Epidemiology of community-associated methicillin resistant staphylococcus aureus (CA-MRSA) infection in Hong Kong, 2007 : a descriptive and analytical study

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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