scholarly journals 587. Risk Factors for Nosocomial Methicillin-Resistant Staphylococcus aureus (MRSA) Colonization in a Neonatal Intensive Care Unit (NICU): A Case–Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S277-S277
Author(s):  
Archana Balamohan ◽  
Joanna Beachy ◽  
Nina Kohn ◽  
Lorry G Rubin
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Pass Rate ◽  
Respiratory Support ◽  
Colonization Pressure ◽  
Negative Culture ◽  
Mrsa Colonization ◽  
Control Study

Abstract Background Staphylococcus aureus (SA) is a leading cause of nosocomial infection in NICUs. Colonization is a prerequisite for most SA infections. Previously recognized risk factors for colonization include the length of stay (LOS), multiple gestation, low birth weight, Caesarean delivery and multibed location. The objective of this study was to determine risk factors for MRSA colonization in a Level IV NICU independent of LOS and gestational age (GA) in the context of a circulating MRSA clone. Methods Weekly MRSA colonization cultures were performed from April 2017 through March 2018. Case–control study. Cases: Infants with newly acquired MRSA colonization and at least one previous negative culture. Controls: Infants with negative surveillance cultures, matched 1:1 with cases by GA and LOS. Factors compared: (a) neonatal demographics; (b) maternal factors; (c) neonatal factors since admission including antimicrobial therapy; (d) neonatal factors during the week prior to MRSA acquisition, including bed location, number of location changes, presence of central line, respiratory support, NICU census, ATP surface bioburden testing pass rate, MRSA colonization pressure. Results 50 case infants were matched with controls. Forty-five of the 50 isolates were mupirocin-resistant and related by pulse-field gel electrophoresis On matched univariable analysis, the following were significantly associated with a risk for MRSA acquisition: (1) Bed location in the acute area (P = 0.03), (2) The requirement of any level of respiratory support during the week prior to MRSA detection (P = 0.04), (3) Higher ATP pass rate during the week of and week prior (P = 0.01), (4) Higher MRSA colonization pressure during the prior week (P = 0.002), (5) Not having a hearing test during the time between the previous negative culture and MRSA acquisition (P = 0.01). A multivariable conditional logistic regression model (that excluded ATP pass rate) found that only colonization pressure was associated with acquisition of MRSA colonization. Conclusion Independent of LOS and GA, MRSA colonization pressure, ATP pass rate and higher patient acuity, reflected by location within the acute area and requiring respiratory support, are significantly associated with MRSA acquisition in the NICU; only colonization pressure remained associated in a multivariable model. Disclosures All authors: No reported disclosures.

scholarly journals Diabetic Foot Infections: Local Prevalence of and Case–Control Study of Risk Factors for Methicillin-Resistant Staphylococcus aureus and Pseudomonas aeruginosa

2020 ◽  
Vol 7 (10) ◽  
Author(s):  
Justin J Kim ◽  
Alison Lydecker ◽  
Rohini Davé ◽  
Jacqueline T Bork ◽  
Mary-Claire Roghmann
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Pseudomonas Aeruginosa ◽  
Diabetic Foot ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Methicillin Resistant ◽  
Diabetic Foot Infections ◽  
Control Study

Abstract We identified deep diabetic foot infections by culture and conducted a case–control study examining the risk factors for moderate to severe methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (PsA) diabetic foot infections. Our MRSA prevalence was lower than literature values; PsA was higher. Gangrene may be predictive of Pseudomonas infection.

scholarly journals Determining the clinical significance of co-colonization of vancomycin-resistant enterococci and methicillin-resistant Staphylococcus aureus in the intestinal tracts of patients in intensive care units: a case–control study

2019 ◽  
Vol 18 (1) ◽  
Author(s):  
Young Kyung Yoon ◽  
Min Jung Lee ◽  
Yongguk Ju ◽  
Sung Eun Lee ◽  
Kyung Sook Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Clinical Outcomes ◽  
Intensive Care Units ◽  
Case Control Study ◽  
Case Control ◽  
Methicillin Resistant ◽  
Vancomycin Resistant ◽  
Control Study

Abstract Background The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) has become a global concern for public health. The proximity of vancomycin-resistant enterococcus (VRE) and methicillin-resistant S. aureus (MRSA) is considered to be one of the foremost risk factors for the development of VRSA. This study aimed to determine the incidence, risk factors, and clinical outcomes of intestinal co-colonization with VRE and MRSA. Methods A case–control study was conducted in 52-bed intensive care units (ICUs) of a university-affiliated hospital from September 2012 to October 2017. Active surveillance using rectal cultures for VRE were conducted at ICU admission and on a weekly basis. Weekly surveillance cultures for detection of rectal MRSA were also conducted in patients with VRE carriage. Patients with intestinal co-colonization of VRE and MRSA were compared with randomly selected control patients with VRE colonization alone (1:1). Vancomycin minimum inhibitory concentrations (MICs) for MRSA isolates were determined by the Etest. Results Of the 4679 consecutive patients, 195 cases and 924 controls were detected. The median monthly incidence and duration of intestinal co-colonization with VRE and MRSA were 2.3/1000 patient-days and 7 days, respectively. The frequency of both MRSA infections and mortality attributable to MRSA were higher in the case group than in the control group: 56.9% vs. 44.1% (P = 0.011) and 8.2% vs. 1.0% (P = 0.002), respectively. Independent risk factors for intestinal co-colonization were enteral tube feeding (odds ratio [OR], 2.09; 95% confidence interval [CI] 1.32–3.32), metabolic diseases (OR, 1.75; 95% CI 1.05–2.93), male gender (OR, 1.62; 95% CI 1.06–2.50), and Charlson comorbidity index < 3 (OR, 3.61; 95% CI 1.88–6.94). All MRSA isolates from case patients were susceptible to vancomycin (MIC ≤ 2 mg/L). Conclusions Our study indicates that intestinal co-colonization of VRE and MRSA occurs commonly among patients in the ICU with MRSA endemicity, which might be associated with poor clinical outcomes.

scholarly journals 172. Risk Factors for 30-Day Mortality in Patients with Staphylococcus aureus Bacteremia at a Community Hospital: A Prospective Case–Control Study

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S109-S110
Author(s):  
Charles Hoffmann ◽  
Gordon Watkins ◽  
Patrick DeSimone ◽  
Peter Hallisey ◽  
David Hutchinson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Case Control Study ◽  
Community Hospital ◽  
Univariate Analysis ◽  
Case Control ◽  
Blood Cultures ◽  
Staphylococcus Aureus Bacteremia ◽  
Initial Blood ◽  
Control Study

Abstract Background Staphylococcus aureus bacteremia (SAB) is associated with 30-day all-cause mortality rates approaching 20–30%. The purpose of this case–control study was to evaluate risk factors for 30-day mortality in patients with SAB at a community hospital. Methods As part of an antimicrobial stewardship program (ASP) initiative mandating Infectious Diseases consultation for episodes of SAB, our ASP prospectively monitored all cases of SAB at a 341-bed community hospital in Jefferson Hills, PA from April 2017–February 2019. Cases included patients with 30-day mortality from the initial positive blood culture. Only the first episode of SAB was included; patients were excluded if a treatment plan was not established (e.g., left against medical advice). Patient demographics, comorbidities, laboratory results, and clinical management of SAB were evaluated. Inferential statistics were used to analyze risk factors associated with 30-day mortality. Results 100 patients with SAB were included; 18 (18%) experienced 30-day mortality. Cases were older (median age 76.5 vs. 64 years, P < 0.001), more likely to be located in the intensive care unit (ICU) at time of ASP review (55.6% vs. 30.5%, P = 0.043), and less likely to have initial blood cultures obtained in the emergency department (ED) (38.9% vs. 80.5%, P < 0.001). Variables associated with significantly higher odds for 30-day mortality in univariate analysis: older age, location in ICU at time of ASP review, initial blood cultures obtained at a location other than the ED, and total Charlson Comorbidity Index (CCI). Variables with P < 0.2 on univariate analysis were analyzed via multivariate logistic regression (Table 1). Conclusion Results show that bacteremia due to MRSA and total CCI were not significantly associated with 30-day mortality in SAB, whereas older age was identified as a risk factor. Patients with initial blood cultures obtained at a location other than the ED were at increased odds for 30-day mortality on univariate analysis, which may raise concern for delayed diagnosis. Disclosures All authors: No reported disclosures.

Risk Factors for Staphylococcus aureus Acquisition in the Neonatal Intensive Care Unit: A Matched Case-Case-Control Study

2017 ◽  
Vol 39 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Matthew C. Washam ◽  
Andrea Ankrum ◽  
Beth E. Haberman ◽  
Mary Allen Staat ◽  
David B. Haslam
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Neonatal Intensive Care ◽  
Case Control Study ◽  
Case Control ◽  
Entire Cohort ◽  
Matched Case ◽  
Control Study

OBJECTIVETo determine risk factors independent of length of stay (LOS) for Staphylococcus aureus acquisition in infants admitted to the neonatal intensive care unit (NICU).DESIGNRetrospective matched case–case-control study.SETTINGQuaternary-care referral NICU at a large academic children’s hospital.METHODSInfants admitted between January 2014 and March 2016 at a level IV NICU who acquired methicillin resistant (MRSA) or susceptible (MSSA) S. aureus were matched with controls by duration of exposure to determine risk factors for acquisition. A secondary post hoc analysis was performed on the entire cohort of at-risk infants for risk factors identified in the primary analysis to further quantify risk.RESULTSIn total, 1,751 infants were admitted during the study period with 199 infants identified as having S. aureus prevalent on admission. There were 246 incident S. aureus acquisitions in the remaining at-risk infant cohort. On matched analysis, infants housed in a single-bed unit were associated with a significantly decreased risk of both MRSA (P=.03) and MSSA (P=.01) acquisition compared with infants housed in multibed pods. Across the entire cohort, pooled S. aureus acquisition was significantly lower in infants housed in single-bed units (hazard ratio,=0.46; confidence interval, 0.34–0.62).CONCLUSIONSNICU bed design is significantly associated with S. aureus acquisition in hospitalized infants independent of LOS.Infect Control Hosp Epidemiol 2018;39:46–52

Risk Factors for Colonization or Infection Due to Methicillin-Resistant Staphylococcus Aureus in HIV-Positive Patients A Retrospective Case-Control Study

1999 ◽  
Vol 20 (01) ◽  
pp. 26-30 ◽  
Author(s):  
Michelle Onorato ◽  
Michael J. Borucki ◽  
Gwen Baillargeon ◽  
David P. Paar ◽  
Daniel H. Freeman ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Central Venous Catheter ◽  
Case Control Study ◽  
Venous Catheter ◽  
Case Control ◽  
Central Venous ◽  
Methicillin Resistant ◽  
Hospital Days ◽  
Control Study

AbstractObjective:To determine the risk factors for colonization or infection with methicillin-resistantStaphylococcus aureusin human immunodeficiency virus (HIV)-infected patients.Design:Retrospective matched-pair case-control study.Setting:Continuity clinic and inpatient HIV service of a university medical center.Population:Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice.Data Collection:Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive forS aureus, and a history of opportunistic illnesses, diabetes, or dermatologie diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications.Results:In the univariate analysis, the presence of a central venous catheter, an underlying dermatologie disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistantS aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologie disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistantS aureus.Conclusions:In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologie disease were risk factors for acquisition of methicillin-resistantS aureus

Prevalence of Methicillin-Resistant Staphylococcus aureus and Risk Factors for Carriage in Dutch Hospitals

2010 ◽  
Vol 31 (11) ◽  
pp. 1188-1190 ◽  
Author(s):  
A. M. Kaiser ◽  
A. J. P. Haenen ◽  
A. J. de Neeling ◽  
C. M. J. E. Vandenbroucke-Grauls
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Case Control Study ◽  
Case Control ◽  
Prevalence Survey ◽  
Methicillin Resistant ◽  
Professional Contact ◽  
Nested Case Control ◽  
Control Study

To evaluate the actual burden of methicillin-resistant Staphylococcus aureus and determine risk factors for carriage and infection, we performed a prevalence survey with a nested case-control study among inpatients in Dutch hospitals. The prevalence of carriage was 0.94 cases per 1,000 inpatients, and the prevalence of infection was 0.21 cases per 1,000 inPatients. Professional contact with livestock and a stay in a foreign hospital were associated with carriage.

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