multidrug-resistant organisms (MDROs), which enabled outbreak identification and public health response. A high COVID-19 burden and related changes in infection control practices have been associated with MDRO transmission elsewhere in California. This factor might have contributed to spread at ACH A and hampered earlier screening efforts at SNF A, likely leading to undetected transmission. Extensive movement of positive patients among a regional healthcare network including at least 6 ACHs and 7 LTCFs likely contributed to the prolonged duration of this outbreak. This investigation highlights the importance of enhanced novel MDRO surveillance strategies coupled with strong infection prevention and control practices as important factors in identifying outbreaks and preventing further transmission in regional networks.Funding: NoDisclosures: None

scholarly journals S. aureus and MRSA Nasal Carriage in Dental Students: A Comprehensive Approach

2021 ◽  
Vol 5 (1) ◽  
pp. 34
Author(s):  
Patrícia Cavaco-Silva ◽  
Maria Mole ◽  
Beatriz Meliço ◽  
Helena Barroso
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Infection Control ◽  
Health Problem ◽  
Sccmec Type ◽  
Public Health Problem ◽  
Nasal Carriage ◽  
Dental Students ◽  
Clinical Pathogens ◽  
Mrsa Colonization

Staphylococcus aureus and MRSA are important clinical pathogens representing a serious public health problem. This study aimed to determine the prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) nasal carriage among dental students, identify the factors that influence this carriage, and characterize MRSA. A prevalence of S. aureus and MRSA carriage of 25.2% and 0.86% was estimated, respectively, and SCCmec Type VI, was identified in all isolated MRSA. The low MRSA colonization rate can reflect good infection control practices followed by students.

scholarly journals Intra- and Extra-Hospital Dissemination of IMP-22-Producing Klebsiella pneumoniae in Northern Portugal: The Breach of the Hospital Frontier Toward the Community

2021 ◽  
Vol 12 ◽  
Author(s):  
Daniela Gonçalves ◽  
Pedro Cecílio ◽  
Alberta Faustino ◽  
Carmen Iglesias ◽  
Fernando Branca ◽  
...  
Keyword(s):  
Public Health ◽  
Klebsiella Pneumoniae ◽  
Acute Care Hospital ◽  
Care Facility ◽  
Public Health Problem ◽  
Clinical Settings ◽  
Care Hospital ◽  
Term Care ◽  
Long Term Care Facility ◽  
The North

The emergence of infections (and colonization) with Enterobacteriaceae-producing carbapenemases is a threatening public health problem. In the last decades, we watched an isolated case becoming a brutal outbreak, a sporadic description becoming an endemic problem. The present study aims to highlight the dissemination of IMP-22-producing Klebsiella pneumoniae in the North of Portugal, through the phenotypic and genotypic characterization of isolates collected from hospitalized patients (n=5) and out-patients of the emergency ward of the same acute care hospital (n=2), and isolates responsible for the intestinal colonization of residents in a Long-Term Care Facility (n=4). Pulsed-field gel electrophoresis (PFGE) results, associated with conjugation experiments pointed to a pattern of both vertical and horizontal dissemination. Overall, and complementing other studies that give relevance to IMP-22-producing K. pneumoniae in the clinical settings, here we show for the first time the public health threatening breach of the hospital frontier of this resistance threat, toward the community.

scholarly journals Association between Health Risk Behavior and Suicidal Ideation, Continuous Sadness and Depression among Malaysian Youth

2017 ◽  
Vol 10 (1) ◽  
pp. 11
Author(s):  
Nor Asiah Muhamad ◽  
Norazilah Mohd Roslan ◽  
Aziman Mahdi ◽  
Norbaidurah Ithnain ◽  
Normi Mustapha ◽  
...  
Keyword(s):  
Public Health ◽  
Sexual Abuse ◽  
Suicidal Ideation ◽  
Health Risk ◽  
Risk Behavior ◽  
Public Health Problem ◽  
The United States ◽  
Health Risk Behavior ◽  
Global Public Health ◽  
Public Health Importance

BACKGROUND: Suicide is a global public health importance and a second leading cause of death in adolescents. It is more common among adolescents and is considered as a serious public health problem worldwide. This study aims to determine the association between health risk behavior with suicidal ideation, continuous sadness and depression among Malaysian youth.METHODS: A cross-sectional study was carried out among 4088 youth aged 13–17 years old from 50 selected schools. A stratified random sampling was used to select respondents from different classes. The students were randomly selected using the same software throughout the country. Verbal consent was obtained from the student and parents prior to data collection. A standardized self-administered questionnaire adapted from the United States’ Youth Behaviour Risk Surveillance Survey (YBRSS) were used.RESULTS: The rates of Continuous Sadness (CS), Depression (DP) and Suicidal Ideation (SI) were 34.3%, 13.2% and 7.9% respectively. The multivariable-adjusted odds ratio showed that sexual abuse was associated with SI 8.04 (95% CI: 4.66, 13.84), CS 5.72 (95% CI: 3.21, 9.82) and DP 4.68% (95% CI: 2.80, 7.83); alcohol use was associated with SI 1.62 (95% CI: 1.06, 2.47) and DP 1.67 (95% CI: 1.20, 2.33). Female was associated with all suicidal behaviours: SI 2.48 (95% CI: 1.90, 3.24), CS 2.07 (95% CI: 1.80, 2.37) and DP 1.41 (95% CI: 2.17, 1.71). Smoking and drug was not associated with CS, DP and SI.CONCLUSIONS: Given the well-founded concern of increasing risk of suicidal behaviour among youth, preventive efforts should adopt a more comprehensive approach in dealing with sexual abuse and alcohol abuse, especially in female.

scholarly journals Containment of a COVID-19 Outbreak in an Inpatient Geriatric Psychiatry Unit

2020 ◽  
Vol 27 (1) ◽  
pp. 77-82
Author(s):  
Cheri Constantino-Shor ◽  
Golo Rani ◽  
Svaya Olin ◽  
Charity Holmes ◽  
Keri Nasenbeny
Keyword(s):  
Infection Control ◽  
Care Facility ◽  
The United States ◽  
Geriatric Psychiatry ◽  
Control Measures ◽  
Care Staff ◽  
King County ◽  
Term Care ◽  
Staff Members ◽  
Prolonged Contact

OBJECTIVES: The first known COVID-19 outbreak in a long-term care facility in the United States was identified on February 28, 2020, in King County, Washington. That facility became the initial U.S. epicenter of the COVID-19 pandemic when they discovered 129 cases associated with the outbreak (81 residents, 34 staff members, and 14 visitors) and 23 persons died. The vulnerability of the elderly population, shared living and social spaces, suboptimal infection control practices, and prolonged contact between residents were identified as contributing factors to the rapid spread of the disease. The first known case of a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak in a U.S. inpatient geriatric psychiatry unit was also in King County, Washington, and occurred soon afterward on March 11th, 2020. Between March 11 and March 18, nine inpatients and seven staff members were confirmed to have SARS-CoV-2 infection. This article examines how the swift identification and isolation of confirmed patients, an enhanced infection prevention protocol, and engagement of frontline psychiatric care staff prevented a catastrophic outcome in a vulnerable population. METHODS: Here we describe infection control and nursing-led interventions that were quickly enacted in response to this SARS-CoV-2 outbreak in an inpatient geriatric psychiatry unit. RESULTS: The interventions effectively contained the outbreak, with no further patients and only one staff member testing positive for SARS-CoV-2 over the subsequent 2-month time period. CONCLUSIONS: We share our learnings and preventative infection control measures that can be adapted to a variety of settings to prevent or contain future outbreaks of COVID-19.

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