New Approaches to Reduce Staphylococcus Aureus Nosocomial Infection Rates: Treating S. Aureus Nasal Carriage

1998 ◽  
Vol 32 (1) ◽  
pp. S7-S16 ◽  
Author(s):  
Trish M Perl ◽  
Jonathan E Golub
Keyword(s):  
Staphylococcus Aureus ◽  
Nosocomial Infections ◽  
English Language ◽  
Treatment Strategies ◽  
Cost Effective ◽  
Nasal Carriage ◽  
Medline Search ◽  
Increased Risk ◽  
Pseudomonic Acid ◽  
Systemic Antibiotics

BACKGROUND: Nosocomial infections cause significant patient morbidity and mortality. The 2.5 million nosocomial infections that occur each year cost the US healthcare system $5 million to $10 million. Staphylococcus aureus has long been recognized as an important pathogen in human disease and is the most common cause of nosocomial infections. OBJECTIVE To describe the epidemiology of S. aureus nosocomial infections that are attributable to patients' endogenous colonization. DATA SOURCES Review of the English-language literature and a MEDLINE search (as of September 1997). DATA SYNTHESIS: The ecologic niche of S. aureus is the anterior nares. The prevalence of S. aureus nasal carriage is approximately 20–25%, but varies among different populations, and is influenced by age, underlying illness, race, certain behaviors, and the environment in which the person lives or works. The link between S. aureus nasal carriage and development of subsequent S. aureus infections has been established in patients on hemodialysis, on continuous ambulatory peritoneal dialysis, and those undergoing surgery. S. aureus nasal carriers have a two- to tenfold increased risk of developing S. aureus surgical site or intravenous catheter infections. Thirty percent to 100% of S. aureus infections are due to endogenous flora and infecting strains were genetically identical to nasal strains. Three treatment strategies may eliminate nasal carriage: locally applied antibiotics or disinfectants, systemic antibiotics, and bacterial interference. Among these strategies, locally applied or systemic antibiotics are most commonly used. Nasal ointments or sprays and oral antibiotics have variable efficacy and their use frequently results in antimicrobial resistance among S. aureus strains. Of the commonly used agents, mupirocin (pseudomonic acid) ointment has been shown to be 97% effective in reducing S. aureus nasal carriage. However, resistance occurs when the ointment has been applied for a prolonged period over large surface areas. CONCLUSIONS Given the importance of S. aureus nosocomial infections and the increased risk of S. aureus nasal carriage in patients with nosocomial infections, investigators need to study cost-effective strategies to prevent certain types of nosocomial infections or nosocomial infections that occur in specific settings. One potential strategy is to decrease S. aureus nasal carriage among certain patient populations.

NASAL CARRIAGE OF STAPHYLOCOCCUS AUREUS AS A RISK OF NOSOCOMIAL INFECTIONS

2014 ◽  
Vol 5 (4) ◽  
pp. 205-209
Author(s):  
MAŁGORZATA M. KOZIOŁ ◽  
AGNIESZKA SIKORA ◽  
SYLWIA TARGOŃSKA ◽  
ANNA SIKORA
Keyword(s):  
Staphylococcus Aureus ◽  
Nosocomial Infections ◽  
Nasal Carriage

Excess mortality of mental disorder

1998 ◽  
Vol 173 (1) ◽  
pp. 11-53 ◽  
Author(s):  
Clare Harris ◽  
Brian Barraclough
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
English Language ◽  
Common Mental Disorders ◽  
Premature Death ◽  
Medline Search ◽  
Risk Of Death ◽  
Increased Risk ◽  
Standardised Mortality Ratios ◽  
The Common

BackgroundWe describe the increased risk of premature death from natural and from unnatural causes for the common mental disorders.MethodWith a Medline search (1966–1995) we found 152 English language reports on the mortality of mental disorder which met our inclusion criteria. From these reports, covering 27 mental disorder categories and eight treatment categories, we calculated standardised mortality ratios (SMRs) and 95% confidence intervals (CIs) for all causes of death, all natural causes and all unnatural causes; and for most, SMRs for suicide, other violent causes and specific natural causes.ResultsHighest risks of premature death, from both natural and unnatural causes, are for substance abuse and eating disorders. Risk of death from unnatural causes is especially high for the functional disorders, particularly schizophrenia and major depression. Deaths from natural causes are markedly increased for organic mental disorders, mental retardation and epilepsy.ConclusionAll mental disorders have an increased risk of premature death.

scholarly journals Clearance of Staphylococcus aureus Nasal Carriage Is T Cell Dependent and Mediated through Interleukin-17A Expression and Neutrophil Influx

2013 ◽  
Vol 81 (6) ◽  
pp. 2070-2075 ◽  
Author(s):  
Nathan K. Archer ◽  
Janette M. Harro ◽  
Mark E. Shirtliff
Keyword(s):  
Staphylococcus Aureus ◽  
Immune Response ◽  
T Cell ◽  
Immune Responses ◽  
Neutrophil Migration ◽  
Nasal Carriage ◽  
Causal Connection ◽  
Content Type ◽  
Neutrophil Influx ◽  
Increased Risk

ABSTRACTThe anterior nares of humans are the major reservoir forStaphylococcus aureuscolonization. Approximately 20% of the healthy human population is persistently and 80% is intermittently colonized withS. aureusin the nasal cavity. Previous studies have shown a strong causal connection betweenS. aureusnasal carriage and increased risk of nosocomial infection, as well as increased carriage due to immune dysfunction. However, the immune responses that permit persistence or mediate clearance ofS. aureuson the nasal mucosa are fundamentally undefined. In this study, we developed a carriage model in C57BL/6J mice and showed that clearance begins 14 days postinoculation. In contrast, SCID mice that have a deficient adaptive immune response are unable to eliminateS. aureuseven after 28 days postinoculation. Furthermore, decolonization was found to be T cell mediated but B cell independent by evaluating carriage clearance in T-cell receptor β/δ (TCR-β/δ) knockout (KO) and IgH-μ KO mice, respectively. Upregulation of the cytokines interleukin 1β (IL-1β), KC (also termed CXC ligand 1 [CXCL1]), and IL-17A occurred following inoculation with intranasalS. aureus. IL-17A production was crucial for clearance, since IL-17A-deficient mice were unable to effectively eliminateS. aureuscarriage. Subsequently, cell differential counts were evaluated from nasal lavage fluid obtained from wild-type and IL-17A-deficient colonized mice. These counts displayed IL-17A-dependent neutrophil migration. Antibody-mediated depletion of neutrophils in colonized mice caused reduced clearance compared to that in isotype-treated controls. Our data suggest that the Th17-associated immune response is required for nasal decolonization. This response is T cell dependent and mediated via IL-17A production and neutrophil influx. Th17-associated immune responses may be targeted for strategies to mitigate distal infections originating from persistentS. aureuscarriage in humans.

scholarly journals Nasal carriage of Staphylococcus aureus in farm animals and breeders in North of Morocco

2020 ◽  
Author(s):  
Nadira Mourabit ◽  
Abdelhay Arakrak ◽  
Mohammed Bakkali ◽  
Zeineb Zian ◽  
Joaira Bakkach ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Susceptibility ◽  
Virulence Genes ◽  
Nasal Carriage ◽  
High Rate ◽  
Farm Animals ◽  
Carriage Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
Mrsa Strains

Abstract Background: The objectives of this study were to determine for the first time, in Morocco, the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of Staphylococcus. aureus isolated from animals and breeders in close contact.Methods: From 2015 to 2016, 421 nasal swab samples were collected from 26 different livestock areas in Tangier. Antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2015. The presence of nuc , mec A, mec C, lukS/F-PV, and tst genes were determined by Polymerase Chain Reaction (PCR) for all isolates.Results: The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR= 13.536; 95% CI = 7.070- 25.912; p< 0.001). In general, S. aureus strains were susceptible to the majority of antibiotics and the highest resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No Methicillin-Resistant S. aureus (MRSA) was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been recovered only from animals (11.9% and 16.7%, respectively).Conclusion: Despite the lower rate of nasal carriage of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for further larger and multi-center studies to better define the transmission of the pathogenic S. aureus between livestock, environment, and humans.

scholarly journals Nasal carriage of Staphylococcus aureus in livestock in North of Morocco

2020 ◽  
Author(s):  
Nadira Mourabit ◽  
Abdelhay Arakrak ◽  
Mohammed Bakkali ◽  
Zeineb Zian ◽  
Joaira Bakkach ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Antimicrobial Susceptibility ◽  
Virulence Genes ◽  
Close Contact ◽  
Nasal Carriage ◽  
High Rate ◽  
Carriage Rate ◽  
Increased Risk ◽  
Significant Difference ◽  
Mrsa Strains

Abstract Background : In Morocco, data of LA-MRSA nasal carriage are still limited. The objectives of this study were to determine for the first time the nasal carriage rate, antimicrobial susceptibility profiles and virulence genes of S aureus isolated from animals and breeders in close contact. Methods : From 2015 to 2016, 480 nasal swab samples were collected from 27 different Livestock areas in Tangier. The antimicrobial susceptibility phenotypes were determined by disk diffusion according to EUCAST 2016. The presence of nuc , mec A and his homologue mec C, lukS/F-PV, and tst genes were determined by PCR for all isolates. Results : The overall S. aureus nasal carriage rate was low in animals (9.97%) and high in breeders (60%) with a statistically significant difference, (OR = 14.321; 95% CI = 7.484- 27.405; p< 0.0001). In general, S. aureus strains were susceptible to the majority of antibiotics and the higher resistance rates were found against tetracycline (16.7% in animals and 10% in breeders). No MRSA was detected in animals and breeders. A high rate of tst and lukS/F-PV genes has been found only in animals (11.9% and 16.7%, respectively). Conclusion : Despite the lower colonization rate of S. aureus and the absence of MRSA strains in our study, S. aureus strains harbored a higher frequency of tst and lukS/F-PV of virulence genes, which is associated to an increased risk of infection dissemination in humans. This highlights the need for implementing adequate approaches for prevention. Further larger and multi-center studies are needed to validate and confirm our findings. Keywords: Staphylococcus aureus , nasal carriage, animals, breeders, MRSA, Morocco

scholarly journals Evaluation of effectiveness and compliance with the mupirocin nasal ointment part of Staphylococcus aureus decolonization in real life using UPLC-MS/MS mupirocin quantification

2020 ◽  
Vol 75 (6) ◽  
pp. 1623-1630 ◽  
Author(s):  
Roxane Nicolas ◽  
Anne Carricajo ◽  
Jérôme Morel ◽  
Josselin Rigaill ◽  
Florence Grattard ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Cardiac Surgery ◽  
Real Life ◽  
Nasal Carriage ◽  
Nasal Sample ◽  
Real Life Setting ◽  
Increased Risk ◽  
Nasal Mupirocin ◽  
Compliance Issue

Abstract Background Preoperative decolonization is recommended in Staphylococcus aureus nasal carriers scheduled for cardiac surgery. We aimed to evaluate the effectiveness of and compliance with mupirocin use in nasal S. aureus carriers in a real-life setting. Methods Prospective study including consecutive patients scheduled for cardiac surgery screened for S. aureus nasal carriage at preoperative consultation. Carriers were prescribed mupirocin nasal ointment, chlorhexidine shower and mouthwash. Effectiveness of decolonization was evaluated with a postoperative nasal sample. Compliance was evaluated objectively by determination of nasal mupirocin concentration using UPLC-MS/MS and self-reported by questionnaire. Results Over 10 months, 361 patients were included, 286 had preoperative screening, 75 (26.2%) were S. aureus nasal carriers and 19 of them (25.3%) failed to be effectively decolonized. No resistance to mupirocin was documented. Preoperative and postoperative strains were identical in all cases. Declared good compliance was associated with decolonization success (OR = 24; 95% CI 4–143, P &lt; 0.0001). Mupirocin detection was significantly associated with the level of compliance. Mupirocin was detected in 52.2% (24/46) of patients effectively decolonized and in 12.5% (2/16) of patients with decolonization failure (P &lt; 0.01). In 2/19 patients, failure of decolonization was not associated with a compliance issue. Postoperative carriage was associated with an increased risk of S. aureus infection (OR = 9.8; 95% CI 1.8–53, P &lt; 0.01). Conclusions In real life, decolonization is not always effective, hence there is a persisting risk of S. aureus endogenous infection. Mupirocin concentration measurement may help to understand compliance issues and failures in decolonization.

Pleural Effusions: Pathophysiology and Management

1994 ◽  
Vol 28 (7-8) ◽  
pp. 894-903 ◽  
Author(s):  
Carlota O. Andrews ◽  
Mary Lea Gora
Keyword(s):  
Adverse Effects ◽  
English Language ◽  
Treatment Options ◽  
Cost Effective ◽  
Underlying Disease ◽  
Pleural Space ◽  
Pleural Effusions ◽  
Medline Search ◽  
Sclerosing Agents ◽  
Study Selection

OBJECTIVE: To review the pathophysiology and management of pleural effusions, including available agents for pleural sclerosis. DATA SOURCES: A MEDLINE search (1966 to present) was performed that included clinical studies in the English language involving the pathophysiology and management of pleural effusions; references used in those articles were screened for additional published information. STUDY SELECTION: All clinical trials were considered for potential inclusion in the review. DATA SYNTHESIS: Pleural effusion is an accumulation of fluid in the pleural space that results when homeostatic forces that control the flow into and out of the area are disrupted. The management of transudative pleural effusions is primarily directed at treatment of the underlying disease. There are several treatment options for pleural effusions, including chemical pleurodesis. Many of the trials that examine the use of talc, bleomycin, and doxycycline have poorly described study designs and end points, with inconsistent evaluation of patients. Each agent is considered to be generally effective and safe, with fever and pain as the most frequently reported adverse effects. The use of talc requires sterilization, and many clinicians use general anesthesia with instillation, which increases the risk associated with the procedure. Bleomycin is generally safe; however, it should not be used in doses exceeding 40 mg/m2. Only uncontrolled trials support the use of doxycycline; however, it provides an effective, safe, and relatively inexpensive alternative. CONCLUSIONS: Pleural effusions are defined as an accumulation of fluid in the pleural space. Treatment is generally palliative. Intrapleural administration of talc, bleomycin, and doxycycline are effective sclerosing agents for treatment of recurrent, symptomatic pleural effusions. Although the most cost-effective agent has not been determined, doxycycline is an inexpensive alternative to bleomycin, and may have fewer adverse effects than talc.

Predictive Value and Cost-Effectiveness Analysis of a Rapid Polymerase Chain Reaction for Preoperative Detection of Nasal Carriage of Staphylococcus aureus

2003 ◽  
Vol 24 (5) ◽  
pp. 327-333 ◽  
Author(s):  
Nabin K. Shrestha ◽  
Kenneth M. Shermock ◽  
Steven M. Gordon ◽  
Marion J. Tuohy ◽  
Deborah A. Wilson ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Polymerase Chain Reaction ◽  
Cost Effectiveness ◽  
Cost Effective ◽  
Nasal Carriage ◽  
Initial Therapy ◽  
Cost Effectiveness Analysis ◽  
Chain Reaction ◽  
Effectiveness Analysis ◽  
Polymerase Chain

AbstractObjective:To determine the accuracy and cost-effectiveness of a polymerase chain reaction (PCR) for detecting nasal carriage of Staphylococcus aureus directly from clinical specimens.Cross-Sectional Study:This occurred in a tertiary-care hospital in Cleveland, Ohio, and included 239 consecutive patients who were scheduled for a cardiothoracic surgical procedure. Conventional cultures and a PCR for S. aureus from nasal swabs were used as measurements.Cost-Effectiveness Analysis:Data sources were market prices and Bureau of Labor Statistics. The time horizon was the maximum period for availability of culture results (3 days). Interventions included universal mupirocin therapy without testing; initial therapy, with termination if PCR negative (treat-PCR); initial therapy, with termination if culture negative (treat-culture); treat PCR-positive carriers (PCR-guided treatment); and treat culture-positive carriers (culture-guided treatment). The perspective was institutional and costs and the length of time to treatment were outcome measures.Results:Sixty-seven (28%) of the 239 swabs grew S. aureus. Rapid PCR was 97.0% sensitive and 97.1% specific for the detection of S. aureus. For populations with prevalences of nasal S. aureus carriage of up to 50%, the PCR assay had negative predictive values of greater than 97%. PCR-guided treatment had the lowest incremental cost-effectiveness ratio ($1.93 per additional day compared with the culture strategy). Among immediate treatment strategies, treat-PCR was most cost-effective. The universal therapy strategy cost $38.19 more per additional day gained with carrier identification compared with the PCR strategy.Conclusion:Rapid real-time PCR is an accurate, rapid, and cost-effective method for identifying S. aureus carriers for preoperative intervention.

Recombinant Factor VIIa in the Treatment of Non-Hemophiliac Bleeding

2005 ◽  
Vol 39 (5) ◽  
pp. 885-891 ◽  
Author(s):  
Masha SH Lam ◽  
Rosalyn P Sims-McCallum
Keyword(s):  
English Language ◽  
Recombinant Factor Viia ◽  
Factor Viia ◽  
Pharmacoeconomic Analysis ◽  
Data Extraction ◽  
Standard Of Care ◽  
Controlled Trials ◽  
Close Monitoring ◽  
Medline Search ◽  
Increased Risk

OBJECTIVE: To review the clinical evidence for the use of recombinant factor VIIa (rFVIIa) in the prevention and/or treatment of bleeding in non-hemophiliac patients. DATA SOURCES: A MEDLINE search (1966–December 2004) was conducted to identify pertinent literature. Results were limited to English-language reports and clinical trials. References of relevant articles and selected abstracts presented at scientific meetings were also reviewed. STUDY SELECTION AND DATA EXTRACTION: Human data from prospective and retrospective studies that examined the hemostatic effect of rFVIIa in non-hemophiliac patients were reviewed, with a focus on surgical prophylaxis, liver disease, intractable bleeding associated with trauma and surgery, and anticoagulation reversal. DATA SYNTHESIS: Results from limited controlled trials on the use of rFVIIa as an adjunct for prevention of bleeding in surgery and liver diseases have not been consistent. For treatment of intractable bleeding, earlier use of rFVIIa in one trauma trial was shown to decrease the number of blood transfusions, but no differences in terms of clinical outcomes were observed in all trials. Controlled trials do not suggest an increased risk of thrombotic events. Optimal dosing and timing of administration have yet to be defined. CONCLUSIONS: Until further prospective controlled data are available, it is recommended that conventional intervention for prevention and control of hemorrhage in non-hemophiliac patients should remain the standard of care. Close monitoring of coagulation parameters is recommended before, during, and after therapy, especially in high-risk patients. Pharmacoeconomic analysis may be useful to help control costs and maximize clinical benefits.

scholarly journals Prevalence and population structure of Staphylococcus aureus nasal carriage in healthcare workers in a general population. The Tromsø Staph and Skin Study

2012 ◽  
Vol 141 (1) ◽  
pp. 143-152 ◽  
Author(s):  
K. OLSEN ◽  
M. SANGVIK ◽  
G. S. SIMONSEN ◽  
J. U. E. SOLLID ◽  
A. SUNDSFJORD ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Logistic Regression ◽  
Population Structure ◽  
Regression Models ◽  
Healthcare Workers ◽  
Nasal Carriage ◽  
Population Based ◽  
Family Status ◽  
Logistic Regression Models ◽  
Increased Risk

SUMMARYHealthcare workers (HCWs) may be a reservoir for Staphylococcus aureus transmission to patients. We examined whether HCW status is associated with S. aureus nasal carriage and population structure (spa types) in 1302 women (334 HCWs) and 977 men (71 HCWs) aged 30–69 years participating in the population-based Tromsø Study in 2007–2008. Multivariable logistic regression models were used. While no methicillin-resistant S. aureus (MRSA) was isolated, overall, 26·2% of HCWs and 26·0% of non-HCWs were S. aureus nasal carriers. For women overall and women residing with children, the odds ratios for nasal carriage were 1·54 [95% confidence interval (CI) 1·09–2·19] and 1·86 (95% CI 1·14–3·04), respectively, in HCWs compared to non-HCWs. Moreover, HCWs vs. non-HCWs had a 2·17 and 3·16 times higher risk of spa types t012 and t015, respectively. This supports the view that HCWs have an increased risk of S. aureus nasal carriage depending on gender, family status and spa type.

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