What precautions would be taken to prevent spread of methicillin-resistant Staphylococcus aureus (MRSA) infection from patient to patient on an ophthalmic ward?

Studies in adults support the use of a negative methicillin-resistant Staphylococcus aureus (MRSA) nares screening (MNS) to help limit empiric anti-MRSA antibiotic therapy. We aimed to evaluate the use of MNS for anti-MRSA antibiotic de-escalation in hospitalized children (<18 years). Records of patients admitted between 1 January 2015 and 31 December 2020 with a presumed infectious diagnosis who were started on anti-MRSA antibiotics, had a PCR-based MNS, and a clinical culture performed were retrospectively reviewed. A total of 95 children were included with a median age (range) of 2 (0–17) years. The top three diagnosis groups were skin and soft tissue infections (n = 38, 40%), toxin-mediated syndromes (n = 17, 17.9%), and osteoarticular infections (n = 14, 14.7%). Nasal MRSA colonization and growth of MRSA in clinical cultures was found in seven patients (7.4%) each. The specificity and the negative predictive value (NPV) of the MNS to predict a clinical MRSA infection were both 95.5%. About half (n = 55, 57.9%) had anti-MRSA antibiotics discontinued in-house. A quarter (n = 14, 25.5%) were de-escalated based on the negative MNS test alone, and another third (n = 21, 38.2%) after negative MNS test and negative culture results became available. A high NPV suggests that MNS may be useful for limiting unnecessary anti-MRSA therapy and thereby a useful antimicrobial stewardship tool for hospitalized children. Prospective studies are needed to further characterize the utility of MNS for specific infectious diagnoses.

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1230. Epidemiology and Risk Factors for Recurrent Invasive Methicillin-Resistant Staphylococcus aureus Infection: nine US States, 2006–2013

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1063 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S373-S374

Author(s):

Ian Kracalik ◽

Kelly Jackson ◽

Joelle Nadle ◽

Wendy Bamberg ◽

Susan Petit ◽

...

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Infection Type ◽

The United States ◽

Emerging Infections ◽

Methicillin Resistant ◽

Initial Infection ◽

Joint Infections ◽

Mrsa Infection

Abstract Background Methicillin-resistant Staphylococcus aureus (MRSA) causes >70,000 invasive infections annually in the United States, and recurrent infections pose a major clinical challenge. We examined risk factors for recurrent MRSA infections. Methods We identified patients with an initial invasive MRSA infection (isolation from a normally sterile body site) from 2006 to 2013, through active, population-based surveillance in selected counties in nine states through the Emerging Infections Program. Recurrence was defined as invasive MRSA isolation >30 days after initial isolation. We used logistic regression with backwards selection to evaluate adjusted odds ratios (aOR) associated with recurrence within 180 days, prior healthcare exposures, and initial infection type, controlling for patient demographics and comorbidities. Results Among 24,478 patients with invasive MRSA, 3,976 (16%) experienced a recurrence, including 61% (2,438) within 180 days. Risk factors for recurrence were: injection drug use (IDU) (aOR; 1.38, 95% confidence interval [CI]: 1.15–1.65), central venous catheters (aOR; 1.35, 95% CI: 1.22–1.51), dialysis (aOR; 2.00, 95% CI: 1.74–2.31), and history of MRSA colonization (aOR; 1.35, 95% CI: 1.22–1.51) (figure). Recurrence was more likely for bloodstream infections (BSI) without another infection (aOR; 2.08, 95% CI: 1.74–2.48), endocarditis (aOR; 1.46, 95% CI: 1.16–1.55), and bone/joint infections (aOR; 1.38, 95% CI: 1.20–1.59), and less likely for pneumonia (aOR: 0.75, 95% CI: 0.64–0.89), compared with other initial infection types. When assessed separately, the presence of a secondary BSI with another infection increased the odds of recurrence over that infection without a BSI (aOR: 1.96, 95% CI: 1.68–2.30). Conclusion Approximately one in six persons with invasive MRSA infection had recurrence. We identified potential opportunities to prevent recurrence through infection control (e.g., management and early removal of central catheters). Other possible areas for preventing recurrence include improving the management of patients with BSI and bone/joint infections (including both during and after antibiotic treatment) and mitigating risk of infection from IDU. Disclosures All authors: No reported disclosures.

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Methicillin-Resistant Staphylococcus aureus (MRSA) Infection

Advanced Emergency Nursing Journal ◽

10.1097/01.tme.0000270333.96508.7d ◽

2007 ◽

Vol 29 (2) ◽

pp. 118-128

Author(s):

Linda Rod ◽

K. Sue Hoyt

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Methicillin Resistant ◽

Mrsa Infection

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Correlation Between Patients With Methicillin-Resistant Staphylococcus aureus (MRSA) Nares Colonization and MRSA Diabetic Foot Infections

The International Journal of Lower Extremity Wounds ◽

10.1177/1534734620963570 ◽

2020 ◽

pp. 153473462096357

Author(s):

Jacquelyn Brondo ◽

Kathleen Morneau ◽

Teri Hopkins ◽

Linda Yang ◽

Jose Cadena-Zuluaga ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Diabetic Foot ◽

Predictive Value ◽

Methicillin Resistant Staphylococcus Aureus ◽

Empiric Therapy ◽

Inclusion Criteria ◽

Methicillin Resistant ◽

Diabetic Foot Infections ◽

Prior Literature ◽

Mrsa Infection

Infectious Diseases Society of America diabetic foot infection (DFI) guidelines indicate empiric methicillin-resistant Staphylococcus aureus (MRSA) coverage for patients with a history of MRSA infection, when local prevalence of MRSA is high, or infection is clinically severe. These recommendations may lead to overutilization of empiric MRSA coverage, which can result in serious consequences. A strong negative predictive value (NPV) has been reported in literature for pneumonia, and recently, for all anatomical sites of infection. While these findings are promising, further validation is needed before clinicians may confidently use MRSA nares to guide empiric therapy for DFIs. A retrospective electronic medical record review was completed between October 1, 2013 and October 1, 2019. Patients met inclusion criteria if they were at least 18, admitted with a DFI, had MRSA nares test results, and DFI cultures. Patients were excluded if pregnant or MRSA infection within 1 year prior to index admission for DFI. A total of 200 patients met inclusion criteria. The majority of study participants were male with a mean age of 63. NPV of MRSA nares for MRSA DFIs was determined to be 94% and positive predictive value 58%. Sensitivity and specificity were 56% and 94%, respectively. Results of this study are consistent with prior literature supporting strong correlation of NPV for MRSA nares. The DFIs evaluated suggest a strong NPV of MRSA nares for MRSA DFIs, which may allow for faster de-escalation of empiric anti-MRSA antibiotic therapy and lower risk of adverse events associated with anti-MRSA therapy.

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In vivo photothermal inhibition of methicillin-resistant Staphylococcus aureus infection by in situ templated formulation of pathogen-targeting phototheranostics

Nanoscale ◽

10.1039/d0nr00181c ◽

2020 ◽

Vol 12 (14) ◽

pp. 7651-7659 ◽

Cited By ~ 19

Author(s):

Xujuan Guo ◽

Bing Cao ◽

Congyu Wang ◽

Siyu Lu ◽

Xianglong Hu

Keyword(s):

Staphylococcus Aureus ◽

Magnetic Resonance ◽

Methicillin Resistant Staphylococcus Aureus ◽

Photoacoustic Imaging ◽

Methicillin Resistant ◽

Aureus Infection ◽

Mrsa Infection ◽

Efficient Elimination

Herein, pathogen-targeting phototheranostic nanoparticles, Van-OA@PPy, are in situ developed for efficient elimination of MRSA infection, which is reflected by dual-modality magnetic resonance and photoacoustic imaging.

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A Computer-Driven Approach to Discover Natural Product Leads for Methicillin-Resistant Staphylococcus aureus Infection Therapy

Marine Drugs ◽

10.3390/md17010016 ◽

2018 ◽

Vol 17 (1) ◽

pp. 16 ◽

Cited By ~ 5

Author(s):

Tiago Dias ◽

Susana Gaudêncio ◽

Florbela Pereira

Keyword(s):

Staphylococcus Aureus ◽

Drug Discovery ◽

Natural Product ◽

Regression Models ◽

Methicillin Resistant Staphylococcus Aureus ◽

External Validation ◽

Machine Learning Techniques ◽

Methicillin Resistant ◽

Madeira Archipelago ◽

Mrsa Infection

The risk of methicillin-resistant Staphylococcus aureus (MRSA) infection is increasing in both the developed and developing countries. New approaches to overcome this problem are in need. A ligand-based strategy to discover new inhibiting agents against MRSA infection was built through exploration of machine learning techniques. This strategy is based in two quantitative structure–activity relationship (QSAR) studies, one using molecular descriptors (approach A) and the other using descriptors (approach B). In the approach A, regression models were developed using a total of 6645 molecules that were extracted from the ChEMBL, PubChem and ZINC databases, and recent literature. The performance of the regression models was successfully evaluated by internal and external validation, the best model achieved R2 of 0.68 and RMSE of 0.59 for the test set. In general natural product (NP) drug discovery is a time-consuming process and several strategies for dereplication have been developed to overcome this inherent limitation. In the approach B, we developed a new NP drug discovery methodology that consists in frontloading samples with 1D NMR descriptors to predict compounds with antibacterial activity prior to bioactivity screening for NPs discovery. The NMR QSAR classification models were built using 1D NMR data (1H and 13C) as descriptors, from crude extracts, fractions and pure compounds obtained from actinobacteria isolated from marine sediments collected off the Madeira Archipelago. The overall predictability accuracies of the best model exceeded 77% for both training and test sets.

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Screening for Methicillin-Resistant Staphylococcus aureus Colonization Using Sponges

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2014.4 ◽

2015 ◽

Vol 36 (1) ◽

pp. 28-33 ◽

Cited By ~ 3

Author(s):

Chang-Seop Lee ◽

Bianca Montalmont ◽

Jessica A. O’Hara ◽

Alveena Syed ◽

Charma Chaussard ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Nasal Swab ◽

Methicillin Resistant Staphylococcus Aureus ◽

Type Ii ◽

Chain Reaction ◽

Methicillin Resistant ◽

Nasal Swabs ◽

Positive Specimen ◽

Mrsa Infection ◽

Polymerase Chain

OBJECTIVENasal swab culture is the standard method for identifying methicillin-resistant Staphylococcus aureus (MRSA) carriers. However, this method is known to miss a substantial portion of those carrying MRSA elsewhere. We hypothesized that the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection.DESIGNHospitalized patients with recent MRSA infection were enrolled and underwent MRSA screening of the forehead, nostrils, pharynx, axilla, and groin with separate swabs and the forehead, axilla, and groin with separate sponges. Staphylococcal cassette chromosome mec (SCCmec) typing was conducted by polymerase chain reaction (PCR).PATIENTSA total of 105 MRSA patients were included in the study.RESULTSAt least 1 specimen from 56.2% of the patients grew MRSA. Among patients with at least 1 positive specimen, the detection sensitivities were 79.7% for the swabs and 64.4% for the sponges. Notably, 86.4% were detected by a combination of sponges and nasal swab, and 72.9% were detected by a combination of pharyngeal and nasal swabs, whereas only 50.9% were detected by nasal swab alone (P<0.0001 and P=0.0003, respectively). Most isolates had SCCmec type II (59.9%) and IV (35.7%). No correlation was observed between the SCCmec types and collection sites.CONCLUSIONScreening using a sponge significantly improves MRSA detection when used in addition to screening with the standard nasal swab.Infect Control Hosp Epidemiol 2014;36(1): 28–33

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Chlorhexidine and Mupirocin Susceptibility of Methicillin-Resistant Staphylococcus aureus Isolates in the REDUCE-MRSA Trial

Journal of Clinical Microbiology ◽

10.1128/jcm.01444-16 ◽

2016 ◽

Vol 54 (11) ◽

pp. 2735-2742 ◽

Cited By ~ 45

Author(s):

Mary K. Hayden ◽

Karen Lolans ◽

Katherine Haffenreffer ◽

Taliser R. Avery ◽

Ken Kleinman ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Methicillin Resistant Staphylococcus Aureus ◽

Cluster Randomized Trial ◽

Confidence Limits ◽

Methicillin Resistant ◽

Content Type ◽

Mrsa Infection ◽

Mupirocin Resistance ◽

Cluster Randomized ◽

High Level

Whether targeted or universal decolonization strategies for the control of methicillin-resistant Staphylococcus aureus (MRSA) select for resistance to decolonizing agents is unresolved. The REDUCE-MRSA trial (ClinicalTrials registration no. NCT00980980) provided an opportunity to investigate this question. REDUCE-MRSA was a 3-arm, cluster-randomized trial of either screening and isolation without decolonization, targeted decolonization with chlorhexidine and mupirocin, or universal decolonization without screening to prevent MRSA infection in intensive-care unit (ICU) patients. Isolates from the baseline and intervention periods were collected and tested for susceptibility to chlorhexidine gluconate (CHG) by microtiter dilution; mupirocin susceptibility was tested by Etest. The presence of the qacA or qacB gene was determined by PCR and DNA sequence analysis. A total of 3,173 isolates were analyzed; 2 were nonsusceptible to CHG (MICs, 8 μg/ml), and 5/814 (0.6%) carried qacA or qacB . At baseline, 7.1% of MRSA isolates expressed low-level mupirocin resistance, and 7.5% expressed high-level mupirocin resistance. In a mixed-effects generalized logistic regression model, the odds of mupirocin resistance among clinical MRSA isolates or MRSA isolates acquired in an ICU in intervention versus baseline periods did not differ across arms, although estimates were imprecise due to small numbers. Reduced susceptibility to chlorhexidine and carriage of qacA or qacB were rare among MRSA isolates in the REDUCE-MRSA trial. The odds of mupirocin resistance were no different in the intervention versus baseline periods across arms, but the confidence limits were broad, and the results should be interpreted with caution.

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