phenylephrine-hydrochloride and Cross-Infection

To address 3 questions: What are the origins of bacteria causing surgical site infections (SSIs)? Is there evidence that the offending bacteria are present at the incision site when surgery begins? What are the estimates of the proportion of SSIs that can be prevented with perioperative control of the microbiome?. Review of the literature, examining recognized sources of bacteria causing surgical site infections.. Specifically, I examined the impact of improved control of the microbiome of the skin and nares on reducing SSIs. The initial effort was to examine the reduction of SSIs linked solely to preoperative skin preparation regimens and to either topical nasal antibiotics or pre- and postoperative nasal antiseptic regimens. To corroborate the concept of the importance of the microbiome, a review of studies showing the relationship of SSIs and marker organisms (eg, Propionobacterium acnes) present at the incision sites was performed. The relationships of SSIs to the microbiome of the skin and nares were summarized.. Depending on key assumptions, ∼70%-95% of all SSIs arise from the microbiome of the patients' skin or nares. Data from the studies of marker organisms suggest that the infecting bacteria are present at the incision site at the time of surgery.. Almost all SSIs arise from the patient's microbiome. The occurrence of SSIs can be viewed as a perioperative failure to control the microbiome.

Topics: Bacterial Infections; Cross Infection; Humans; Microbiota; Nose; Propionibacterium acnes; Skin; Surgical Wound Infection; United States

Recent literature has highlighted methicillin-resistant Staphylococcus aureus (MRSA) nasal screening as a possible antimicrobial stewardship program tool for avoiding unnecessary empiric MRSA therapy for pneumonia, yet current guidelines recommend MRSA therapy based on risk factors. The objective of this meta-analysis was to evaluate the diagnostic value of MRSA nasal screening in MRSA pneumonia.. PubMed and EMBASE were searched from inception to November 2016 for English studies evaluating MRSA nasal screening and development of MRSA pneumonia. Data analysis was performed using a bivariate random-effects model to estimate pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV).. Twenty-two studies, comprising 5163 patients, met our inclusion criteria. The pooled sensitivity and specificity of MRSA nares screen for all MRSA pneumonia types were 70.9% and 90.3%, respectively. With a 10% prevalence of potential MRSA pneumonia, the calculated PPV was 44.8%, and the NPV was 96.5%. The pooled sensitivity and specificity for MRSA community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP) were 85% and 92.1%, respectively. For CAP and HCAP both the PPV and NPV increased, to 56.8% and 98.1%, respectively. In comparison, for MRSA ventilated-associated pneumonia, the sensitivity, specificity, PPV, and NPV were 40.3%, 93.7%, 35.7%, and 94.8%, respectively.. Nares screening for MRSA had a high specificity and NPV for ruling out MRSA pneumonia, particularly in cases of CAP/HCAP. Based on the NPV, MRSA nares screening is a valuable tool for AMS to streamline empiric antibiotic therapy, especially among patients with pneumonia who are not colonized with MRSA.

Topics: Antimicrobial Stewardship; Cross Infection; Humans; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Nasal Cavity; Nose; Pneumonia, Staphylococcal; Risk Factors

Colonization with health care-associated pathogens such as Staphylococcus aureus, enterococci, Gram-negative organisms, and Clostridium difficile is associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused on S. aureus decolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent for S. aureus nasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well as Candida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

Topics: Administration, Topical; Anti-Bacterial Agents; Bacteria; Cross Infection; Drug Resistance, Bacterial; Fungi; Gastrointestinal Tract; Humans; Nose; Skin

To provide assistance to otolaryngologists to decide the best manner in which to reprocess flexible nasopharyngoscopes, a review of existing English language medical literature regarding the methods of flexible endoscope reprocessing was performed, including previously published guidelines from other medical disciplines. Multiple steps were confirmed to be critical to effectively reprocess flexible nasopharyngoscopes. High-level disinfection has been determined to be the minimum level of disinfection required for reprocessing of flexible nasopharyngoscopes. Several steps are important in all reprocessing techniques, including manual cleaning, leak testing, cleaning with an enzymatic agent, high-level disinfection, and drying with vertical storage. Three techniques are available to achieve high-level disinfection: manual disinfection with a liquid disinfectant/sterilant, use of an automated endoscope reprocessor, and use of a disposable sheath. Achieving high-level disinfection of flexible nasopharyngoscopes can be accomplished by a variety of methods. Strict adherence to recommended procedures is critical.

Topics: Cross Infection; Disinfection; Endoscopes; Equipment Contamination; Equipment Reuse; Guidelines as Topic; Humans; Nose; Pharynx; Pliability

This review summarizes the clinically relevant aspects of nasal carriage of Staphylococcus aureus. The epidemiology, associated risk, and the effects of eradication are discussed. The main conclusions are that nasal carriage of S. aureus is a well-defined risk factor for subsequent infection in nearly all categories of hospitalized patients that have been studied. However, studies that have been performed to evaluate the effect of eradication of carriage using mupirocin nasal ointment have been inconclusive so far in most subgroups. Only in patients on hemodialysis or chronic ambulatory peritoneal dialysis (CAPD) was a significant reduction of the infection rate found. But prolonged treatment in these groups carries a risk for the development of resistance. In surgical patients two randomized studies have found an effect on the surgical site infection rate in carriers that, when those studies are combined, was close to being statistically significant (p = 0.06). In non-surgical patients a significant delay in the onset of infection was found but the overall infection rate was not significantly different. When the results of all well-designed studies that have been performed are combined, a significant reduction of the nosocomial S. aureus infections in carriers is found (approximately 50% lower). Future studies should focus on treating carriers only and consider other treatment regimens.

Topics: Anti-Bacterial Agents; Carrier State; Cost-Benefit Analysis; Cross Infection; Humans; Nasal Mucosa; Nose; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcal Vaccines; Staphylococcus aureus

The current literature indicates that surgical-site infections significantly increase costs and length of stay. Nosocomial infections that are acquired after operative procedures increase mortality rates. Staphylococcus aureus is a major cause of surgical-site infections among patients, particularly patients who undergo cardiothoracic surgery. Patients who carry S aureus in their nares are at increased risk for surgical-site infections that are caused by this organism. Occasionally, health care workers who carry S aureus in their nares can cause outbreaks of surgical-site infections or other nosocomial infections. Persons who carry S aureus in their nares and have upper respiratory tract infections may spread this organism to numerous staff members and patients. Key measures for decreasing rates of these and other nosocomial infections include the appropriate use of prophylactic antimicrobial agents, surveillance and reporting of infections, and surveillance for clusters of infection caused by the same strain of S aureus and culture and surveys, when appropriate, to help identify infected health care workers. Additionally, surgical masks may prevent health care workers from inadvertent transmission of S aureus from their nares to patients' surgical sites.

Topics: Cardiac Surgical Procedures; Carrier State; Cross Infection; Humans; Infectious Disease Transmission, Professional-to-Patient; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Health care-related infections cause significant patient morbidity and mortality rates and add excess costs that frequently are not reimbursed. Staphylococcus aureus has long been recognized as an important pathogen in human disease and is the most common cause of nosocomial infections.. The objective of this review of the English language literature and a MEDLINE search was to describe recent advances in the prevention of S aureus health care-related infections that are attributable to patients' endogenous colonization. The ecologic niche of S aureus is the anterior nares and nasal carriage increases the risk of the development of a surgical-site, lower respiratory tract, or bloodstream infection. S aureus carriers have a 2- to 9-fold increased risk of the development of a surgical-site or intravenous catheter infection.. 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 used most commonly. 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. In a recently published randomized, double-blind, placebo-controlled trial to determine whether intranasal mupirocin reduced the rate of S aureus-infected surgical-site and other S aureus health care-related infections; 4% of S aureus nasal carriers who received mupirocin acquired S aureus health care-related infections compared with 7.7% of S aureus nasal carriers who received placebo (P=.02). The S aureus surgical-site infection rate was not reduced significantly, but carriers who received mupirocin before cardiothoracic or general surgery operations had almost 50% fewer S aureus surgical-site infections than carriers who received placebo. In this setting resistance rarely has been reported.. Given the importance of S aureus nosocomial infections and the increased risk of S aureus nasal carriage in patients with health care-related infections, investigators must study cost-effective strategies to further prevent certain types of health care-related infections or nosocomial infections that occur in specific settings. One potential strategy is to decrease or eliminate S aureus nasal carriage among certain patient populations or in certain healthcare settings.

Topics: Carrier State; Cost-Benefit Analysis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Infection Control; Methicillin Resistance; Microbial Sensitivity Tests; Nose; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus; Vancomycin Resistance; Wounds and Injuries

Methicillin-resistant Staphylococcus aureus (MRSA) has become a major nosocomial pathogen in many hospitals worldwide. Even more alarming, MRSA strains that are vancomycin intermediate-susceptible are isolated with increasing frequency, making therapy for staphylococcal infections even more difficult and prevention more important than ever. Spread of S. aureus in hospitals and infection control measures are reviewed. The major sources of S. aureus in hospitals are septic lesions and carriage sites of patients and personnel. Carriage often precedes infection. The anterior nares are the most consistent carriage site, followed by the perineal area. Skin contamination and aerial dissemination vary markedly between carriers and are most pronounced for combined nasal and perineal carriers. The principal mode of transmission is via transiently contaminated hands of hospital personnel. Airborne transmission seems important in the acquisition of nasal carriage. Infection control strategies include screening and isolation of newly admitted patients suspected of carrying MRSA or S. aureus with intermediáte resistance to vancomycin, implementation of an infection control program to prevent transmission of resistant strains between patients and hospital personnel, and institution of a proper antibiotic policy to minimize antibiotic resistance development. MRSA carriers should be treated with intranasal antibiotics, e.g. mupirocin, and skin disinfectants to eliminate carriage. Education of hospital personnel is essential. Improved knowledge about the best ways to ensure favourable infection control practices is needed. Active intervention against the spread of MRSA is important.

Topics: Carrier State; Cost-Benefit Analysis; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Infection Control; Methicillin Resistance; Nose; Staphylococcal Infections; Staphylococcus aureus; Vancomycin Resistance

Topics: Animals; Carrier State; Communicable Diseases; Cross Infection; Humans; Nose; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Nasal carriage by health care workers represents an important hospital reservoir of Staphylococcus aureus. Approximately 25% of all hospital-based healthcare workers are stable nasal carriers. Several studies in the US and UK have shown that following treatment of this group with a single 5-day course of intranasal mupirocin, nasal carriage was usually eradicated within 24 hours, and after 12 weeks was only present in 25% of participants. Long-term follow-up in one institution after 52 weeks showed that there were significantly fewer carriers in the mupirocin group than in the group receiving identical placebo. In the same study, between 30% and 50% of those hospital workers who carried S. aureus in their nose, before the start of therapy, were also hand carriers. After treatment, a dramatic reduction in hand carriage of S. aureus was noted, in contrast to no change in the placebo group. After 6 months, the level of hand carriage was still statistically lower in the mupirocin group than in those given placebo. The association between nasal carriage and hand carriage makes it important that health care workers decontaminate their hands effectively between patients. Current evidence suggests, however, that compliance with such control measures is low. Other studies examining the role of S. aureus nasal carriage in the development of post-operative wound infection, have shown that almost half of those isolates recovered from the wound site were present in the nose of the patient pre-operatively. Due to its ability to eliminate nasal carriage of S. aureus, current studies are investigating whether intranasal mupirocin can prevent post-operative wound infections in patients undergoing surgery.

Topics: Cross Infection; Hand; Health Personnel; Humans; Incidence; Methicillin Resistance; Mupirocin; Nose; Staphylococcal Infections; Surgical Wound Infection; United States

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Bacteria; Cross Infection; Digestive System; Drug Resistance, Microbial; Female; Host-Parasite Interactions; Humans; Infections; Nose; Oropharynx; Skin; Vagina; Yeasts

Topics: Air Microbiology; Antisepsis; Bacteria; Bacterial Infections; Blood Bactericidal Activity; Cross Infection; Equipment and Supplies, Hospital; Humans; Length of Stay; Mouth; Nose; Skin; Surgical Wound Infection; Urinary Catheterization; Urinary Tract Infections; Urology

Low hand-hygiene compliance (HHC) in low-income countries due to deficient hand hygiene resources may increase nasal carriage of S. aureus, a causative agent of health care-associated infections. The study aimed to assess the effect of using locally available portable alcohol-based handrub (ABHR) regarding nurses' HHC and nasal carriage of S. aureus.. Nonrandomized interventional design. Seventy-two (72) of 86 nurses were provided with portable ABHR to use during patient care (intervention group). The remaining 14 nurses constituted the control group. Evaluation was done via HHC observation per WHO 5-moments of HH, determining S. aureus nasal carriage prevalence and HH guideline knowledge assessment via a self-response questionnaire.. In the intervention group, HHC improved from 48.9% to 67.7% (P < .001) especially for hand-hygiene before and after patient contact. Hand-hygiene by handrubbing improved from 16 to 105 moments. There was positive feedback to portable ABHR use from nurses. S. aureus nasal carriage significantly decreased from 30.6% to 21% (P < .031). Negative carriage of S. aureus was significantly associated with increase in HHC (P < .001). Despite the low preintervention HHC, nurses showed considerably high levels of knowledge on relevance of hand hygiene.. Portable ABHR use was associated with improved HHC and reduced S. aureus nasal carriage prevalence. As nurses' knowledge of HH guidelines was high, provision of portable ABHR compensated for deficient facility HH resources resulting in improved HHC, which effected reduction in nasal carriage of S. aureus among nurses.

Topics: Adult; Cross Infection; Ethanol; Female; Guideline Adherence; Hand Hygiene; Hand Sanitizers; Humans; Longitudinal Studies; Male; Nose; Nursing Staff, Hospital; Staphylococcus aureus; Zimbabwe

Smoking increases hospitalization and healthcare-associated infection. Our primary aim of this pilot, randomized-controlled trial was to examine the feasibility and acceptability of a tobacco cessation intervention compared with usual care in inpatients. S. aureus carriage, healthcare-associated infections and infections post discharge were exploratory outcomes.. Current inpatient smokers from a university hospital facility were randomized to usual care or a face to face tobacco cessation counseling session where patients' tobacco use and strategies for quitting were discussed. Patient engagement, satisfaction and withdrawal symptoms were measured at 1 week and 12 weeks post discharge. Nasal swabs were collected at enrollment and discharge and assessed for S. aureus colonization. P-values were calculated using Fisher's exact and t-tests were used to compare groups.. For the study's primary outcome, participants reported the intervention as being generally acceptable and reported high overall levels of satisfaction, with a Likert scale score of at least 4/5 for all measures of satisfaction. No subjects utilized free tobacco cessation services after discharge. 83 % of the intervention group and 93 % of the control group smoked at least one cigarette after discharge. Secondary outcomes with regard to infections showed that, at discharge, 12 % of the intervention group (n = 17) and 18 % of the control group (n = 22) tested positive for S. aureus. After 3 months, 9 % of the intervention group developed infection, 41 % visited an emergency room, and 24 % were readmitted within 3 months post-discharge, compared to 27, 32 and 36 % of the control group respectively.. With regards to the primary aim of this study, there were overall high levels of satisfaction with the intervention, indicating good feasibility and acceptance among patients. However, more intensive interventions in hospitalized patients and impact on healthcare-associated infections and post-discharge infections should be explored.

Topics: Adult; Cross Infection; Feasibility Studies; Female; Humans; Inpatients; Male; Middle Aged; Nose; Patient Satisfaction; Pilot Projects; Smoking Cessation; Staphylococcal Infections; Substance Withdrawal Syndrome; Wisconsin

We tested infection prevention strategies to limit exposure of long-term care facility residents to drug-resistant pathogens in a prospective, cluster randomized 2-year trial involving 3 long-term care facilities (LTCFs) using methicillin-resistant Staphylococcus aureus (MRSA) as a model. We hypothesized that nasal MRSA surveillance using rapid quantitative polymerase chain reaction and decolonization of carriers would successfully lower overall MRSA colonization. In year 1, randomly assigned intervention units received decolonization with nasal mupirocin and chlorhexidine bathing and enhanced environmental cleaning with bleach every 4 months. Newly admitted MRSA nares-positive residents were decolonized on admission. Control units were screened but not decolonized. All units received periodic bleach environmental cleaning and instruction on hand hygiene. In year 2, all units followed intervention protocol caused by failure of the cluster randomized approach to sufficiently segregate patients. MRSA colonization was monitored using point prevalence testing every 4-6 months. Colonization status at admission and discharge was performed 1 quarter per year to determine acquisition. Fisher exact test was used for statistical analysis. Baseline MRSA colonization rate was 16.64%. In year 1, the colonization rate of intervention units was 11.61% (P = .028) and 17.85% in control units (P = .613) compared with baseline. Intervention unit rate difference compared with the controls was significant (P = .001). In year 2, the colonization rate was 10.55% (P < .001) compared with baseline. The transmission rates were 1.66% and 3.52% in years 1 and 2, respectively (P = .034). The planned interventions of screening and decolonization were successful at lowering MRSA colonization.

Topics: Anti-Bacterial Agents; Carrier State; Chlorhexidine; Cross Infection; Disinfectants; Infection Control; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Mupirocin; Nose; Nursing Homes; Prospective Studies; Sodium Hypochlorite; Staphylococcal Infections

To compare an interventional protocol with a standard protocol for preventing the acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in the intensive care unit (ICU).. Prospective, randomized, controlled, parallel-group, nonblinded clinical trial.. Medical ICUs of 2 French university hospitals.. Five hundred adults with an expected length of stay in the ICU greater than 48 hours.. For the intervention group, the protocol required repeated MRSA screening, contact and droplet isolation precautions for patients at risk for MRSA at ICU admission and for MRSA-positive patients, and decontamination with nasal mupirocin and chlorhexidine body wash for MRSA-positive patients. For the standard group, the standard precautions protocol was used, and the results of repeated MRSA screening in the standard group were not communicated to investigators.. MRSA acquisition rate in the ICU. An audit was conducted to assess compliance with hygiene and isolation precautions.. In the intent-to-treat analysis ([Formula: see text]), the MRSA acquisition rate in the ICU was similar in the standard (13 [5.3%] of 243) and intervention (16 [6.5%] of 245) groups ([Formula: see text]). The audit showed that the overall compliance rate was 85.5% in the standard group and 84.1% in the intervention group ([Formula: see text]), although compliance was higher when isolation precautions were absent than when they were in place (88.2% vs 79.1%; [Formula: see text]). MRSA incidence rates were higher without isolation precautions (7.57‰) than with isolation precautions (2.36‰; [Formula: see text]).. Individual allocation to MRSA screening, isolation precautions, and decontamination do not provide individual benefit in reducing MRSA acquisition, compared with standard precautions, although the collective risk was lower during the periods of isolation.. Clinicaltrials.gov identifier: NCT00151606.

Topics: Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Female; France; Guideline Adherence; Hospitals, Teaching; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Patient Isolation; Staphylococcal Infections

The multicenter, cluster-randomized Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) trial was performed in 18 U.S. adult intensive care units (ICUs). It evaluated the effectiveness of infection control strategies to reduce the transmission of methicillin-resistant Staphylococcus aureus (MRSA) colonization and/or infection. Our study objective was to examine the molecular epidemiology of MRSA and assess the prevalence and risk factors for community acquired (CA)-MRSA genotype nasal carriage at the time of ICU admission.. Selected MRSA isolates were subjected to molecular typing using pulsed-field gel electrophoresis.. Of 5,512 ICU patient admissions in the STAR*ICU trial during the intervention period, 626 (11%) had a nares sample culture result that was positive for MRSA. A total of 210 (34%) of 626 available isolates were selected for molecular typing by weighted random sampling. Of 210 patients, 123 (59%) were male; mean age was 63 years. Molecular typing revealed that 147 isolates (70%) were the USA100 clone, 26 (12%) were USA300, 12 (6%) were USA500, 8 (4%) were USA800, and 17 (8%) were other MRSA genotypes. In a multivariate analysis, patients who were colonized with a CA-MRSA genotype (USA300, USA400, or USA1000) were less likely to have been hospitalized during the previous 12 months (PR [prevalence ratio], 0.39 [95% confidence interval (CI), 0.21-0.73]) and were less likely to be older (PR, 0.97 [95% CI, 0.95-0.98] per year) compared with patients who were colonized with a healthcare-associated (HA)-MRSA genotype.. CA-MRSA genotypes have emerged as a cause of MRSA nares colonization among patients admitted to adult ICUs in the United States. During the study period (2006), the predominant site of CA-MRSA genotype acquisition appeared to be in the community.

Topics: Adult; Aged; Aged, 80 and over; Carrier State; Community-Acquired Infections; Cross Infection; Female; Genotype; Humans; Infection Control; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Multivariate Analysis; Nose; Patient Admission; Prevalence; Risk Factors; Staphylococcal Infections; United States; Young Adult

The aim of this cluster randomised controlled trial was to test the impact of an infection control education and training programme on meticillin-resistant Staphylococcus aureus (MRSA) prevalence in nursing homes. Nursing homes were randomised to intervention (infection control education and training programme; N=16) or control (usual practice continued; N=16). Staff in intervention homes were educated and trained (0, 3 and 6 months) in the principles and implementation of good infection control practice with infection control audits conducted in all sites (0, 3, 6 and 12 months) to assess compliance with good practice. Audit scores were fed back to nursing home managers in intervention homes, together with a written report indicating where practice could be improved. Nasal swabs were taken from all consenting residents and staff at 0, 3, 6 and 12 months. The primary outcome was MRSA prevalence in residents and staff, and the secondary outcome was a change in infection control audit scores. In all, 793 residents and 338 staff were recruited at baseline. MRSA prevalence did not change during the study in residents or staff. The relative risk of a resident being colonised with MRSA in an intervention home compared with a control home at 12 months was 0.99 (95% confidence interval: 0.69, 1.42) after adjustment for clustering. Mean infection control audit scores were significantly higher in the intervention homes (82%) compared with the control homes (64%) at 12 months (P<0.0001). Consideration should be given to other approaches which may help to reduce MRSA in this setting.

Topics: Aged; Aged, 80 and over; Carrier State; Cross Infection; Education, Medical; Female; Guideline Adherence; Humans; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Nursing Homes; Prevalence; Staphylococcal Infections

Staphylococcus aureus is a common cause of postoperative wound infections, and nasal colonization by this organism is an important factor in the development of infections. Treatment with mupirocin can eradicate the organism in the short term, and prophylactic treatment of colonized patients may prevent postoperative S. aureus infections. A double-blind, randomized, placebo-controlled trial was performed to determine whether nasal mupirocin administered pre-operatively to S. aureus carriers reduces the rates of sternal and leg wound infections after cardiac surgery. The study enrolled 263 patients with nasal S. aureus undergoing elective cardiac surgery at St. Michael's Hospital, Toronto, Canada. Patients were assessed for infections in the immediate postoperative period and two months later. Two hundred and fifty-seven patients were included in the intention-to-treat analysis and re-analysed according to the actual treatment applied. Wound infections occurred in 17 (13.5%) mupirocin recipients and 11 (9.1%) placebo recipients (P=0.319), with seven (5.4%) and six (4.7%) sternal infections, respectively. Two (1.6%) wound infections were acquired postoperatively in the mupirocin group, neither of which were caused by S. aureus. The placebo group had three (2.4%) nosocomial wound infections, with two (1.6%) S. aureus bacteraemias (P=0.243). Among patients receiving mupirocin, 106 (81.5%) cleared S. aureus compared with 59 (46.5%) patients receiving placebo (P<0.0001). There was no significant difference between intention-to-treat and actual treatment groups. Prophylactic intranasal mupirocin administered to S. aureus carriers did not reduce the rates of overall surgical site infections by S. aureus, and only showed a trend towards decreased incidence of nosocomial S. aureus infections.

Topics: Administration, Cutaneous; Anti-Bacterial Agents; Carrier State; Coronary Artery Bypass; Cross Infection; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Preoperative Care; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Treatment Outcome

Staphylococcus aureus nasal carriage is a major risk factor for nosocomial S. aureus infection. Studies show that intranasal mupirocin can prevent nosocomial surgical site infections. No data are available on the efficacy of mupirocin in nonsurgical patients.. To assess the efficacy of mupirocin prophylaxis in preventing nosocomial S. aureus infections in nonsurgical patients.. Randomized, double-blind, placebo-controlled trial.. 3 tertiary care academic hospitals and 1 nonacademic hospital.. 1602 culture-proven S. aureus carriers hospitalized in nonsurgical departments.. Therapy with mupirocin 2% nasal ointment (n = 793) or placebo ointment (n = 809), twice daily for 5 days, started 1 to 3 days after admission.. Nosocomial S. aureus infections according to defined criteria, in-hospital mortality, duration of hospitalization, and time to nosocomial S. aureus infection. Staphylococcus aureus isolates were genotyped to assess whether infection was caused by endogenous strains.. The mupirocin and placebo groups did not statistically differ in the rates of nosocomial S. aureus infections (mupirocin, 2.6%; placebo, 2.8%; risk difference, 0.2 percentage point [95% CI, -1.5 to 1.9 percentage points]), mortality (mupirocin, 3.0%; placebo, 2.8%; risk difference, -0.2 percentage point [CI, -1.9 to 1.5 percentage points]), or duration of hospitalization (median for both, 8 days). However, time to nosocomial S. aureus infection was decreased in the mupirocin group from 12 to 25 days (P > 0.2). A total of 77% of S. aureus nosocomial infections were endogenous.. A few infections in both groups may have been missed because investigators assessed a patient for infection only if microbiology culture results were positive for S. aureus.. Routine culture for S. aureus nasal carriage at admission and subsequent mupirocin application does not provide effective prophylaxis against nosocomial S. aureus infections in nonsurgical patients.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Double-Blind Method; Female; Genotype; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Staphylococcus aureus is the agent of community-acquired and nosocomial infections. Twenty to 35% of the population permanently carries it in the nose and oropharynx, and additional 50%, carries it intermittently. Topical calcium mupirocin is an antibacterial agent against Staphylococcus aureus recommended to eradicate nasal and hand colonization in patients and health care workers. The prevalence of nasal S. aureus was determined in patients undergoing cardiovascular surgery. In addition, the effect of mupirocine on the number of carriers and rate of nosocomial infections was evaluated. An experimental prospective study was undertaken with two groups of patients: one treated with mupirocin (n = 96), and the other without treatment (n = 95). Tests for presence of nasal S. aureus and nosocomial infections were conducted in all patients. A 34% prevalence of S. aureus carriers was found. A decrease of the prevalence was found in both treated (87%) and untreated patients (33%), but in significantly different proportions (p = 0.0002, RR = 0.22, 95%CI = 0.09-0.054). This result demonstrated the effectiveness of a mupirocin treatment program to decrease numbers of nasal carriers. With regard to nosocomial infection, S. aureus prevalence was 3.6%, occurring mostly in control patients (6 of 7). Total nosocomial infection prevalence was 17.3%, evenly distributed in treated and untreated patients. This suggested that mupirocin use did not decrease the number of nosocomial infections.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Female; Humans; Male; Middle Aged; Mupirocin; Nasal Mucosa; Nose; Prevalence; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical-site infections caused by that organism. Treatment with mupirocin ointment can reduce the rate of nasal carriage and may prevent postoperative S. aureus infections.. We conducted a randomized, double-blind, placebo-controlled trial to determine whether intranasal treatment with mupirocin reduces the rate of S. aureus infections at surgical sites and prevents other nosocomial infections.. Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3 percent of mupirocin recipients and 2.4 percent of placebo recipients had S. aureus infections at surgical sites. Of the 891 patients (23.1 percent of the 3864 who completed the study) who had S. aureus in their anterior nares, 444 received mupirocin and 447 received placebo. Among the patients with nasal carriage of S. aureus, 4.0 percent of those who received mupirocin had nosocomial S. aureus infections, as compared with 7.7 percent of those who received placebo (odds ratio for infection, 0.49; 95 percent confidence interval, 0.25 to 0.92; P=0.02).. Prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall, but it did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Double-Blind Method; Female; Humans; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

The action of mupirocin as a nasal ointment (Bactroban) was studied on intranasal carriers of the hospital staphylococcal strains. The study included 37 medical workers from different and mainly problem units of the large general hospital. The tolerability of the ointment was good. After the Bactroban use no complications of the patients were recorded. The efficacy of Bacroban by the microbiological criteria in total amounted to 100 per cent. The eradication of methicillin resistant Staphylococcus aureus (MRSA) was observed in 93 per cent of the cases. A decrease of the level of the nasal passages dissemination by MRSA and methicillin resistant coagulase-negative staphylococci (MRSC) up to such low titers as 100 and 90 per cent was stated. No difference in the action of Bactroban on MRSA, MSSA and MRSC was noted. The bacteriological monitoring for 3 to 4 months revealed a change of the staphylococcal strains in 94 per cent of the cases, recolonization by the same staphylococcal strain in 19 per cent, recolonization by some another staphylococcal strains in 33 per cent and no recolonization in 14 per cent. A stable decrease of staphylococcal strains was possible with simultaneous Bactroban sanitation of all the bacterial carriers of the hospital or its isolated unit.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Medical Staff, Hospital; Microbial Sensitivity Tests; Mupirocin; Nose; Nose Diseases; Staphylococcal Infections; Staphylococcus

The combination of a 4% tea tree oil nasal ointment and 5% tea tree oil body wash was compared with a standard 2% mupirocin nasal ointment and triclosan body wash for the eradication of methicillin-resistant Staphylococcus aureus carriage. The tea tree oil combination appeared to perform better than the standard combination, although the difference was not statistically significant due to the small number of patients.

Topics: Administration, Cutaneous; Adult; Aged; Aged, 80 and over; Anti-Infective Agents, Local; Carrier State; Cross Infection; Female; Humans; Male; Methicillin Resistance; Middle Aged; Nose; Pilot Projects; Staphylococcal Infections; Tea Tree Oil

To assess the impact of the use of mupirocin ointment on colonization, transmission, and infection with methicillin-resistant Staphylococcus aureus (MRSA) in a long-term-care facility.. All 321 residents of a Veterans Affairs long-term-care facility from June 1990 through June 1991 were studied for MRSA colonization and infection. MRSA-colonized patients received mupirocin ointment to nares in the first 7 months and to nares and wounds in the second 5 months. The effect of mupirocin use on MRSA colonization and infection was monitored. All S. aureus strains isolated were tested for the development of resistance to mupirocin.. A total of 65 patients colonized with MRSA received mupirocin ointment. Mupirocin rapidly eliminated MRSA at the sites treated in most patients by the end of 1 week. Weekly maintenance mupirocin was not adequate to prevent recurrences--40% of patients had recurrence of MRSA. Overall, MRSA colonization in the facility, which was 22.7% +/- 1% prior to the use of mupirocin, did not change when mupirocin was used in nares only (22.2% +/- 2.1%), but did decrease to 11.5% +/- 1.8% when mupirocin was used in nares and wounds. Although colonization decreased, roommate-to-roommate transmission and MRSA infection rates, low to begin with, did not change when mupirocin was used. Mupirocin-resistant MRSA strains were isolated in 10.8% of patients.. Mupirocin ointment is effective at decreasing colonization with MRSA. However, constant surveillance was required to identify patients colonized at admission or experiencing recurrence of MRSA during maintenance treatment. Long-term use of mupirocin selected for mupirocin-resistant MRSA strains. Mupirocin should be saved for use in outbreak situations, and not used over the long term in facilities with endemic MRSA colonization.

Topics: Aged; Carrier State; Cross Infection; Female; Humans; Incidence; Infection Control; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Prevalence; Recurrence; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Nosocomial maxillary sinusitis during mechanical ventilation may cause life-threatening complications in ICU patients. The aim of this prospective study was to compare the incidence of maxillary sinusitis according to the route of intubation. 111 consecutive adult patients (mean age: 53, mean SAPS: 12) were randomly assigned to receive either orotracheal (n = 53) or nasotracheal (n = 58) intubation. All had a nasogastric feeding tube. Patients with head trauma or mechanical ventilation for less than 48 h were excluded. Sinusitis diagnosis was made by radiography (waters' view) at the bedside. The two groups were similar in age, SAPS, duration of ventilation. Maxillary sinusitis occurred in 1/53 (1.8%) of the orotracheal group (on the nasogastric tube side), and in 25/58 (43.1%) of the nasotracheal group (7 on the nasogastric tube side, 11 on the endotracheal tube side, 7 bilateral; p less than 0.001). Nine of the 26 cases of sinusitis were initially treated by sinus drainage because of signs of infection (3 failures) and the 17 others were treated by tube removal. This procedure proved successful in 12 out of 17 cases but secondary drainage was performed in 5 cases (1 failure). Incidents related to the route for long-term intubation were significantly (p less than 0.001) more frequent in the orotracheal group (8/53 vs 2/58), however no patient died because of them. In this study, long-term orotracheal intubation reduced significantly the incidence of maxillary sinusitis in comparison with nasotracheal intubation.

Topics: Aged; Cross Infection; Humans; Incidence; Intubation, Intratracheal; Maxillary Sinusitis; Middle Aged; Mouth; Nose; Prospective Studies; Radiography; Respiration, Artificial

We conducted a randomized study to evaluate the effect of gowning by visitors and hospital personnel on a postpartum ward on nose and umbilical colonization and disease in healthy newborn infants. Cultures were obtained in infants assigned to the gowning and nongowning groups within 6 hours of birth from the anterior part of the nares and the base of the umbilicus and at the time of discharge from the nursery. There were 102 infants in the gowning group and 100 infants in the nongowning group. No significant differences were noted between the two groups with respect to sex, length of stay, mode of delivery, weight, or status of nursery admission culture results. The use of gowns on a postpartum ward failed to decrease nose or umbilical colonization when compared with infants in the nongowning group. Seventy (68.6%) of 102 infants in the gowning group and 65 (65%) of 100 infants in the nongowning group had negative umbilical cord cultures on admission to the nursery that became positive at discharge. On follow-up, no differences were noted between the two groups with respect to their health. Only one infant in each group had an infection develop in the first 4 weeks of life. We conclude that the routine use of cover gowns on postpartum units in healthy full-term infants is ineffective and costly. It may discourage health care providers from examining patients and providing care.

Topics: Cross Infection; Female; Humans; Infant, Newborn; Male; Nose; Personnel, Hospital; Postpartum Period; Protective Clothing; Random Allocation; Umbilical Cord; Visitors to Patients

Mupirocin eliminates nasal carriage of Staphylococcus aureus among medical and surgical personnel for periods varying from several weeks up to one year. In persons recolonized after therapy densities of S. aureus populations in nares were much lower than in the same persons before therapy.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Double-Blind Method; Fatty Acids; Humans; Mupirocin; Nose; Personnel, Hospital; Poland; Staphylococcal Infections

The role of gastric microbial colonization in nosocomial infections and endotoxemia was investigated prospectively in 40 neurosurgical patients requiring mechanical ventilation for greater than 48 h. Each was studied up to 7 d. Swabs from the nose and oropharynx were cultured at admission, and aspirates from the stomach and trachea were cultured daily until enteral alimentation was started. Patients were evaluated every second day for endotoxemia and coagulation activation. Of 153 gastric aspirates, 66.7% contained microorganisms at a mean quantity of 10(7) cfu/ml. Nosocomial pneumonia occurred in 15 patients, septicemia in 5, and meningitis in 1. The stomach was the evident source of infection in only 1 patient with pneumonia. Of 140 plasma samples, 12 (8.6%) from 10 patients showed detectable endotoxin levels, but there was no association between endotoxemia or coagulation activation and the presence of microorganisms in the stomach. The stomach was not an important source for nosocomial infections or endotoxemia, even in patients with high gastric pH.

Topics: Adult; Bacteria; Bacterial Infections; Candida; Cross Infection; Female; Humans; Male; Neurosurgery; Nose; Oropharynx; Prospective Studies; Respiration, Artificial; Stomach; Toxemia; Trachea

In a prospective randomized study different regimens for skin and umbilical disinfection in newborn infants were tested: daily whole body soap wash (control group), daily whole body soap wash and umbilical cleansing with (i) benzine solution, or (ii) 0.05% chlorhexidine, and daily whole body wash and umbilical cleansing with a 4% chlorhexidine detergent solution (Hibiscrub). Bacterial cultures were taken from the nose and umbilical area at discharge. Clinical infections were registered in the nursery, and after discharge until 6 weeks of age. Cultures were taken from infected areas. In the control group a high colonization rate was found for S. aureus (91%), E. coli (39%), and group B streptococci (GBS) (20%). The colonization rates were influenced by the Hibiscrub regimen (colonization rate for S. aureus 59%, E. coli 23%, and GBS 10%), but not by the other regimens. Infections (pemphigus, paronychia, conjunctivitis, umbilical infection) occurred in 12.9% of the infants, of whom 65% got infection after discharge from the nursery. 96% of the infections were caused by S. aureus, and 87% caused by strains colonizing the infants in the nursery. None of the tested regimens reduced the rate of infections during the first 6 weeks of life.

Topics: Alkanes; Bacterial Infections; Chlorhexidine; Clinical Trials as Topic; Cross Infection; Disinfectants; Humans; Infant, Newborn; Nose; Prospective Studies; Random Allocation; Skin; Soaps; Umbilicus

Healthcare-associated infections pose a potentially fatal threat to patients worldwide and Staphylococcus aureus is one of the most common causes of healthcare-associated infections. S. aureus is a common commensal pathogen and a frequent cause of bacteremia, with studies demonstrating that nasal and blood isolates from single patients match more than 80% of the time. Here we report on a contemporary collection of colonizing isolates from those with methicillin-resistant S. aureus (MRSA) bloodstream infections to evaluate the diversity within hosts, and detail the clinical features associated with concomitant nasal colonization.. Swabs of the bilateral anterior nares were obtained from patients diagnosed with MRSA bacteremia. A single colony culture from the blood and an average of 6 colonies from the nares were evaluated for MRSA growth. For the nares cultures, we typed multiple isolates for staphylococcal protein A (spa) and derived the clonal complexes. Demographic and clinical data were obtained retrospectively from the electronic medical record system and analysed using univariate and multivariable regression models.. Over an 11-month period, 68 patients were diagnosed with MRSA bloodstream infection, 53 were swabbed, and 37 (70%) were colonized with MRSA in the anterior nares. We performed molecular typing on 213 nasal colonies. Spa types and clonal complexes found in the blood were also detected in the nares in 95% of the cases. We also found that 11% of patients carried more than one clone of MRSA in the nares. Male sex and history of prior hospitalization within the past 90 days increased odds for MRSA colonization.. The molecular epidemiological landscape of colonization in the setting of invasive disease is diverse and defining the interplay between colonization and invasive disease is critical to combating invasive MRSA disease.

Topics: Bacteremia; Carrier State; Cross Infection; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus

During the Covid-19 pandemic every hospital has had to change its internal organization. Different institutions have highlighted the risks connected with endoscopic endonasal surgery. The goal of this paper is to illustrate the feasibility of pituitary region surgery during the SARS-CoV-2 pandemic.. After two negative Covid tests were obtained, three patients with macro GH-secreting tumors, and two patients with micro ACTH-secreting tumors resistant to medical treatment underwent surgery during the pandemic. During the surgery, every patient was treated as if they were positive.. Neither operator, nor patient have developed Covid symptoms. The two neurosurgeons performing the operations underwent two Covid swab, which resulted negative.. Pituitary surgery is a high risk non-urgent surgery. However, the method described has so far been effective and is safe for both patients and healthcare providers.

Topics: ACTH-Secreting Pituitary Adenoma; Adenoma; COVID-19; COVID-19 Testing; Cross Infection; Endoscopy; Feasibility Studies; Growth Hormone-Secreting Pituitary Adenoma; Humans; Infection Control; Italy; Neurosurgical Procedures; Nose; Pandemics; Patient Safety; Patient Selection; Protective Clothing; Protective Devices; Retrospective Studies; SARS-CoV-2

Nasal carriage of Staphylococcus aureus by healthcare workers is of great clinical importance as it facilitates the contamination of medical devices and cross-transmission. However, studies regarding the epidemiology and dissemination of S. aureus and Methicillin-resistant S. aureus (MRSA) within the Primary Health Care in Brazil are scarce. The current study aimed to detect and characterize S. aureus and MRSA strains from the nasal cavities of 63 healthcare working in primary health care units in order to determine the prevalence of S. aureus and MRSA, biofilm formation and resistance profile of these isolates. PCR reactions were performed for detecting mecA, icaA and icaD genes. The phenotypic antimicrobial susceptibility was assessed by the disk diffusion method and biofilm formation by the Congo Red Agar (CRA) method. The MRSA isolates were typed for the Staphylococcal Cassette Chromosome mec (SCCmec). The prevalence of nasal carriage of S. aureus was 74.6%, of which 72.3% were MRSA carrying SCCmec type I (24.4%), III (34.1%), IV (36.6%). Two (4.9%) isolates presented a non-typeable cassette by the performed technique. The antimicrobial susceptibility evaluation evidenced penicillin resistance in 66.1% of S. aureus, erythromycin resistance in 49.2%, while 37.3% were resistant to oxacillin, 28.8% to cefoxitin, 5.1% to levofloxacin and 5.1% to clindamycin. All isolates were biofilm producers and 96.6% of the strains contained the ica biofilm-forming genes (icaA and/or icaD). We have demonstrated a high prevalence of S. aureus and MRSA carriage among health care working in Primary Health Care units, the presence of SCCmec types I, III and IV, in addition to their high ability to form biofilm, factors that possibly contribute to the dissemination and persistence of these pathogens within the primary care services. These observations highlight the importance of broadening the perspective of Health Care-Associated Infections prevention, including all health care levels, which are currently little explored. In addition, the dynamics and resistance mechanisms of S. aureus transmission still need to be further clarified to enable the implementation of more effective prevention measures.

Topics: Adult; Anti-Bacterial Agents; Biofilms; Brazil; Carrier State; Cross Infection; Cross-Sectional Studies; Female; Genes, Bacterial; Health Personnel; Humans; Infectious Disease Transmission, Patient-to-Professional; Infectious Disease Transmission, Professional-to-Patient; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Nose; Prevalence; Primary Health Care; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Commensal flora colonization during hospitalization by bacteria is the first step for nosocomial infections while antibiotic resistance reduces therapeutic options. In aim to control this phenomenon, we initiated this study to describe the impact of hospitalization on colonization by methicillin-resistant Staphylococcus aureus in the surgical department of 03 health facilities in the Ndé division, West-Cameroon.. This study was carried out on patients admitted for surgery in 03 health facilities of the Ndé division, West-Cameroon (District Hospital of Bangangté, Protestant Hospital of Bangwa and Cliniques Universitaires des Montagnes). After obtaining ethical clearance and authorizations, nasal swabs were performed at admission and discharge, with the aim of isolating bacteria and performing their antibiotic susceptibility tests. Informations on each participant's antibiotic therapy were recorded. Laboratory investigations were carried out according to standard protocols (CASFM, 2019).. The most commonly used antibiotics were β-lactams. A total of 104 nasal swabs were performed on 52 patients who agreed to participate to the study. From the analysis, 110 (57 at admission versus 53 at discharge) Staphylococcus isolates were obtained. Overall, susceptibility testing showed that antibiotic resistance rates were higher at discharge than at admission; with significant differences between the susceptibility profiles obtained at admission and discharge for β-lactams and not significant for fluoroquinolones and aminoglycosides. Globally, frequency of nasal carriage of methicillin-resistant Staphylococcus aureus at discharge 16 (30.77%) was significantly higher than at admission 07 (13.46%) with Chi-2 = 4.52 and p = 0.0335.. The high rates of antibiotic resistance of bacteria isolated at discharge compared to those isolated at admission obtained in the present investigation, highlights the important role that hospitalization plays in the selection and dissemination of methicillin-resistant Staphylococcus aureus and colonization by these bacteria in health structures of Ndé division. As a result, further investigations to find the factors that promote this phenomenon should be carried out.

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Cameroon; Child; Child, Preschool; Cross Infection; Cross-Sectional Studies; Female; Health Facilities; Hospitalization; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Nose; Staphylococcal Infections; Staphylococcus aureus; Young Adult

High-flow nasal therapy is increasingly used in hospitals because of its effectiveness and patient comfort. However, pathogens in the patient's nasal and oral cavities may be dispersed by forced air. This study aimed to investigate the risk of pathogen dispersal during high-flow nasal therapy. Liquid and bacterial dispersal were assessed via in-vitro experimental set-ups using a manikin. Thickened water or fresh yeast solution mimicked saliva and nasal mucus secretions. Dispersal was limited to the proximal area of the face and nasal cannula, suggesting that high-flow nasal therapy does not increase the risk of droplet and contact infection.

Topics: Air Movements; Cannula; Cross Infection; Environmental Exposure; Humans; Manikins; Nose; Yeasts

Nasal colonization by coagulase-negative Staphylococci (CoNS) play an important role in nosocomial infections. This study aims to determine antibiotics susceptibility pattern and molecular screening of methicillin- and vancomycin-resistant nasal CoNS among hospitalized patients.. Nasal swabs were collected from 202 inpatients at Prince Hamzah Hospital, Jordan. Swabs were processed according to standard microbiological procedures to isolate Staphylococci. Antibiotic susceptibility testing was performed using disk diffusion, E-test, microdilution, and Vitek 2. Molecular analysis was performed using PCR for the detection of mecA, vanA, and vanB genes.. Nasal Staphylococci was isolated in 64/202 (31.7%) samples. Thirty isolates (14.8%) were CoNS, including S. haemolyticus (n = 17, 8.4%), S. sciuri (n = 6, 3%), S. epidermidis (n = 2, 1%), S. warneri (n = 2, 1%), S. hominis (n = 2, 1%), and S. lentus (n = 1, 0.5%). Twenty-two (10.9%) isolates were MR-CoNS harboring mecA gene. CoNS and MR-CoNS isolates were highly resistant to benzylpenicillin, erythromycin, fosfomycin, and imipenem. All isolates were sensitive to vancomycin by E-test and microdilution test and were negative for vanA and vanB genes. Nasal CoNS colonization was associated with an increased number of family members living with the participant (P = 0.04) and with admission to the orthopedic department (P = 0.03), while MR-CoNS colonization was associated with smoking (P = 0.03).. Nasal colonization by unusual CoNS species and mecA-positive MR-CoNS are common among hospitalized patients. Absence of vanA and vanB genes suggests little contribution of nasal CoNS to vancomycin resistance transmission.

Topics: Adult; Aged; Anti-Bacterial Agents; Coagulase; Cross Infection; Cross-Sectional Studies; Drug Resistance, Bacterial; Female; Hospitalization; Humans; Jordan; Male; Methicillin; Microbial Sensitivity Tests; Nose; Staphylococcal Infections; Staphylococcus; Vancomycin

The aim of this study was to detect the frequency of methicillin-resistant Staphylococcus aureus (MRSA) colonization at admission in a group of presumably high-risk international or Turkish patients referred to our center for elective operations, some of whom were from countries with an unknown prevalence of MRSA infection or colonization.. The results of nasal swab screening for MRSA colonization performed using a specific algorithm between 2011 and 2018 in a private medical center were retrospectively reviewed. Presence of MRSA was ascertained using culture and/or real-time polymerase chain reaction (real-time PCR).. A total of 3,795 patients were included in the study. More than half of the patients were ≤19 years of age (2,094, 55.2%), and MRSA positivity was more common among these patients. Turkish patients constituted 24.5% of the study population. International patients were most frequently referred from Iraq (55.92%), Libya (11.44%), Romania (2.69%), and Bulgaria (1.98%). MRSA positivity was significantly more common among patients referred from other countries when compared to Turkish nationals (11.5% vs. 4.4%, P = 0.00001). Countries with the highest prevalence rates of MRSA colonization were as follows with decreasing order: United Arab Emirates, 25.0%; Georgia, 23.1%; Russia, 22.7%; Iraq, 13.0%, Romania, 12.7%. Other countries with high number of admitted patients (>70 patients) had the following MRSA rates: Turkey, 4.4%; Libya, 6.0%; Bulgaria, 5.3%.. Although MRSA has a low prevalence in our center, a variation in the rate of MRSA positivity was observed across patients from different countries. Absence hospital acquired contamination or outbreaks in our institution may be attributed to the screening algorithm used and underscores the importance of risk analysis for patients referred from geographical locations with unknown MRSA frequency, to reduce the risk of transmission.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Load; Bulgaria; Child; Child, Preschool; Cross Infection; Female; Hospitalization; Human Migration; Humans; Infant; Iraq; Libya; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Polymerase Chain Reaction; Prevalence; Risk Factors; Romania; Staphylococcal Infections; Tourism; Turkey; United Arab Emirates; Young Adult

Carriage of Staphylococcus aureus is associated with S aureus infection. However, associations between S aureus carriage and the development of S aureus intensive care unit (ICU) pneumonia (SAIP) have not been quantified accurately, and interpretation of available data is hampered because of variations in definitions.. To quantify associations of patient-related and contextual factors, including S aureus colonization status, with the occurrence of SAIP.. This cohort study was conducted in ICUs of 30 hospitals in 11 European countries, geographically spread across 4 regions. Among patients with an anticipated length of stay 48 hours or longer who were undergoing mechanical ventilation at ICU admission, S aureus colonization was ascertained in the nose and lower respiratory tract. From this group, S aureus-colonized and noncolonized patients were enrolled into the study cohort in a 1:1 ratio. Data analysis was performed from May to November 2019.. SAIP was defined as any pneumonia during the ICU stay developing 48 hours or more after ICU admission with S aureus isolated from lower respiratory tract specimens or blood samples. The incidence of SAIP was derived in the study cohort and estimated on the weighted incidence calculation for the originating overarching population, while taking competing events into account. Weighted risk factor analysis was performed using Cox multivariable regression.. The study cohort consisted of 1933 patients (mean [SD] age, 62.0 [16.0] years); 1252 patients (64.8%) were men, and 950 patients (49.1%) were S aureus carriers at ICU admission. In all, 304 patients (15.7%) developed ICU-acquired pneumonia, of whom 131 patients (6.8%) had SAIP. Weighted SAIP incidences were 11.7 events per 1000 patient-days in the ICU for S aureus-colonized patients and 2.9 events per 1000 patient-days in the ICU for noncolonized patients (overall incidence, 4.9 events per 1000 patient-days in the ICU). The only factor independently associated with SAIP was S aureus colonization status at ICU admission (cause-specific hazard ratio, 3.6; 95% CI, 2.2-6.0; P < .001). There were marked regional differences in SAIP incidence and cause-specific hazard ratios for colonization status.. SAIP incidence was 4.9 events per 1000 ICU patient-days for patients undergoing mechanical ventilation at ICU admission (or shortly thereafter). The daily risk of SAIP was 3.6 times higher in patients colonized with S aureus at ICU admission compared with noncolonized patients.

Topics: Cohort Studies; Colony Count, Microbial; Cross Infection; Diagnostic Tests, Routine; Europe; Female; Hospitalization; Humans; Incidence; Intensive Care Units; Male; Middle Aged; Nose; Outcome Assessment, Health Care; Pneumonia, Staphylococcal; Respiratory System; Risk Assessment; Staphylococcus aureus

Surveillance of current changes in the epidemiology of Invasive Fungal Diseases (IFDs) as an important component of the antifungal stewardship programs (ASP), requires careful regular monitoring, especially in high-risk settings such as oncology centers. This study aimed to examine Candida colonization status and corresponding current changes in children with malignancy during repeated admissions and also investigate the possible epidemiological shifts after the implementation of ASP.. In this prospective observational study, all eligible patients younger than 18 years were recruited during 2016-2017 at Amir Medical Oncology Center (AMOC) in Shiraz, Iran. Totally, 136 patients were enrolled and 482 samples were collected from different sites (oral/nasal discharges, urine and stool). Weekly regular sampling was carried out during hospitalization. Candida colonization status and epidemiological changes were monitored during repeated admissions. Samples were cultivated on Sabouraud Dextrose agar medium and identified by Polymerase Chain Reaction -Restriction Fragment Length Polymorphism (PCR-RFLP).. Estimated Candida colonization incidence was 59.9% (82/136) in our patients. Candida colonization was found to be higher in oral cavity and rectum than that in nasal cavity. Among those long-term follow ups and repetitive hospitalizations, a significant number of patients exhibited changes in their colonization patterns (37.7%). Candida colonization did not reveal any significant relationship with age, sex, oncologic diseases and degree of neutropenia. C. albicans (72.0%) was found as the most common Candida species in colonized patients, followed by C. krusei, C. kefyr, C. glabrata and C. parapsilosis.. Given the high incidence of Candida infections in children with cancers, close monitoring of epidemiologic changes is essential for judicious management, based on local surveillance data and improvement of overall quality of care in high risk patients.

Topics: Adolescent; Candida; Candidiasis; Child; Child, Preschool; Cross Infection; Female; Hematologic Neoplasms; Hospitalization; Humans; Incidence; Iran; Male; Mouth; Nose; Patient Readmission; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Prospective Studies; Rectum; Recurrence

Healthcare personnel (HCP) acquire antibiotic-resistant bacteria on their gloves and gowns when caring for intensive care unit (ICU) patients. Yet, contact precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA) remains controversial despite existing guidelines. We sought to understand which patients are more likely to transfer MRSA to HCP and to identify which HCP interactions are more likely to lead to glove or gown contamination.. This was a prospective, multicenter cohort study of cultured HCP gloves and gowns for MRSA. Samples were obtained from patients' anterior nares, perianal area, and skin of the chest and arm to assess bacterial burden.. Among 402 MRSA-colonized patients with 3982 interactions, we found that HCP gloves and gowns were contaminated with MRSA 14.3% and 5.9% of the time, respectively. Contamination of either gloves or gowns occurred in 16.2% of interactions. Contamination was highest among occupational/physical therapists (odds ratio [OR], 6.96; 95% confidence interval [CI], 3.51, 13.79), respiratory therapists (OR, 5.34; 95% CI, 3.04, 9.39), and when any HCP touched the patient (OR, 2.59; 95% CI, 1.04, 6.51). Touching the endotracheal tube (OR, 1.75; 95% CI, 1.38, 2.19), bedding (OR, 1.43; 95% CI, 1.20, 1.70), and bathing (OR, 1.32; 95% CI, 1.01, 1.75) increased the odds of contamination. We found an association between increasing bacterial burden on the patient and HCP glove or gown contamination.. Gloves and gowns are frequently contaminated with MRSA in the ICU. Hospitals may consider using fewer precautions for low-risk interactions and more for high-risk interactions and personnel.

Topics: Anal Canal; Bacterial Load; Cross Infection; Drug Resistance, Multiple, Bacterial; Equipment Contamination; Gloves, Protective; Health Personnel; Humans; Infection Control; Infectious Disease Transmission, Patient-to-Professional; Intensive Care Units; Methicillin-Resistant Staphylococcus aureus; Nose; Patients; Prospective Studies; Protective Clothing; Skin; Staphylococcal Infections

We have noticed that patients colonized with methicillin-susceptible Staphylococcus aureus (MSSA) rarely get methicillin-resistant S. aureus (MRSA) infections. The purpose of this study was to compare the odds of a Staphylococcus aureus (SA) infection being an MRSA infection in MSSA carriers, MRSA carriers and non-carriers of SA.. Hospitalizations of adult patients at the Cleveland Clinic Health System from 2008 to 2015 were screened to identify those where the patient was tested for SA colonization. The first such hospitalization was identified. Among these 90 891 patients, those who had an SA infection during the hospitalization were included. SA carrier status (MRSA, MSSA, or non-carrier), was defined based on the first nasal SA test result. The association of carrier status and MRSA infection was examined.. The mean (±standard deviation (SD)) age of the 1999 included patients was 61 (17) years, and 1160 (58%) were male. Thirty percent, 26%, and 44%, were MRSA carriers, MSSA carriers and non-carriers, respectively. Of the 601 SA infections in MRSA carriers (reference group), 552 (92%) were MRSA infections compared with 42 (8%) of 516 in MSSA carriers (odds ratio (OR) 0.008, 95% confidence interval (CI) 0.005-0.012, p <0.0001) and 430 (49%) of 882 in non-carriers (OR 0.072, 95% CI 0.051-0.100, p <0.0001), after controlling for age, sex, hospital length of stay and calendar year.. Among patients with SA infection, the odds of the infection being an MRSA infection are 125-times lower in an MSSA carrier than in an MRSA carrier.

Topics: Adult; Aged; Carrier State; Cross Infection; Female; Hospitalization; Humans; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nasal Cavity; Nose; Odds Ratio; Ohio; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus frequently causes infections in outpatient and hospital settings and can present as a highly variable entity. Typical manifestations are endocarditis, osteoarticular infections or infection of implanted prostheses, intravascular devices or foreign bodies. A thorough diagnostic evaluation with early focus identification is mandatory to improve patient outcome.. We report a case of a 68-year old patient with a history of double allogeneic stem cell transplant for acute myeloid leukemia who developed a S. aureus bacteremia with dissemination, severe sepsis and lethal outcome due to nasal handkerchief packing after nose bleeding.. A thorough medical examination with further diagnostic work-up is most important in S. aureus blood stream infection to identify and eradicate the portal(s) of entry, to rule out endocarditis, to search for spinal abscesses, osteomyelitis or spondylodiscitis. Adherence to management guides for clinicians must be of major importance to achieve optimal quality of clinical care, and thus improve patient outcome.

Topics: Aged; Bacteremia; Cross Infection; Diagnosis, Differential; Fatal Outcome; Germany; Humans; Leukemia, Myeloid, Acute; Male; Nose; Staphylococcal Infections; Staphylococcus aureus; Stem Cell Transplantation; Transplantation, Homologous

Topics: Carrier State; Cross Infection; Drug Resistance, Multiple, Bacterial; Humans; Intensive Care Units, Pediatric; Nose; Prospective Studies; Rectum

Methicillin-resistant Staphylococcus aureus (MRSA) is responsible for many hospital-associated infections. Both MRSA-colonized and MRSA-infected patients must be isolated on contact precautions per the Centers for Disease Control and Prevention guidelines. This study evaluates the current practice for removing MRSA-colonized patients from contact precautions and proposes a new protocol to decrease inconsistencies with screening methodologies.. This was a retrospective chart review of MRSA screening swabs collected at an academic medical center between January 1, 2010 and December 31, 2017. Of those patients with MRSA screening swabs, extra-nasal cultures were also evaluated for MRSA infection. Screening swabs were analyzed for appropriateness of order and timing between swabs and active infections. Analysis of variance and the χ² tests were used to determine significance between groups.. This study included 8,310 patients with a combined total of 11,601 nasal swabs. Significantly more (P = .0159) patients with 2 negative nasal swabs returned with a recurrent MRSA infection or colonization than those who had 3 consecutive negative nasal swabs (27.8% vs 17.0%, respectively). Additionally, 47.8% of patients only had 1 appropriately ordered negative nasal swab, indicating that a nurse-driven protocol may be more effective in obtaining the full series of samples required to remove contact precautions.. The current practice for removing a patient from contact precautions for MRSA is insufficient. The number of negative nasal swabs required should be increased from 2 to 3 and a decolonization protocol should be implemented.

Topics: Academic Medical Centers; Adult; Aged; Anti-Bacterial Agents; Carrier State; Cross Infection; Female; Humans; Male; Methicillin; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Retrospective Studies; Staphylococcal Infections

Dialysis patients are frequently exposed to Staphylococcus aureus due to stays in dialysis centers, hospitals or rest homes. The hemodialysis vascular access is a potential entry site for S. aureus, in particular when using a central venous catheter (CVC) which increases the risk of sepsis compared to arteriovenous (AV) fistula. We prospectively followed a cohort of 86 hemodialysis patients from an outpatient dialysis center over 25 months analyzing S. aureus carrier status, S. aureus infection rates and mortality.. Demographic data and patients´ medical histories were collected and followed from all hemodialysis patients. Blood samples, nasal swabs and swabs from the hemodialysis vascular access site were taken every six months for a period of 25 months and tested for S. aureus. Strains were cultured and further characterized by spa PCR and microarray-based genotyping. Resulting data were compared with those from the general population.. In cross-sectional analyses, an average of 40% of hemodialysis patients were S. aureus carriers compared to 27% in the general population. Longitudinally, a total of 65% were S. aureus carriers: 16% were persistent carriers, 43% were intermittently colonized. The most common S. aureus lineage in the dialysis patient cohort was the clonal complex (CC) 8 and the spa type t008, while in the general population, the clonal complex CC30 dominates. During the study period, we observed six S. aureus-associated blood stream infections with one S. aureus attributable death. S. aureus carriers with an AV fistula were more densely colonized in the nasal mucosa compared to patients with a CVC. Overall mortality was lower for hemodialysis patients with a positive S. aureus carrier status compared to non-carriers (hazard ratio of 0.19).. Compared to the general population, hemodialysis patients were more frequently colonized with S. aureus and displayed both different S. aureus colonization densities as well as lineages, possibly explained by more frequent exposure to health care environments. The lower overall mortality in carriers compared to non-carriers is intriguing and will be investigated in detail in the future.. ISRCTN 14385893 , 2. October 2018, retrospectively registered.

Topics: Adult; Aged; Aged, 80 and over; Arteriovenous Shunt, Surgical; Bacteremia; Carrier State; Catheter-Related Infections; Cause of Death; Central Venous Catheters; Cross Infection; Cross-Sectional Studies; Female; Follow-Up Studies; Germany; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prospective Studies; Renal Dialysis; Staphylococcal Infections; Time Factors; Young Adult

The pandemic spread of multidrug-resistant (MDR) bacteria (i.e., methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii) pose a threat to healthcare Worldwide. We found limited data of MDR bacteria in pediatric patients hospitalized in Tunisian tertiary healthcare.The aim of the study is to evaluate the acquisition rate of MDR acquisition during hospitalization and to explore some of the associated risk factors for both carriage and acquisition at the pediatric department, Sahloul University Hospital. During September and October 2016, newly admitted patients were screened, at admission, during care and at discharge. Risk factors for colonization were explored by multivariate analysis. Of 112 newly admitted patients, 8.92% were colonized with at least one MDR. No risk factor was identified at admission. During hospitalization, five newly acquisition MDR (4.9%) were detected and eight (7.84%) at discharge. The specie most frequently detected on admission was Escherichia coli (50%), whereas, on discharge, Escherichia coli and K. pneumoniae were the species most frequently detected (52.7%). The pediatric intensive care unit (PICU) hospitalization, the length of hospital stay (more than 3days) and age under 2 years were identified as risk factor for acquisition of MDR during hospitalization. We identified several independent risk factors for contracting MDR bacteria during hospitalization in a tertiary pediatric department. The incidence of symptomatic MDR Infection among those colonized should be under close surveillance and long-term screening for those children is required. An institutional screening program for MDR especially in PICU might be discussed in regards to cost effectiveness.

Topics: Age Factors; Carrier State; Child, Preschool; Cross Infection; Drug Resistance, Multiple, Bacterial; Escherichia coli; Female; Humans; Intensive Care Units, Pediatric; Klebsiella pneumoniae; Length of Stay; Male; Nose; Patient Admission; Patient Discharge; Prevalence; Prospective Studies; Rectum; Risk Factors; Tertiary Care Centers; Tunisia

Several studies have shown that Staphylococcus aureus (S aureus) nasal colonization is associated with surgical site infection and that preoperative decolonization can reduce infection rates. Up to 30% of joint arthroplasty patients have positive S aureus nasal swabs. Patient risk factors for colonization remain largely unknown. The aim of this study was to determine whether there is a specific patient population at increased risk of S aureus nasal colonization.. This study is a retrospective review of 716 patients undergoing hip or knee arthroplasty beginning in 2011. All patients were screened preoperatively for nasal colonization. Univariate and multivariate analyses were used to assess risk factors for nasal colonization.. A total of 716 patients undergoing joint arthroplasty had preoperative nasal screening. One hundred twenty-five (17.50%) nasal swabs were positive for methicillin-susceptible S aureus (MSSA), 13 (1.80%) were positive for methicillin-resistant S aureus (MRSA), and 84 (11.70%) were positive for other organisms. In bivariate analysis, diabetes (P = .04), renal insufficiency (P = .03), and immunosuppression (P = .02) were predictors of nasal colonization with MSSA/MRSA. In multivariate analysis, immunosuppression (P = .04; odds ratio, 2.0; 95% confidence interval, 1.03-3.71) and renal insufficiency (P = .04; odds ratio, 2.5; 95% confidence interval, 1.01-6.18) were independent predictors of nasal colonization with MSSA/MRSA.. Overall, 17.5% of patients undergoing primary hip or knee arthroplasty screened positive for S aureus. Diabetes, renal insufficiency, and immunosuppression are risk factors for such colonization. Given that these comorbidities are already known independent risk factors for periprosthetic joint infection, these patients should be particularly screened and when necessary, decolonized.

Topics: Aged; Arthroplasty, Replacement, Knee; Cross Infection; Diagnostic Tests, Routine; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Retrospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Data concerning intensive care unit (ICU)-acquired bacterial colonization and infections are scarce from low and middle-income countries (LMICs). ICU patients in these settings are at high risk of becoming colonized and infected with antimicrobial-resistant organisms (AROs). We conducted a prospective observational study at the Ho Chi Minh City Hospital for Tropical Diseases, Vietnam from November 2014 to January 2016 to assess the ICU-acquired colonization and infections, focusing on the five major pathogens in our setting: Staphylococcus aureus (S. aureus), Escherichia coli (E. coli), Klebsiella spp., Pseudomonas spp. and Acinetobacter spp., among adult patients with more than 48 hours of ICU stay. We found that 61.3% (223/364) of ICU patients became colonized with AROs: 44.2% (161/364) with rectal ESBL-producing E. coli and Klebsiella spp.; 30.8% (40/130) with endotracheal carbapenemase-producing Acinetobacter spp.; and 14.3% (52/364) with nasal methicillin-resistant S. aureus. The incidence rate of ICU patients becoming colonized with AROs was 9.8 (223/2,276) per 100 patient days. Significant risk factor for AROs colonization was the Charlson Comorbidity Index score. The proportion of ICU patients with HAIs was 23.4% (85/364), and the incidence rate of ICU patients contracting HAIs was 2.3 (85/3,701) per 100 patient days. The vascular catheterization (central venous, arterial and hemofiltration catheter) was significantly associated with hospital-acquired bloodstream infection. Of the 77 patients who developed ICU-acquired infections with one of the five specified bacteria, 44 (57.1%) had prior colonization with the same organism. Vietnamese ICU patients have a high colonization rate with AROs and a high risk of subsequent infections. Future research should focus on monitoring colonization and the development of preventive measures that may halt spread of AROs in ICU settings.

Topics: Adult; Bacterial Infections; Catheter-Related Infections; Catheterization; Cross Infection; Drug Resistance, Bacterial; Female; Humans; Intensive Care Units; Male; Nose; Prospective Studies; Rectum; Trachea; Vietnam

This study was performed to investigate the concordance in terms of molecular characteristics and antimicrobial susceptibility between colonizing and clinical Staphylococcus aureus isolates obtained from children in Korea, where ST72 is the major genotype.This was a prospective observational descriptive study of culture-confirmed S aureus infections obtained from children ≤18 years old admitted to Asan Medical Center Children's Hospital in Seoul, Korea, from March 2014 to April 2015. Molecular studies including multilocus sequence typing (MLST), SCCmec typing, polymerase chain reaction amplification of the Panton-Valentine leukocidin (PVL) genes, and antibiotic susceptibility tests were performed on S aureus isolates obtained from nares and clinical specimens.During the study period, 126 clinically significant S aureus infections were identified. Nasal swab cultures were made from 113 of the 126 children, and 46.0% (52/113) showed S aureus colonization. The overall concordance between colonizing and clinical isolates by methicillin susceptibility was 94.2% (49/52); all 3 discordant cases were HA-MSSA cases with nasal MRSA. Among the 37 pairs of colonizing and clinical S aureus isolates included in the genotyping analysis, ST72-SCCmec type IV was the most prevalent clone and the PVL genes were positive in 2 patients. Among the 31 pairs of healthcare-associated cases, concordance rates by methicillin susceptibility and sequence type (ST) were 90.3% (28/31) and 84% (26/31), respectively. For the 6 pairs of community-associated (CA) S aureus including 3 CA-MRSA cases, 100% concordance was observed by methicillin susceptibility and ST.The concordance between isolates obtained from children who required medical services was relatively high in Korean children where ST72-SCCmec type IV is the predominant clone as the colonizer and the pathogen. It is suggested that decolonization and continuous care to prevent transmission could be effective in managing and preventing both HA- and CA-SA infections in our setting.

Topics: Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Drug Resistance, Bacterial; Female; Genotype; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multilocus Sequence Typing; Nose; Prospective Studies; Republic of Korea; Staphylococcal Infections; Staphylococcus aureus

This study aimed to investigate the spread of methicillin-resistant coagulase-positive staphylococci (MRCoPS) among veterinary staff, hand-touch sites and surgical tissue during cystotomy operations on cats and dogs that were patients, and to analyze the genetic relatedness and antimicrobial resistance profiles of the isolates. Human and environmental samples were obtained from the nasal passageways of 12 surgeons and veterinary assistants and from 29 hand-touch sites of instruments in operative units and subjected to bacterial isolation and enumeration. Swab samples were collected in triplicate from 29 dogs and three cats at the site of incision, from the incision area, from the peritoneum during surgery and from the peritoneum before suture. MRCoPS were identified by mecA gene detection and characterized by their antibiogram profile, SCCmec type and pulsed-field gel electrophoresis. Twenty-four staphylococci were isolated, derived from one veterinary assistant, 12 operating room floor areas and hand-touch sites, three dogs and one cat. Methicillin-resistant S. pseudintermedius (MRSP) was found on an electric clipper and rebreathing circuits in the operating room. Three dogs were positive for MRSP during surgery, and one methicillin-resistant S. aureus (MRSA) was detected in a cat. All MRCoPS were resistant to doxycycline, erythromycin, clindamycin and enrofloxacin, but no patients developed surgical site infections. According to their genotypic patterns, the clones obtained from the environment and human sources differed from the animal clones. Despite intensive hygienic management, a variety of MRCoPS clones were present within the surgical unit and during surgery.

Topics: Animal Technicians; Animals; Cat Diseases; Cats; Coagulase; Cross Infection; Cystotomy; Dog Diseases; Dogs; Equipment Contamination; Hand; Hospitals, Animal; Hospitals, Teaching; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nose; Surgery Department, Hospital; Surgical Wound Infection; Thailand; Veterinarians

Nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) is poorly described for surgeons, despite the increased exposure to nosocomial pathogens and at-risk patients. This study investigated the molecular epidemiology and antimicrobial resistance of 26 MRSA isolates cultured from the nares of an international cross-sectional study of 1166 human and 60 veterinary surgeons.. All isolates were subjected to agr, spa and multilocus sequence typing, and the presence of 22 virulence factors was screened for by PCR. Additionally, biofilm-forming ability, haemolytic activity, staphyloxanthin production and antibiotic resistance were determined. The genome of a rifampicin-resistant MRSA was sequenced.. Approximately half of the isolates belonged to well-described clonal lineages, ST1, ST5, ST8, ST45 and ST59, that have previously been associated with severe infections and increased patient mortality. Two of the three veterinarian MRSA belonged to epidemic livestock-associated MRSA clonal lineages (ST398 and ST8) previously associated with high transmission potential between animals and humans. The isolates did not display any consistent virulence gene pattern, and 35 % of the isolates carried at least one of the Panton-Valentine leukocidin (lukFS-PV), exfoliative toxin (eta) or toxic shock syndrome (tst) genes. Resistance to rifampicin was detected in one veterinarian isolate and was found to be due to three mutations in the rpoB gene.. Surgeons occupy a critical position in the healthcare profession due to their close contact with patients. In this study, surgeons were found to be colonized with MRSA at low rates, similar to those of the general population, and the colonizing strains were often common clonal lineages.

Topics: Bacterial Toxins; Biofilms; Cross Infection; Cross-Sectional Studies; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Female; Genome, Bacterial; Genotype; Humans; Internationality; Male; Methicillin-Resistant Staphylococcus aureus; Molecular Epidemiology; Multilocus Sequence Typing; Nose; Phenotype; Polymerase Chain Reaction; Rifampin; Sequence Analysis, DNA; Staphylococcal Infections; Surgeons; Veterinarians; Virulence Factors

Nasal carriage of Staphylococcus aureus among hospital personnel is a common cause of hospital acquired infections. Emergence of drug resistant strains especially methicillin resistant S. aureus (MRSA) is a serious problem in hospital environment. Therefore, the aim of this study was to determine the nasal carriage rate of S. aureus and MRSA among Health Care Workers (HCWs) at Al Shifa Hospital, the major hospital in Gaza Strip.. A cross sectional study was conducted on 200 HCWs. Nasal swabs were collected during February - April 2015, and cultured on blood and mannitol salt agar. The isolates were identified as S. aureus based on morphology, coagulase test, DNase test and mannitol salt agar fermentation. Disk diffusion antibiotic susceptibility tests were performed according to the guidelines of the Clinical and Laboratory Standards Institute. MRSA were confirmed by detection of the mecA gene by PCR.. Out of the 200 healthcare workers, 62 (31%) carried S. aureus, of which 51 (82.3%) were MRSA. Therefore, 25.5% of all HCWs were identified as MRSA carriers. MRSA carriage rate was highest among nurses (30.4%) whereas the carriage rate among doctors was (16%). The majority of MRSA carriers were workers of internal medicine department and surgical wards (41.3 and 35% respectively). Out of the 51 MRSA isolates identified by oxacillin disc resistance, 40 were confirmed by PCR targeting the mecA gene. Penicillin showed the highest rate of resistance among MRSA and MSSA isolates (100%).. The high rate of nasal MRSA carriage among healthcare workers found in this study is alarming and highlights the need for adjusted infection control measures to prevent MRSA transmission from HCWs to the vulnerable patient.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Carrier State; Cross Infection; Cross-Sectional Studies; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle East; Nose; Oxacillin; Penicillin-Binding Proteins; Personnel, Hospital; Polymerase Chain Reaction; Staphylococcal Infections

To compare the presence of Staphylococcus aureus and pathogenic Gram-negative rods (GNR) in the anterior nares, posterior pharynx and three skin sites in community-based adults and nursing home-based adults before and after treatment with nasal mupirocin and topical chlorhexidine.. S. aureus-colonized adults were recruited from the community (n=26) and from nursing homes (n=8). Eligible participants were cultured for S. aureus and GNR during two study visits and then received intranasal mupirocin and topical chlorhexidine for 5days, with a 2-month follow-up period.. After decolonization, we found sustained decreases of S. aureus colonization in nose, throat and skin sites over 4-8weeks in both populations. Intranasal mupirocin did not increase GNR colonization in nose or throat. Chlorhexidine did not decrease GNR colonization in skin sites.. Decolonization with mupirocin and chlorhexidine leads to a sustained effect on S. aureus colonization without affecting GNR colonization.

Topics: Administration, Topical; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Chlorhexidine; Community-Acquired Infections; Cross Infection; Female; Gram-Negative Bacterial Infections; Gram-Positive Asporogenous Rods; Humans; Male; Middle Aged; Mupirocin; Nose; Nursing Homes; Pharynx; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Biofilm production is an important virulence factor which allows staphylococci to adhere to medical devices. The principal component of biofilm is a "polysaccharide intercellular adhesin (PIA)" which is composed of a beta-1,6-N-acetylglucosamine polymer synthesized by an enzyme (N-acetylglucosamine transferase) encoded by the ica operon found on the bacterial chromosome. This operon is composed of four genes (A, B, C, and D), and a transposable element IS256. In this study, we aimed to determine the biofilm production characteristics of invasive/non-invasive staphylococcus isolates and different staphylococcus species. Biofilm production of 166 staphylococci was phenotypically investigated on Congo Red Agar (CRA); the presence of icaA, icaD and IS256 genes were investigated by polymerase chain reaction (PCR). 74 of the isolates (44.6%) were identified as methicillin resistant Staphylococcus aureus (MRSA), 25 (15.1%) as methicillin sensitive S.aureus (MSSA), 25 (37.3%) as Staphylococcus hominis, 20 (12%) as S.epidermidis, ten (15%) as Staphylococcus haemolyticus, nine (13.4%) as Staphylococcus capitis, two (3%) Staphylococcus saprophyticus and one (1.5%) as Staphylococcus warnerii. Of the MRSA strains, 52 were isolated from blood and 22 from nose; all MSSA strains were isolated from nose cultures. Coagulase-negative staphylococci (CoNS) strains were composed of invasive and non-invasive strains isolated from nose, catheter tip and blood cultures from patients with catheter. Production with CRA method was found to be statistically significant in invasive isolates (p< 0.001). It is concluded that; as the biofilm formation capacity of invasive isolates can cause refractory infections and the importance of carriage and hospital infections of these bacteria, it is important to prevent the spread of these isolates. A combination of phenotypic and genotypic tests is recommended for the investigation of biofilm formation in staphylococci. 40.3% of the CoNS isolates, and 85.8% of S.aureus isolates produced biofilm on CRA (p< 0.001) and with PCR method the ratio of carrying three genes was found to be statistically important in S.aureus when compared with CoNS. Carriage of three genes and biofilm formation capacity of invasive isolates can cause refractory infections and the importance of carriage and hospital infections of these bacteria, it is important to prevent the spread of these isolates. A combination of phenotypic and genotypic tests is recommended for the

Topics: Bacteremia; Biofilms; Carrier State; Catheters; Cross Infection; DNA Transposable Elements; Humans; N-Acetylglucosaminyltransferases; Nose; Operon; Polysaccharides, Bacterial; Staphylococcal Infections; Staphylococcus; Virulence

Nosocomial transmission of respiratory syncytial virus (RSV) occurs in children within the neonatal intensive care unit (NICU). During peak community RSV transmission, three swabs were collected from the nose, hand and personal clothing of visitors and health care workers (HCW) in NICU once every week for eight weeks. Nasal swabs were collected from every third neonate and from any neonate clinically suspected of having a respiratory infection. Environmental sampling of high touch areas was done once during the study period. All swabs were tested for RSV using real time RT-PCR. There were 173 (519 total) and 109 (327 total) swabs, each of nose, hand and dress from 84 HCWs and 80 visitors respectively and 81 nasal swabs from 55 neonates collected. Thirty five environmental swabs from surfaces of the beds, side tables, counter tops, chairs, tables and computers were collected. Overall 1% of nasal swabs from each of HCWs, visitors and neonates, 4% of dress specimens from visitors and 9% of environmental swabs were positive for RSV-RNA. The results suggest that though the risk for RSV in the NICU remains low, personnel clothing are contaminated with RSV-RNA and may have a role in transmission.

Topics: Adolescent; Adult; Child; Child, Preschool; Cross Infection; Environmental Microbiology; Female; Hand; Humans; Infant; Infant, Newborn; Intensive Care Units, Neonatal; Male; Nose; Prospective Studies; Real-Time Polymerase Chain Reaction; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Reverse Transcriptase Polymerase Chain Reaction; RNA, Viral

A history of methicillin-resistant Staphylococcus aureus (MRSA) is a determinant of inpatient bed assignment.. We assessed outcomes associated with rapid testing and discontinuation of MRSA contact precautions (CP) in a prospective cohort study of polymerase chain reaction (PCR)-based screening in the Emergency Department (ED) of Massachusetts General Hospital. Eligible patients had a history of MRSA and were assessed and enrolled if documented off antibiotics with activity against MRSA and screened for nasal colonization (subject visit). PCR-negative subjects had CP discontinued; the primary outcome was CP discontinuation. We identified semiprivate rooms in which a bed was vacant owing to the CP status of the study subject, calculated the hours of vacancy, and compared idle bed-hours by PCR results. Program costs were compared with predicted revenue.. There were 2864 eligible patients, and 648 (22.6%) subject visits were enrolled. Of these, 65.1% (422/648) were PCR-negative and had CP discontinued. PCR-negative subjects had fewer idle bed-hours compared with PCR-positive subjects (28.6 ± 25.2 vs 75.3 ± 70.5; P < .001). The expected revenues from occupied idle beds and averted CP costs ranged from $214,160 to $268,340, and exceeded the program costs.. A program of targeted PCR-based screening for clearance of MRSA colonization resulted in expected revenues and decreased CP costs that outweighed programmatic costs.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Cost-Benefit Analysis; Cross Infection; Female; Humans; Infection Control; Male; Massachusetts; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Pilot Projects; Polymerase Chain Reaction; Prospective Studies; Staphylococcal Infections; Universal Precautions

Respiratory viruses are a cause of upper respiratory tract infections (URTI), but can be associated with severe lower respiratory tract infections (LRTI) in immunocompromised patients. The objective of this study was to investigate the genetic variability of influenza virus, parainfluenza virus and respiratory syncytial virus (RSV) and the duration of viral shedding in hematological patients. Nasopharyngeal swabs from hematological patients were screened for influenza, parainfluenza and RSV on admission as well as on development of respiratory symptoms. Consecutive swabs were collected until viral clearance. Out of 672 tested patients, a total of 111 patients (17%) were infected with one of the investigated viral agents: 40 with influenza, 13 with parainfluenza and 64 with RSV; six patients had influenza/RSV or parainfluenza/RSV co-infections. The majority of infected patients (n = 75/111) underwent stem cell transplantation (42 autologous, 48 allogeneic, 15 autologous and allogeneic). LRTI was observed in 48 patients, of whom 15 patients developed severe LRTI, and 13 patients with respiratory tract infection died. Phylogenetic analysis revealed a variety of influenza A(H1N1)pdm09, A(H3N2), influenza B, parainfluenza 3 and RSV A, B viruses. RSV A was detected in 54 patients, RSV B in ten patients. The newly emerging RSV A genotype ON1 predominated in the study cohort and was found in 48 (75%) of 64 RSV-infected patients. Furthermore, two distinct clusters were detected for RSV A genotype ON1, identical RSV G gene sequences in these patients are consistent with nosocomial transmission. Long-term viral shedding for more than 30 days was significantly associated with prior allogeneic transplantation (p = 0.01) and was most pronounced in patients with RSV infection (n = 16) with a median duration of viral shedding for 80 days (range 35-334 days). Long-term shedding of respiratory viruses might be a catalyzer of nosocomial transmission and must be considered for efficient infection control in immunocompromised patients.

Topics: Adult; Aged; Aged, 80 and over; Cohort Studies; Communicable Disease Control; Cross Infection; Female; Genotype; Hematologic Diseases; Humans; Influenza, Human; Male; Middle Aged; Mutation; Nose; Orthomyxoviridae; Parainfluenza Virus 3, Human; Paramyxoviridae Infections; Phylogeny; Polymerase Chain Reaction; Respiratory Syncytial Virus Infections; Respiratory Syncytial Viruses; Retrospective Studies; Sequence Analysis, DNA; Time Factors; Transplantation, Homologous; Virus Shedding; Young Adult

Staphylococcus aureus is a persistent companion bacterial species in one-third of humankind. Reservoirs include the nasal and nasopharyngeal cavities, skin, and gastrointestinal (GI) tract. Despite earlier claims that colonization of individuals is caused by clonal organisms, next-generation sequencing (NGS) has revealed that resident type heterogeneity is not exceptional. Carriage, whether overt or hidden, is correlated with a risk of autoinfection. In a recent article in mBio, it was shown that, based on staphylococcal genome sequencing, low-level GI persistence may cause long-term nosocomial outbreaks [L. Senn et al., 7(1):e02039-15, 2016, doi:10.1128/mBio.02039-15]. Institutional endemicity with methicillin-resistant S. aureus (MRSA) sequence type 228 (ST228) is shown to originate not from high-level nasal carriage or poor compliance with infection control practice but from low-grade asymptomatic GI colonization. This shows the power of NGS in elucidating staphylococcal epidemiology and, even more important, demonstrates that (drug-resistant) microorganisms may possess stealthy means of persistence. Identifying these persistence mechanisms is key to successful infection control.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Disease Outbreaks; Drug Resistance, Bacterial; Genotype; High-Throughput Nucleotide Sequencing; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topical antimicrobials are often employed for decolonization and infection prevention and may alter the endogenous microbiota of the skin. The objective of this study was to compare the microbial communities and levels of richness and diversity in community-dwelling subjects and intensive care unit (ICU) patients before and after the use of topical decolonization protocols. We enrolled 15 adults at risk for Staphylococcus aureus infection. Community subjects (n = 8) underwent a 5-day decolonization protocol (twice daily intranasal mupirocin and daily dilute bleach-water baths), and ICU patients (n = 7) received daily chlorhexidine baths. Swab samples were collected from 5 anatomic sites immediately before and again after decolonization. A variety of culture media and incubation environments were used to recover bacteria and fungi; isolates were identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry. Overall, 174 unique organisms were recovered. Unique communities of organisms were recovered from the community-dwelling and hospitalized cohorts. In the community-dwelling cohort, microbial richness and diversity did not differ significantly between collections across time points, although the number of body sites colonized with S. aureus decreased significantly over time (P = 0.004). Within the hospitalized cohort, richness and diversity decreased over time compared to those for the enrollment sampling (from enrollment to final sampling, P = 0.01 for both richness and diversity). Topical antimicrobials reduced the burden of S. aureus while preserving other components of the skin and nasal microbiota.

Topics: Adult; Aged; Anti-Bacterial Agents; Anti-Infective Agents, Local; Chlorhexidine; Cross Infection; Female; Humans; Intensive Care Units; Male; Microbiota; Middle Aged; Mupirocin; Nose; Skin; Sodium Hypochlorite; Staphylococcal Infections; Staphylococcus aureus

Cell-phones are the typical kind of object brought into the operating room from outside by hospital staff. A great effort is made to reduce the level of potentially contaminating bacteria in the operating room, and introducing these devices may run counter to good practice. The study hypothesis was that cell-phones are colonized by several strains of bacteria and may constitute a source of nosocomial contamination. The main study objective was to screen for bacterial colonies on the surfaces of cell-phones introduced in an orthopedic surgery room. The secondary objective was to assess the efficacy of decontamination.. Samples were taken from the cell-phones of hospital staff (surgeons, anaesthetists, nurses, radiology operators, and external medical representatives) entering the operating room of the university hospital center orthopedic surgery department, Toulouse (France). Sampling used Count Tact. Fifty-two cell-phones were sampled. Before decontamination, the mean number of colony-forming units (CFU) was 258 per phone (range, 0-1,664). After decontamination, it was 127 (range, 0-800) (P=0.0001). Forty-nine cell-phones bore CFUs before decontamination (94%), and 39 after (75%) (P=0.02).. Cell-phones are CFU carriers and may thus lead to contamination. Guidelines should be drawn up to encourage cleaning phones regularly and to reduce levels of use within the operating room.

Topics: Adult; Bacteria; Cell Phone; Colony Count, Microbial; Cross Infection; Decontamination; Female; Fomites; Humans; Male; Middle Aged; Nose; Operating Rooms; Orthopedic Procedures; Personnel, Hospital; Staphylococcus aureus; Young Adult

Bacterial pathogens such as methicillin-resistant Staphylococcus aureus (MRSA) represent a well-known public health problem affecting both healthcare-associated and community populations. Past studies have clearly shown the value of characterizing problem organisms including MRSA through the use of molecular techniques (i.e. strain typing), with the aim of informing local, regional and national efforts in epidemiological analysis and infection control. The country of Libya represents a challenge for such analysis due to limited historical infectious disease information and major political unrest culminating in the Libyan Civil War (Libyan Revolution) in 2011. A MRSA study population of 202 isolates, cultured from patients in Tripoli Medical Center through this historical period (2008-2014), was characterized by both phenotypic and molecular methods. The results revealed a diversification of epidemic MRSA strains over time with generally increasing resistance to fluoroquinolone antibiotics. The study identified prevalent MRSA in comparison to known global epidemic types, providing unique insight into the change of strains and/or characteristics over time especially with reference to the potential influence of the political revolution (i.e. pre- and post-2011).

Topics: Anti-Bacterial Agents; Bacterial Typing Techniques; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Fluoroquinolones; Humans; Infection Control; Libya; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Nose; Phenotype; Prevalence; Staphylococcal Infections

During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU).. Over 12 months in 2006-2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates.. We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes.. Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting.

Topics: Aged; Aged, 80 and over; Cross Infection; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Health Personnel; Hospitals; Humans; Intensive Care Units; Male; Methicillin Resistance; Middle Aged; Multilocus Sequence Typing; Nose; Patients; Prospective Studies; Staphylococcal Infections; Staphylococcus epidermidis; Sweden

OBJECTIVE To explore the economic impact to a hospital of universal methicillin-resistant Staphylococcus aureus (MRSA) screening. METHODS We used a decision tree model to estimate the direct economic impact to an individual hospital of starting universal MRSA screening and contact precautions. Projected costs and benefits were based on literature-derived data. Our model examined outcomes of several strategies including non-nares MRSA screening and comparison of culture versus polymerase chain reaction-based screening. RESULTS Under baseline conditions, the costs of universal MRSA screening and contact precautions outweighed the projected benefits generated by preventing MRSA-related infections, resulting in economic costs of $104,000 per 10,000 admissions (95% CI, $83,000-$126,000). Cost-savings occurred only when the model used estimates at the extremes of our key parameters. Non-nares screening and polymerase chain reaction-based testing, both of which identified more MRSA-colonized persons, resulted in more MRSA infections averted but increased economic costs of the screening program. CONCLUSIONS We found that universal MRSA screening, although providing potential benefit in preventing MRSA infection, is relatively costly and may be economically burdensome for a hospital. Policy makers should consider the economic burden of MRSA screening and contact precautions in relation to other interventions when choosing programs to improve patient safety and outcomes.

Topics: Carrier State; Colony Count, Microbial; Cost-Benefit Analysis; Cross Infection; Hospital Costs; Humans; Infection Control; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Nose; Oropharynx; Polymerase Chain Reaction; Staphylococcal Infections

Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination.. To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination. DESIGN Nested case-control study.. French long-term care facility in 2009.. Patients (n=329) and HCWs (n=261).. We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables.. The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04-1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01-1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14-2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage.. Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.

Topics: Adult; Aged; Aged, 80 and over; Carrier State; Case-Control Studies; Cross Infection; Female; Humans; Incidence; Infectious Disease Transmission, Patient-to-Professional; Infectious Disease Transmission, Professional-to-Patient; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Rehabilitation Centers; Risk Factors; Staphylococcal Infections; Time Factors; Wireless Technology; Young Adult

Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; beta-Lactamases; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Germany; Health Facilities; Humans; Long-Term Care; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Oropharynx; Prevalence; Rectum; Risk Factors; Vancomycin Resistance; Vancomycin-Resistant Enterococci

There is a global trend for an increase in prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation in children. A decade ago, MRSA colonisation was studied in Swiss paediatric hospitals and revealed an extraordinarily low proportion (<1 %). The primary goal of this study was to determine if the current proportion of nasal colonisation with MRSA in hospitalised children was still favourable. We aimed to screen all children from the age of 0-16 years admitted to the paediatric and surgical wards at the University Children's Hospital Basel (UKBB) during 8 pre-defined surveillance weeks. After obtaining consent, a nasal swab was taken and analysed for growth of S. aureus. Furthermore, a standardised questionnaire was completed by interview with a parent. Of 535 eligible children, 340 (64 %) were enrolled. Mean age was 6.2 years (median 4.3, IQR 1 to 11.25), 111 (33 %) children were colonised with S. aureus but no MRSA was found.. The prevalence of MRSA in children admitted to the UKBB during this surveillance period was zero. General MRSA screening in hospitalised children continues to be unjustified in our area.. • The prevalence of nasal methicillin-resistant Staphylococcus aureus (MRSA) colonisation in children is increasing in many regions worldwide. • Surveillance for MRSA colonisation in healthcare settings varies considerably.. • Periodic and risk-factor-based surveillance for MRSA colonisation is sufficient when regional prevalence is low.

Topics: Adolescent; Child; Child, Hospitalized; Child, Preschool; Cross Infection; Cross-Sectional Studies; Female; Hospitals, University; Humans; Infant; Infant, Newborn; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Nose; Prevalence; Prospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections; Switzerland

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Axilla; Carrier State; Cross Infection; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Patient Admission; Patient Isolation; Patient Selection; Perineum; Pharynx; Risk Assessment; Staphylococcal Infections; Time Factors

The epidemiology of Staphylococcus aureus in the community in Ghana was never investigated prior to this study. The aims of the study were: i) to assess prevalence of nasal S. aureus carriage in Ghanaian people living in an urban and a rural area, and ii) to identify phenotypic and genotypic traits of strains isolated from the two communities. Nasal swabs were collected from healthy individuals living in an urban community situated in the suburb of the capital city, Accra (n = 353) and in a rural community situated in the Dangme-West district (n = 234). The overall prevalence of nasal carriage was 21% with a significantly higher prevalence in the urban (28%) than in the rural community (11%) (p<0.0001). The levels of antimicrobial resistance were generally low (<5%) except for penicillin (91%) and tetracycline (25%). The only two (0.3%) MRSA carriers were individuals living in the urban area and had been exposed to hospitals within the last 12 months prior to sampling. Resistance to tetracycline (p = 0.0009) and presence of Panton-Valentine leukocidin (PVL) gene (p = 0.02) were significantly higher among isolates from the rural community compared to isolates from the urban community. Eleven MLST clonal complexes (CC) were detected based on spa typing of the 124 S. aureus isolates from the two communities: CC8 (n = 36), CC152 (n = 21), CC45 (n = 21), CC15 (n = 18), CC121 (n = 6), CC97 (n = 6), CC30 (n = 5), CC5 (n = 5), CC508 (n = 4), CC9 (n = 1), and CC707 (n = 1). CC8 and CC45 were less frequent in the rural area than in the urban area (p = 0.02). These results reveal remarkable differences regarding carriage prevalence, tetracycline resistance, PVL content and clonal distribution of S. aureus in the two study populations. Future research may be required to establish whether such differences in nasal S. aureus carriage are linked to socio-economic differences between urban and rural communities in this African country.

Topics: Adult; Anti-Bacterial Agents; Cross Infection; Cross-Sectional Studies; Drug Resistance, Multiple, Bacterial; Female; Ghana; Humans; Male; Middle Aged; Multilocus Sequence Typing; Nose; Penicillins; Rural Population; Staphylococcal Infections; Staphylococcus aureus; Tetracycline; Urban Population

If not adequately cleaned, rigid nasal endoscopes (RNEs) have the potential to cause iatrogenic cross-contamination.. To test the efficacy of various disinfection methods in reducing bacterial load on RNEs in vitro.. In vitro model.. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Haemophilus influenzae contamination was separately induced on RNEs in vitro. Two experimental sets were completed. The RNEs were disinfected using the following protocols: 30-second scrub with antimicrobial soap (ABS) and water, 30-second scrub with 70% isopropyl alcohol (IA), 30-second scrub with ABS followed by 30-second scrub with IA, 30-second scrub with germicidal cloth, isolated 5-minute soak in an enzymatic soap solution, 5- and 10-minute soaks in ortho-phthalaldehyde, 0.55%, solution (Cidex OPA), and isolated 30-second rinse with tap water, all with 30-second precleaning and postcleaning rinses with tap water. Two sets of experiments (experiment sets A and B) were carried out with a 30-second tap water rinse after inoculation of each RNE. This was followed by immediate cleaning in set A and a 1-hour air-dry delay in set B. Otherwise there were no differences in the disinfection protocols between sets for each method noted.. Effectiveness of various disinfection protocols in cleaning rigid nasal endoscopes experimentally inoculated with bacteria commonly found in the upper aerodigestive tract. Positive cultures following disinfection indicated ineffective or incomplete disinfection.. Most cleaning methods were effective in eliminating S aureus, S pneumoniae, and H influenzae from the scopes following experimental contamination. Continued growth of P aeruginosa was found after all of the disinfection trials in experiment set A with the exception of a 10-minute immersion in Cidex OPA, and in set B except for the 10-minute Cidex OPA immersion and ABS plus IA trials.. Most cleaning methods used in our trials appear to properly disinfect RNEs after in vitro inoculation with S aureus, S pneumoniae, and H influenzae. However, it appears that disinfectants may be less effective in cleaning rigid scopes experimentally inoculated with P aeruginosa. There is a paucity of published data regarding cross-contamination during rigid nasal endoscopy, and these results should guide future studies and to some extent practice to avoid iatrogenic spread of contamination.

Topics: Cross Infection; Disinfectants; Disinfection; Endoscopes; Equipment Contamination; Glutaral; Haemophilus influenzae; Humans; In Vitro Techniques; Nose; o-Phthalaldehyde; Pseudomonas aeruginosa; Soaps; Staphylococcus aureus; Streptococcus pneumoniae

To determine the relationship between methicillin-resistant Staphylococcus aureus (MRSA) colonization density, colonization site, and probability of infection in a frequently screened cohort of intensive care unit (ICU) patients.. Patients had swab samples tested for MRSA at admission to the ICU, discharge from the ICU, and twice weekly during their ICU stay, and they were followed up for development of MRSA infection. Swab test results were analyzed to determine the proportion of patients colonized and the proportion colonized at each screening site. Hazard of MRSA infection (rate of infection per day at risk) was calculated using a Cox proportional hazards analysis, and risk factors for MRSA infection, including presence of MRSA, degree of colonization, and pattern of colonization were determined.. Among the 4,194 patient episodes, 238 (5.7%) had screening results that were positive for MRSA, and there were 34 cases of MRSA infection. The hazard ratio (HR) for developing an infection increased as more sites were colonized (HR, 3.4 for being colonized at more than 1 site compared with colonization at 1 site [95% confidence interval, 1.2-9.9]). Colonization site was predictive of developing infection (HR for nose or throat colonization compared with no colonization, 168 [95% confidence interval, 69-407]).. This study demonstrated that the hazard of developing an infection was higher when more sites were colonized and that certain sites were more predictive of infection than others. These results may be useful for predicting infection in ICU patients and may influence treatment.

Topics: Axilla; Carrier State; Critical Care; Cross Infection; Female; Groin; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Pharynx; Population Surveillance; Predictive Value of Tests; Prospective Studies; Risk Factors; Staphylococcal Infections

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen worldwide. Malta is one of the countries with the highest MRSA prevalence in Europe, as identified from hospital blood cultures [1]. However, community prevalence of MRSA has never previously been investigated. This study aimed at establishing the prevalence of community MRSA nasal colonization in Maltese individuals and identifying the clonal characteristics of the detected isolates. Nasal swabs were collected from 329 healthy individuals who were also asked to complete a brief questionnaire about risk factors commonly associated with MRSA carriage and infection. The swabs were transported and enriched in a nutrient broth supplemented with NaCl. The presence of MRSA was then determined by culturing on MRSA Select chromogenic agar and then confirming by several assays, including catalase, coagulase and PBP2a agglutination tests. The isolates were assayed for antibiotic susceptibilities and typed by microarray analysis to determine the clonal characteristics of each strain. The prevalence of MRSA nasal colonization in the healthy Maltese population was found to be 8.81% (95% confidence interval [CI], 5.75-11.87%), much higher than that found in other studies carried out in several countries. No statistical association was found between MRSA carriage and demographics or risk factors; however, this was hindered by the small sample size. Almost all the isolates were fusidic-acid resistant. The majority were found to belong to a local endemic clone (CC5) which seems to be replacing the previously prevalent European clone UK-EMRSA-15 in the country. A new clone (CC50-MRSA-V) was also characterized. The presence of such a significant community reservoir of MRSA increases the burdens already faced by the local healthcare system to control the MRSA epidemic. Colonization of MRSA in otherwise healthy individuals may represent a risk for endogenous infection and transmission to hospitalized patients after admission to a healthcare facility, leading to longer hospital stays and, consequently, increased healthcare costs.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Cross Infection; Female; Humans; Male; Malta; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prevalence; Staphylococcal Infections; Young Adult

to determine the rate of MRSA-carrier among patients, family members and health care providers, and the association between MRSA-carrier family members and health care providers on MRSA infection patient after orthopaedic surgery.. this is a cross-sectional analytical study. Samples were taken consecutively during December 2010 to December 2011, consisting of postoperative patients infected with MRSA, attending family members, and the medical officers with history of contact with the patient. Swab culture were taken from nasal and axilla of all subjects. The incidence of MRSA infection, and MRSA-carrier on the patient, family members and medical officers were presented descriptively, while their association with MRSA infection was statistically tested using Fischer exact test.. during the study period, there were 759 surgeries, with 4 (0.5%) patients were identified to have MRSA infection. Of these four cases, 48 subjects were enrolled. The rate of MRSA-carrier among patients, family and health care providers were 50%, 25% and 0% respectively. There were no significant association between MRSA and the rates of MRSA-carrier on the family member or health care providers.. the incidence of MRSA infection, MRSA-carrier patient, MRSA-carrier health care providers, and family member carrier were 0.5%, 50%, 0%, and 25% respectively. No significant association found between MRSA-carrier on the family member or health care providers and MRSA infection patient. There were no MRSA infection found on the health care provider.

Topics: Axilla; Carrier State; Cross Infection; Cross-Sectional Studies; Family; Female; Humans; Indonesia; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Nurses; Orthopedic Procedures; Physicians; Staphylococcal Infections; Surgical Wound Infection

Staphylococcus aureus is an important cause of cardiac surgical site infection. Based on studies in adults, nasal screening to detect S aureuscolonization is used to guide decolonization and selection of prophylactic antibiotics. In our Children's Hospital, a sensitive polymerase chain reaction (PCR)-based assay is used to screen patients undergoing cardiac surgery for nasal colonization with methicillin-sensitive S aureus (MSSA) and methicillin-resistant S aureus (MRSA). Additionally for patients in diapers, cultures are used to detect MRSA colonization of the groin. The purpose of this study was to determine whether screening two anatomic locations results in a higher MRSA detection rate among children undergoing cardiac surgery.. A retrospective chart review determined whether the frequency of bacterial colonization with MRSA differed by anatomic site. Records for 322 pediatric cardiac surgery procedures performed between January 2009 and June 2011 were reviewed. Both a nasal PCR and a second anatomic site culture were performed before 102 procedures.. The overall rate of colonization with MRSA and MSSA was 4.2% and 29.1%, respectively. Of the seven dually screened patients who tested positive for MRSA, two were identified solely via a groin test, four by nasal screening alone, and one by both the tests. Screening of only the nose would have failed to detect 28.6% of the MRSA cases.. Preoperative detection of MRSA colonization may be enhanced by screening both the nose and a second anatomic site. The clinical utility of the extranasal MRSA culture was limited due to the long assay turnaround time.

Topics: Cardiac Surgical Procedures; Child; Child, Preschool; Cross Infection; Early Diagnosis; Female; Groin; Heart Defects, Congenital; Humans; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Polymerase Chain Reaction; Preoperative Care; Staphylococcal Infections; Surgical Wound Infection

To optimize preventive measures to control MRSA, we investigated retrospectively the suitability of a multiple site screening model and the optimal sampling technique to detect MRSA in a university-based phlebology and skin cancer center in Germany.. During 4.5 years samples of 3 712 inpatients in a dermatologic department were analyzed for MRSA by conventional microbiologic cultures and in parallel by PCR. Samples were taken from nares, wounds and skin lesions.. MRSA was detected in 60 inpatients (1.6%). 268 of 7 269 (3.7%) samples at admission and during hospital stay were found positive ñ 96 (35.8%) of these were swabs of nares, 59 (22.0%) surveillance swabs, 53 (19.8%) wound swabs and 42 (15.7%) from other dermatologic lesions. Twenty-five of 60 patients (41.7%) were found positive only in the nares, 10 (16.7%) patients only in wounds and 4 (6.7%) patients only in lesions. 166 (61.9%) of all positive culture samples became positive 24 hours after cultivation, 86 (32.1%) after 48 hours, and 16 (6.0%) after 72 hours.. Highest sensitivity to detect MRSA can be reached by combining three swabs: nares, wounds and skin lesions (ìtriple-testî). Culture of screening specimens for 72 hours is recommended.

Topics: Academic Medical Centers; Cross Infection; Germany; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Prevalence; Reproducibility of Results; Risk Assessment; Risk Factors; Sensitivity and Specificity; Soft Tissue Infections; Staphylococcal Infections; Tertiary Care Centers

In acute-care hospitals, no evidence of a protective effect of healthcare worker (HCW) vaccination on hospital-acquired influenza (HAI) in patients has been documented. Our study objective was to ascertain the effectiveness of influenza vaccination of HCW on HAI among patients.. A nested case-control investigation was implemented in a prospective surveillance study of influenza-like illness (ILI) in a tertiary acute-care university hospital. Cases were patients with virologically-confirmed influenza occurring ≥ 72 h after admission, and controls were patients with ILI presenting during hospitalisation with negative influenza results after nasal swab testing. Four controls per case, matched per influenza season (2004-05, 2005-06 and 2006-07), were randomly selected. Univariate and multivariate conditional logistic regression models were fitted to assess factors associated with HAI among patients.. In total, among 55 patients analysed, 11 (20%) had laboratory-confirmed HAI. The median HCW vaccination rate in the units was 36%. The median proportion of vaccinated HCW in these units was 11.5% for cases vs. 36.1% for the controls (P = 0.11); 2 (20%) cases and 21 (48%) controls were vaccinated against influenza in the current season (P = 0.16). The proportion of ≥ 35% vaccinated HCW in short-stay units appeared to protect against HAI among patients (odds ratio = 0.07; 95% confidence interval 0.005-0.98), independently of patient age, influenza season and potential influenza source in the units.. Our observational study indicates a shielding effect of more than 35% of vaccinated HCW on HAI among patients in acute-care units. Investigations, such as controlled clinical trials, are needed to validate the benefits of HCW vaccination on HAI incidence in patients.

Topics: Adult; Aged; Aged, 80 and over; Case-Control Studies; Cross Infection; Female; Health Personnel; Hemagglutination Inhibition Tests; Hospitals; Humans; Influenza Vaccines; Influenza, Human; Male; Middle Aged; Nose; Orthomyxoviridae; Prospective Studies; Vaccination

Screening for nares carriage of methicillin-resistant Staphylococcus aureus (MRSA) could be used to identify patients at reduced risk for MRSA infection. However, recent studies suggest that negative results of nares surveillance testing are not reliable to predict a low risk for MRSA infection.. To derive a clinical prediction rule, logistic regression was performed to identify predictors of MRSA infection in patients with negative nares surveillance results. To validate the prediction rule and modifications of the rule, the sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated in a prospective cohort of inpatients receiving empiric vancomycin.. A prediction rule that included 8 clinical risk factors and nares surveillance results was sensitive with NPV of 99.9%. In the validation cohort, 43 of 451 (10%) patients receiving empiric vancomycin had MRSA infection. In comparison with nares surveillance results (sensitivity, 72%; NPV, 96%), the prediction rule was more reliable for prediction of low risk for MRSA infection (sensitivity, 93%; NPV, 98%). A modified rule that included additional indications for empiric MRSA coverage based on practice guidelines reliably predicted MRSA infection (sensitivity, 100%) while excluding those at low risk (NPV, 100%).. Negative nares screening results in combination with absence of certain clinical risk factors or syndromes could provide a useful strategy to predict patients with low likelihood of MRSA infection.

Topics: Adult; Aged; Aged, 80 and over; Bacteriological Techniques; Carrier State; Clinical Medicine; Cross Infection; Decision Support Techniques; Hospitals, Veterans; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prognosis; Retrospective Studies; Risk Assessment; Risk Factors; Staphylococcal Infections

To determine prevalence, incidence and risk factors of colonization by extended-spectrum β-lactamase-producing Enterobacteriacae (ESBLE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococcus (VRE) in aged subjects admitted to an acute geriatric unit at a teaching hospital.. During 12 months, 337 patients were screened by nasal, oropharyngeal, groin, axillary and rectal swabs upon admission and at discharge.. The prevalence of ESBLE, MRSA and VRE carriage upon admission was 11.6%, 7.5% and 0.6%, respectively. The incidence density of ESBLE and MRSA carriage was respectively of 1.77 and 2.40 new cases for 1000 patient-days. No cases of VRE acquisition were found. Risk factors for ESBLE colonization on admission were: multiple contacts with the hospital within the previous year, chronic catheter use and a high level of dependency. For MRSA, risk factors were: chronic wounds, anti-acid use and a high level of dependency.. This study shows a high prevalence of asymptomatic colonization of ESBL-producing Escherichia coli in patients admitted to an acute geriatric ward, as high as MRSA carriage. A low functional status is a common risk factor both for ESBLE and for MRSA colonization and it highlights the need to reinforce infection control measures.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Axilla; Bacteria; Bacterial Infections; Carrier State; Cross Infection; Drug Resistance, Multiple, Bacterial; Female; Groin; Hospitals; Humans; Incidence; Male; Nose; Oropharynx; Prevalence; Prospective Studies; Rectum; Risk Factors

Staphylococcus epidermidis is a harmless commensal, but it can become a human pathogen, mainly in the hospital environment. In order to clarify strategies used by these bacteria to adapt to the hospital environment, we compared the population structure and staphylococcal cassette chromosome mec (SCCmec) content of S. epidermidis from the community and hospital.. S. epidermidis were collected from nasal swabs of both healthy military draftees (192 isolates) and patients (94 isolates) recovered in the same time period and geographical region. S. epidermidis were characterized by PFGE, multilocus sequence typing and SCCmec typing.. Clonal complex 5 was predominant in the hospital (100%) and the community (58%), but some clonal types were specific to each environment and others were found in both (C/H clones). The methicillin-resistant S. epidermidis (MRSE) colonization rate in the community was very low (7%) when compared with the hospital (30%; P < 0.05). Community-associated MRSE carried mostly SCCmec IV and V [Simpson's index of diversity (SID) = 57.52%; 95% CI 38.35-76.69], whereas hospital-associated MRSE carried 17 SCCmec structures (SID = 82.67%; 95% CI 77.38-87.96). Isolates of the same PFGE type had a much higher number of different SCCmec types when collected in the hospital than in the community.. Our data suggest that the S. epidermidis population is composed of hospital-associated clonal types, community-associated clonal types and types that are able to survive in both environments. Moreover, adaptation to the hospital environment in S. epidermidis appears to promote an increase in the frequency and diversification of SCCmec.

Topics: Adaptation, Biological; Biota; Carrier State; Chromosomes, Bacterial; Cluster Analysis; Community-Acquired Infections; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genetic Variation; Humans; Military Personnel; Multilocus Sequence Typing; Nose; Staphylococcal Infections; Staphylococcus epidermidis

The risk of acquisition of antibiotic resistant-bacteria during or shortly after antibiotic therapy is still unclear and it is often confounded by scarce data on antibiotic usage.Primary objective of the study is to compare rates of acquisition of methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae in hospitalised patients, after starting antibiotic therapy.. The study, running in three European hospitals, is a multicenter, prospective, longitudinal, observational cohort study funded from the European Community's Seventh Framework Programme [FP7/2007-2013] within the project 'Impact of Specific Antibiotic Therapies on the prevalence of hUman host ResistaNt bacteria' (acronym SATURN). Nasal and rectal screening for methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae will be obtained at hospital admission, discharge, at antibiotic start (t0, within one hour) and at the following intervals: day 3 (t1), 7 (t2), 15 (t3), and 30 (t4). Two nested case-control studies will be performed. The objective of the first study will be to define individual level of risk related to specific antibiotics. Patients acquiring methicillin-resistant Staphylococcus aureus and extended spectrum beta-lactamase-producing Enterobacteriaceae (cases) will be compared with patients not acquiring antibiotic-resistant strains after starting antibiotic therapy (controls; ratio 1:4). To define the impact of antibiotics on new acquisition of target antibiotic-resistant bacteria, a second nested case-control study will be done (ratio 1:4). Control group will be selected among patients not receiving antibiotics, admitted in the same ward on the day of the corresponding case, with negative cultures at admission. Epidemiological, clinical and microbiological data will be prospective collected.. The rationale of this study is to better understand the impact of antibiotic use on acquisition, selection and transmission of antimicrobial resistant-bacteria in European hospitals.. ClinicalTrials.gov NCT01208519.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; beta-Lactamases; Case-Control Studies; Child; Child, Preschool; Cross Infection; Drug Utilization; Enterobacteriaceae; Enterobacteriaceae Infections; Europe; Feces; Female; Hospitals; Humans; Infant; Infant, Newborn; Longitudinal Studies; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Prevalence; Prospective Studies; Staphylococcal Infections; Young Adult

To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents.. Multicenter, prospective cohort followed over 6 months.. Three Veterans Affairs (VA) LTCFs.. All current and new residents except those with short stay (<2 weeks).. MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE).. Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1-28.6]; P = .002). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers.. MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Cross Infection; Female; Hospitals, Veterans; Humans; Infection Control; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Multivariate Analysis; Nose; Prevalence; Prospective Studies; Residential Facilities; Risk Factors; Staphylococcal Infections

To determine the proportion of methicillin-resistant Staphylococcus aureus (MRSA) detections identified by nasal swabbing using agar culture in comparison with multiple body site testing using agar and nutrient broth culture.. Cross-sectional study.. Adult patients admitted to 36 general specialty wards of 2 large hospitals in Scotland.. Patients were screened for MRSA via multiple body site swabs (nasal, throat, axillary, perineal, and wound/invasive device sites) cultured individually on chromogenic agar and pooled in nutrient broth. Combined results from all sites and cultures provided a gold-standard estimate of true MRSA prevalence.. This study found that nasal screening performed better than throat, axillary, or perineal screening but at best identified only 66% of true MRSA carriers against the gold standard at an overall prevalence of 2.9%. Axillary screening performed least well. Combining nasal and perineal swabs gave the best 2-site combination (82%). When combined with realistic screening compliance rates of 80%-90%, nasal swabbing alone probably detects just over half of true colonization in practice. Swabbing of clinically relevant sites (wounds, indwelling devices, etc) is important for a small but high-prevalence group.. Nasal swabbing is the standard method in many locations for MRSA screening. Its diagnostic efficiency in practice appears to be limited, however, and the resource implications of multiple body site screening have to be balanced against a potential clinical benefit whose magnitude and nature remains unclear.

Topics: Aged; Aged, 80 and over; Axilla; Bacteriological Techniques; Carrier State; Cross Infection; Cross-Sectional Studies; Culture Media; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Perineum; Pharynx; Staphylococcal Infections; Wounds, Penetrating

To determine the occurrence of colonization and subsequent infection with multidrug-resistant organisms (MDROs) among patients in the neonatal intensive care unit and to assess the yield of surveillance cultures.. Cultures of nose, throat and stool were obtained from 196 neonates admitted to the Neonatal Intensive Care Unit (NICU) at the Clinical Center of the University of Sarajevo in the six-month period upon admission and once a week if the length of stay was more than seven days. At the same time clinical relevant samples (blood, urine, CSF, wounds swabs, tracheal aspirates) were examined for presence of MDROs. Identification and antibiotic sensitivity pattern of organisms were determined according to the CLSI.. A total of 126 (64.3%) patients were identified as colonized and 50 (25.5%) as infected with MDROs. 44.4% (56) of patients were colonized on admission. Fecal carriage was most common with extended-spectrum beta lactamase (ESBL)-producing Klebsiella pneumonia, and nose/throat with Acinetobacter baumannii. The patients become colonized more often during the first week of hospitalization (31.7%; p less .001). The infection is more observed in patients who had previously been colonized than those who had not (78% vs. 22%; p less 0.05). The most common infection was the blood infection (bacteremia). The median length of stay in neonates with an infection was 3.5 weeks and without infection 1 week (p less than 0.001).. An infection was more frequently observed in patients who had been previously colonized than those who had not. Microbial surveillance is necessary to detect colonized neonates when multidrug-resistant organisms become epidemic.

Topics: Bacterial Infections; Cross Infection; Drug Resistance, Multiple, Bacterial; Feces; Female; Humans; Infant, Newborn; Intensive Care Units, Neonatal; Male; Nose; Pharynx

MRSA prevalence in nursing homes often exceeds that in hospitals, but reasons for this are not well understood. We sought to measure MRSA burden in a large number of nursing homes and identify facility characteristics associated with high MRSA burden.. We performed nasal swabs of residents from 26 nursing homes to measure MRSA importation and point prevalence, and estimate transmission. Using nursing home administrative data, we identified facility characteristics associated with MRSA point prevalence and estimated transmission risk in multivariate models.. We obtained 1,649 admission and 2,111 point prevalence swabs. Mean MRSA point prevalence was 24%, significantly higher than mean MRSA admission prevalence, 16%, (paired t-test, p<0.001), with a mean estimated MRSA transmission risk of 16%.In multivariate models, higher MRSA point prevalence was associated with higher admission prevalence (p=0.005) and higher proportions of residents with indwelling devices (p=0.01). Higher estimated MRSA transmission risk was associated with higher proportions of residents with diabetes (p=0.01) and lower levels of social engagement (p=0.03).. MRSA importation was a strong predictor of MRSA prevalence, but MRSA burden and transmission were also associated with nursing homes caring for more residents with chronic illnesses or indwelling devices. Frequent social interaction among residents appeared to be protective of MRSA transmission, suggesting that residents healthy enough to engage in group activities do not incur substantial risks of MRSA from social contact. Identifying characteristics of nursing homes at risk for high MRSA burden and transmission may allow facilities to tailor infection control policies and interventions to mitigate MRSA spread.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carrier State; Child; Child, Preschool; Cross Infection; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Nursing Homes; Risk Factors; Staphylococcal Infections; Young Adult

Endonasal endoscopic skull base surgery (ESBS) is perceived as having a high risk of infection because it is performed through the sinuses, which are not sterile.. To identify the bacteriological characteristics, incidence, mortality, and risk factors for intracranial infection after ESBS.. A retrospective analysis of the first 1,000 ESBS procedures performed at the University of Pittsburgh Medical Center from 1998 to 2008.. In 18 cases (1.8%), the patient developed meningitis. In 2 cases, the patient died within 2 months after surgery, of noninfectious causes. In 11 cases, cerebrospinal fluid (CSF) cultures had positive results. There were no predominant pathogens. Male sex (odds ratio [OR], 3.97 [95% confidence interval {CI}, 1.21-13.03]; P = .02), history of a craniotomy or endonasal surgery (OR, 4.77 [95% CI, 1.68-13.56]; P = .02), surgery with higher levels of complexity (OR, 6.60 [95% CI, 1.77-24.70]; P = .003), the presence of an external ventricular drain or ventriculoperitoneal shunt at the time of surgery (OR, 6.38 [95% CI, 1.07-38.09]; P = .005), and postoperative CSF leak (OR, 12.99 [95% CI, 4.24-39.82]; P < .001) were risk factors for infection.. The incidence of infection of 1.8% in ESBS is comparable to that in open craniotomy. The most important risk factor was a postoperative CSF leak. All patients recovered from their infection.

Topics: Adolescent; Adult; Aged; Brain Abscess; Confidence Intervals; Cross Infection; Endoscopy; Female; Humans; Male; Meningitis; Middle Aged; Nose; Pennsylvania; Postoperative Complications; Retrospective Studies; Risk Factors; Skull Base

This study investigated the transmission dynamics of meticillin-resistant Staphylococcus aureus (MRSA) in a tertiary referral surgical unit with 300 beds. All adult patients were actively screened for MRSA by culture at hospital admission and twice weekly thereafter during hospitalisation from 1 October to 31 December 2008. The colonisation pressure per 1000 patient-days and the incidence density of nosocomial MRSA transmission per 1000 colonisation-days were calculated for the different spa types of MRSA. In total, 6619 nasal swabs were obtained from 2289 patients. One-hundred and forty-eight (7%) patients had MRSA in nasal swabs at admission screening, of which 68/148 (46%) were residents of elderly care homes. Fifty-two of 2141 (2%) patients had conversion of nasal MRSA carriage status from negative to positive during hospitalisation. Among the 200 patients with MRSA, spa types t1081 and t037 were found in 99 (50%) and 30 (15%) patients, respectively. The colonisation pressure per 1000 patient-days was 40.9 for t0181, 22.2 for t037 and 26.3 for the less common spa types. The incidence densities of nosocomial MRSA transmission per 1000 colonisation-days were significantly higher for t1081 (28.5 vs 4.0, P<0.01) and t037 (21.5 vs 4.0, P=0.03) compared with the less common spa types. Proactive screening of MRSA in patients from elderly care homes and targeted isolation of these patients, especially those carrying spa types with high transmissibility, are important for the control of MRSA in hospitals.

Topics: Adult; Aged; Aged, 80 and over; Bacterial Typing Techniques; Carrier State; Cross Infection; Female; Hong Kong; Hospital Units; Hospitals, University; Humans; Incidence; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Staphylococcal Infections; Staphylococcal Protein A; Surgery Department, Hospital

A novel multiplex PCR was developed which targeted virulence genes associated with the major clonal complexes (CCs) of healthcare- and community-associated methicillin-resistant Staphylococcus aureus (MRSA) in the USA. Most isolates (40/66) were identified as CC 5, while remaining isolates represented CCs 1, 8, 30, 45, 59, 133, and five isolates were not S. aureus.

Topics: Base Sequence; Biomarkers; Community-Acquired Infections; Cross Infection; Genotype; Hospitals; Methicillin-Resistant Staphylococcus aureus; Multiplex Polymerase Chain Reaction; Nose; Pennsylvania; United States

To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) carriage and transmission in an ambulatory hemodialysis population.. Prospective cohort study.. Outpatient hemodialysis facility affiliated with a large academic medical center.. Of the 170 facility patients, 103 (61%) participated in the study.. Swab specimens of the nares, axillae, and vascular access site were collected from participants weekly for 3 weeks and then monthly for 5 months. Demographic and clinical data were collected monthly for 12 months. Molecular analysis of MRSA isolates was performed.. The baseline MRSA carriage prevalence was 12%. Factors associated with MRSA carriage included a history of MRSA; failed renal transplantation; hospital admission within 6 months; and receipt of a first-generation cephalosporin, cefepime, or vancomycin. Six subjects acquired MRSA after enrollment (incidence, 1.2 per 100 patient-months at-risk; overall prevalence, 18%). Molecular analysis suggested that transmission occurred within the facility. The incidence of MRSA infection among carriers was 1.76 per 100 patient-months. Community-associated strains (ie, USA300) were isolated from 28% of carriers and at least 25% of infections.. The prevalence of MRSA carriage and the incidence of infection among carriers were high among ambulatory hemodialysis patients, and community-associated MRSA was responsible for a large portion of the MRSA burden. A relatively high rate of MRSA acquisition was observed, with indirect evidence of intrafacility transmission. Additional studies are needed to confirm these findings and to identify effective and feasible methods to prevent MRSA transmission and infection among hemodialysis patients.

Topics: Adult; Aged; Aged, 80 and over; Ambulatory Care; Axilla; Bacterial Typing Techniques; Carrier State; Catheters, Indwelling; Community-Acquired Infections; Cross Infection; Female; Humans; Incidence; Male; Methicillin-Resistant Staphylococcus aureus; Nose; Prevalence; Renal Dialysis; Renal Insufficiency, Chronic; Staphylococcal Infections; Staphylococcal Protein A

We report a case of nasal myiasis caused by Sarcophaga spp., noted during hospitalization. A 74-year-old man was admitted with non-ST-elevation myocardial infarction. The patient underwent coronary arterial bypass surgery and was then mechanically ventilated by means of a nasotracheal tube for the next 8 days. After extubation, a total of seven maggots were retrieved from both nostrils. The larvae were removed and reared to mature flies, which were identified as Sarcophaga peregrina. From the clinical course and the fly's life cycle, it was concluded that the infestation was hospital-acquired.

Topics: Aged; Animals; Cross Infection; Humans; Intubation, Intratracheal; Male; Myiasis; Nose; Sarcophagidae; Tomography, X-Ray Computed

Long-term-care facilities (LTCFs) are reservoirs of resistant bacteria. We undertook a point-prevalence survey and risk factor analysis for specific resistance types among residents and staff of a Bolzano LTCF and among geriatric unit patients in the associated acute-care hospital. Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on chromogenic agar; isolates were typed by pulsed-field gel electrophoresis; resistance genes and links to insertion sequences were sought by PCR; plasmids were analysed by PCR, restriction fragment length polymorphism and incompatibility grouping. Demographic data were collected. Of the LTCF residents, 74.8% were colonized with ≥1 resistant organism, 64% with extended-spectrum β-lactamase (ESBL) producers, 38.7% with methicillin-resistant Staphylococcus aureus (MRSA), 6.3% with metallo-β-lactamase (MBL) producers, and 2.7% with vancomycin-resistant enterococci. Corresponding rates for LTCF staff were 27.5%, 14.5%, 14.5%, 1.5% and 0%, respectively. Colonization frequencies for geriatric unit patients were lower than for those in the LTCF. Both clonal spread and plasmid transfer were implicated in the dissemination of MBL producers that harboured IncN plasmids bearing bla(VIM-1), qnrS, and bla(SHV-12). Most (44/45) ESBL-producing Escherichia coli isolates had bla(CTX-M) genes of group 1; a few had bla(CTX-M) genes of group 9 or bla(SHV-5); those with bla(CTX-M-15) or bla(SHV-5) were clonal. Risk factors for colonization of LTCF residents with resistant bacteria included age ≥86 years, antibiotic treatment in the previous 3 months, indwelling devices, chronic obstructive pulmonary disease, physical disability, and the particular LTCF unit; those for geriatric unit patients were age and dementia. In conclusion, ESBL-producing and MBL-producing Enterobacteriaceae and MRSA were prevalent among the LTCF residents and staff, but less so in the hospital geriatric unit. Education of LTCF employees and better infection control are proposed to minimize the spread of resistant bacteria in the facility.

Topics: Bacteria; Cross Infection; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Enterobacteriaceae; Enterococcus; Health Services for the Aged; Hospital Units; Hospitals; Humans; Inguinal Canal; Italy; Long-Term Care; Methicillin-Resistant Staphylococcus aureus; Nose; Oropharynx; Patients; Personnel, Hospital; Plasmids; Polymerase Chain Reaction; Polymorphism, Restriction Fragment Length; Rectum; Risk Factors; Urine; Vancomycin Resistance

To evaluate the prevalence of and risk factors for extranasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and its relationship to nasal colonization among veterans hospitalized for acute care.. Prospective observational study.. Veterans Affairs (VA) acute care hospital in Boston, Massachusetts.. Convenience sample of 150 patients hospitalized within the previous 36 hours and screened for nasal MRSA who were not known to have an active MRSA infection or MRSA isolates recovered from a wound during the past 12 months.. Potential risk factors for MRSA colonization were assessed, and oropharynx, axilla, hand, perirectal, wound, and catheter insertion site samples were obtained for culture. MRSA was identified in chromogenic agar and confirmed by use of routine culture techniques. Nasal MRSA colonization was detected by means of polymerase chain reaction (PCR).. Nasal swab samples analyzed by use of PCR yielded results positive for MRSA in 16 (11%) of 150 patients. Extranasal cultures yielded positive results for 3 (2%) of 134 patients who tested negative for nasal MRSA colonization and for 9 (56%) of 16 patients who tested positive for nasal MRSA colonization (odds ratio [OR], 56.1 [95% confidence interval {CI}, 12.4-254.6]; p < .001). The oropharynx was the most commonly colonized extranasal site (10 patients [7%]). Independent risk factors for extranasal MRSA colonization included nasal MRSA colonization (OR, 66.9 [95% CI, 11.8-379.7]; P < .001) and end-stage hepatic disease (OR, 98.5 [95% CI, 3.1-3,112.4]; P = .01).. Extranasal MRSA colonization is infrequent among veterans admitted for acute care to VA Boston Healthcare System. Extranasal MRSA colonization was strongly associated with nasal MRSA colonization, which suggests that the VA MRSA Prevention Initiative is not missing a large number of MRSA-colonized patients by focusing on nasal-only screening.

Topics: Adult; Aged; Aged, 80 and over; Boston; Carrier State; Cross Infection; Female; Hand; Hospitals, Veterans; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Oropharynx; Patient Admission; Polymerase Chain Reaction; Prevalence; Rectum; Staphylococcal Infections; Wounds and Injuries; Young Adult

This prospective study was designed to evaluate predictors of skin and soft tissue infections (SSTI) due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Consecutive patients who were hospitalized with S aureus SSTI were enrolled. CA-MRSA infection was diagnosed in 76% of the children. MRSA SSTI was associated with black race (P = .0001) and with infection involving the lower trunk (P = .008). Only 21% of the patients in this study had S aureus colonization in their nares, and in 3 cases there was discordance between the nares and the infection site cultures. Sensitivity, specificity, and predictive values of the risk factors examined were limited in their ability to predict CA-MRSA infection. Given the high prevalence of MRSA in our community and the inability of nasal cultures to reliably predict CA-MRSA infection, empirical antibiotic therapy active against CA-MRSA and contact isolation of patients are recommended.

Topics: Age Distribution; Anti-Bacterial Agents; Blood; Cohort Studies; Community-Acquired Infections; Cross Infection; Female; Hospitals, Pediatric; Humans; Logistic Models; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Multivariate Analysis; Nose; Predictive Value of Tests; Prevalence; Prospective Studies; Risk Assessment; Sensitivity and Specificity; Severity of Illness Index; Sex Distribution; Soft Tissue Infections; Staphylococcal Skin Infections; Statistics, Nonparametric; Treatment Outcome

The aim of this study was to investigate the prevalence and associated risk factors of methicillin-susceptible and methicillin-resistant Staphylocccus aureus (MSSA and MRSA) carriage in care homes, with particular focus on dementia. A point-prevalence survey of 748 residents in 51 care homes in Gloucestershire and Greater Bristol was undertaken. Dementia was assessed by the clock test or abbreviated mini-mental test. Nasal swabs were cultured for S. aureus on selective agar media. Multivariable analysis indicated that dementia was not a significant risk factor for MSSA (16.2%) or MRSA (7.8%); and that residents able to move around the home unassisted were at a lower risk of MRSA (P=0.04). MSSA carriage increased with increasing age (P=0.03) but MRSA carriage decreased with increasing age (P=0.05). Hospitalization in the last 6 months increased the risk of MSSA (P=0.04) and MRSA (P=0.10). We concluded that cross-infection through staff caring for more dependent residents may spread MRSA within care homes and from the recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control interventions.

Topics: Aged; Aged, 80 and over; Carrier State; Cross Infection; Dementia; Female; Homes for the Aged; Humans; Male; Nose; Nursing Homes; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; United Kingdom

Screening and isolation are central components of hospital methicillin-resistant Staphylococcus aureus (MRSA) control policies. Their prevention of patient-to-patient spread depends on minimizing undetected and unisolated MRSA-positive patient days. Estimating these MRSA-positive patient days and the reduction in transmission due to isolation presents a major methodological challenge, but is essential for assessing both the value of existing control policies and the potential benefit of new rapid MRSA detection technologies. Recent methodological developments have made it possible to estimate these quantities using routine surveillance data.. Colonization data from admission and weekly nares cultures were collected from eight single-bed adult intensive care units (ICUs) over 17 months. Detected MRSA-positive patients were isolated using single rooms and barrier precautions. Data were analyzed using stochastic transmission models and model fitting was performed within a Bayesian framework using a Markov chain Monte Carlo algorithm, imputing unobserved MRSA carriage events.. Models estimated the mean percent of colonized-patient-days attributed to undetected carriers as 14.1% (95% CI (11.7, 16.5)) averaged across ICUs. The percent of colonized-patient-days attributed to patients awaiting results averaged 7.8% (6.2, 9.2). Overall, the ratio of estimated transmission rates from unisolated MRSA-positive patients and those under barrier precautions was 1.34 (0.45, 3.97), but varied widely across ICUs.. Screening consistently detected >80% of colonized-patient-days. Estimates of the effectiveness of barrier precautions showed considerable uncertainty, but in all units except burns/general surgery and one cardiac surgery ICU, the best estimates were consistent with reductions in transmission associated with barrier precautions.

Topics: Adult; Carrier State; Cross Infection; Disease Transmission, Infectious; Humans; Intensive Care Units; Methicillin-Resistant Staphylococcus aureus; Nose; Patient Isolation; Staphylococcal Infections

The incidence of and risk factors for acquiring community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among patients staying in intensive care units (ICUs) remain unclear. We enrolled patients staying in two ICUs at the Far Eastern Memorial Hospital during the period of 1 September 2008 to 30 September 2009 to clarify this issue. Surveillance cultures for MRSA were taken from nostril, sputum or throat, axillae, and the inguinal area in all enrolled patients upon admission to the ICU, every 3 days thereafter, and on the day of discharge from the ICU. For each MRSA isolate, we performed multilocus sequence typing, identified the type of staphylococcal cassette chromosome mec, detected the presence of the Panton-Valentine leukocidin gene, and conducted drug susceptibility tests. Among the 1,906 patients who were screened, 203 patients were carriers of MRSA before their admission to the ICU; 81 patients acquired MRSA during their stay in the ICU, including 31 who acquired CA-MRSA. The incidence rates of newly acquired MRSA and CA-MRSA during the ICU stay were 7.9 and 3.0 per 1,000 patient-days, respectively. Prior usage of antipseudomonal penicillins and antifungals and the presence of a nasogastric tube were found to be independent risk factors for acquiring CA-MRSA during the ICU stay when data for CA-MRSA carriers and patients without carriage of MRSA were compared (P=0.0035, 0.0330, and 0.0262, respectively). Prior usage of carbapenems was found to be a protective factor against acquiring CA-MRSA when data for patients with CA-MRSA and those with health care-associated MRSA acquired during ICU stay were compared (P=0.0240).

Topics: Abdomen; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Axilla; Bacterial Toxins; Carrier State; Community-Acquired Infections; Cross Infection; Exotoxins; Female; Humans; Incidence; Intensive Care Units; Leukocidins; Male; Methicillin-Resistant Staphylococcus aureus; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Nose; Pharynx; Risk Factors; Sputum; Staphylococcal Infections; Young Adult

Recognition of methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage by active surveillance cultures has been widely debated. Our institution implemented universal nasal screening by polymerase chain reaction (PCR) for MRSA and isolation of screen positive patients in December 2007. Here we present data about the correlation between screen positivity and subsequent development of infection and the impact of isolation on surgical site infection rates.. This was a retrospective, observational study from January 1, 2008, through June 30, 2008, on all inpatient admissions with a nasal MRSA PCR screen. Genotype of 15 MRSA blood isolates was determined utilizing the Diversilab® (bioMérieux, Hazelwood, MO) system. A phenotypic rule was deduced and utilized for analyzing all MRSA clinical isolates.. 5375 patients were screened at ≤48 hours following admission. 581 MRSA positive nasal carriers (10.80%) were identified. 496 (85.3%) were asymptomatic MRSA nasal carriers. There were a total of 158 MRSA clinical infections. 85 (14.6%) MRSA nasal carriers had clinical infection. Of the 4794 (89.1%) non-nasally colonized patients, 73 (1.5%) had MRSA clinical infection. MRSA surgical site infection rate remained unchanged during the intervention period. Phenotypic predictive rule inferred 59.8% community-acquired MRSA (CA-MRSA) infections and 40% hospital-acquired MRSA (HA-MRSA) infections.. Our study showed a positive correlation between having a nasal screen positivity and subsequent development of infection. Isolation of MRSA screen positive patients alone as an intervention did not reduce the surgical site infection rates. Since most of our isolates are CA-MRSA, our institution is implementing several new interventions to further reduce the incidence of HA-MRSA conditions.

Topics: Carrier State; Cost-Benefit Analysis; Cross Infection; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Outcome Assessment, Health Care; Polymerase Chain Reaction; Population Surveillance; Retrospective Studies; Staphylococcal Infections; Surgical Wound Infection; Texas

The problem of intensive care unit methicillin-resistant Staphylococcus aureus (MRSA) infections has led to routine surveillance and eradication strategies.. Our surgical intensive care unit (SICU) admissions receive MRSA nares cultures and if positive are isolated followed by eradication treatment. This strategy was retrospectively reviewed.. Our nares-positive culture rate was 21% (30/145), and the sputum positive (sputum+) rate was 18% (26/145). Positive nares culture (Nares+) was eradicated in 63%. The rate of sputum+ in Nares+ patients was 36% (9/25). The rate of sputum+ in Nares- was 10% (12/115; P = .003). The sputum+ SICU length of stay (LOS) (18 ± 12 days in 23 S+ patients) is longer than in sputum- (10 ± 9 days in 69 S-patients, P = .0002).. This SICU has high rates of both nares and sputum MRSA cultures. Our data suggest eradicating nares colonization may prevent pneumonia and might decrease SICU LOS.

Topics: Anti-Bacterial Agents; Cross Infection; Female; Humans; Intensive Care Units; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Mupirocin; Nose; Pneumonia, Staphylococcal; Sputum

Colonized or infected patients are a major reservoir for patient-to-patient transmission of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals. Despite attempted adherence to recommended infection prevention and control procedures, a general medicine unit in our hospital continued to experience ongoing transmission of MRSA. The role that colonization pressure (CP) plays in nosocomial transmission of MRSA on a general medicine unit was assessed, and a threshold CP above which additional IP&C practices should be implemented was proposed.. From January 2005 to December 2006, all patients admitted to a 36-bed general medicine unit were screened on admission for MRSA. Monthly MRSA nosocomial incidence (new nosocomial cases x 1000/susceptible patient-days) and CP (number of MRSA patient-days x 100/total patient-days) were calculated. The relative risk (RR) of MRSA transmission above and below the median CP with 95% confidence interval was calculated.. Twenty-one cases of nosocomially acquired MRSA were detected during the study period, with transmission occurring in 8 separate months. The median CP during the 2 years was 6.7%. The RR of MRSA acquisition increased as CP increased above the median (RR, 7.6; 95% CI: 1.1-52.6; P = .008). MRSA outbreaks were declared on 2 separate occasions, and, in each, the CP for the preceding month was greater than the median value of 6.7%.. CP has a significant effect on the subsequent transmission of MRSA on a general medicine unit. Ongoing monitoring of CP provides the opportunity for early implementation of enhanced infection prevention and control practices and can potentially decrease nosocomial transmission of MRSA and prevent outbreaks.

Topics: Carrier State; Catheters, Indwelling; Cross Infection; Disease Outbreaks; DNA Fingerprinting; Electrophoresis, Gel, Pulsed-Field; Hospitals; Humans; Methicillin-Resistant Staphylococcus aureus; Nose; Perineum; Prevalence; Staphylococcal Infections; Wounds and Injuries

We assessed the frequency of carriers of methicillin-resistant Staphylococcus aureus (MRSA) among 500 dental patients of a university clinic. From each participant, two specimens were taken from the anterior nares and the pharynx and analysed by culture. The participants completed a questionnaire on possible risk factors of MRSA infection. Two hundred ten individuals carried S. aureus, 90 in the nares only, 51 in the throat only and 69 in nares and throat. Isolates of 208 patients were methicillin-sensitive; two isolates were methicillin-resistant, both carried in the throat exclusively. In conclusion, the frequency of nasal and/or throat carriers of MRSA among dental patients was low and suggests few opportunities of exposure in the dental clinic assessed.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Bacteriological Techniques; Carrier State; Colony Count, Microbial; Cross Infection; Dental Care; Female; Humans; Infection Control, Dental; Male; Methicillin; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Pharynx; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surveys and Questionnaires; Switzerland; Young Adult

To measure the rate of colonization of outborn infants with methicillin-resistant Staphylococcus aureus (MRSA) to evaluate the need for Contact Precautions (including isolation) at the time of admission to the neonatal intensive care unit (NICU).. All 239 consecutive infants referred from the neonatal units of other hospitals to a tertiary NICU in Al Ain, United Arab Emirates, between January 2000 and December 2007 were screened for MRSA colonization. Swabs from the ear, nose, rectum, axillae, and groin were obtained from each patient, and the rates of colonization were calculated retrospectively.. Some 72% of newborns were admitted to our NICU in the first week. Only 1 patient, admitted from Oman, grew MRSA from the ear swab (rate, 0.4%; 95% confidence interval = 0.01% approximately 2.3%).. This study from a tertiary NICU in a developing country shows that outborn infants are unlikely to harbor MRSA, and thus their routine admission in a single-bed isolation room is not justified. MRSA screening on admission has a very low yield and does not appear to be cost-effective. Contact Precautions should be reserved for those newborns transferred from general pediatric wards and those admitted from home.

Topics: Carrier State; Cross Infection; DNA, Bacterial; Ear, External; Hospitals, Pediatric; Humans; Infant, Newborn; Infection Control; Intensive Care Units, Neonatal; Methicillin-Resistant Staphylococcus aureus; Nose; Patient Isolation; Rectum; Referral and Consultation; Retrospective Studies; Risk Factors; Skin; Staphylococcal Infections; United Arab Emirates

We studied provider- and patient-collected samples from multiple anatomic sites to determine the yield for detection of methicillin-resistant Staphylococcus aureus (MRSA). Sampling of multiple sites was required to achieve a sensitivity of more than 90% for MRSA colonization. Groin and perineum samples yielded positive results significantly more often for community-onset MRSA than for hospital-onset MRSA. Agreement rates between provider- and patient-collected swab specimens were excellent.

Topics: Adolescent; Aged; Anti-Bacterial Agents; Axilla; Child; Community-Acquired Infections; Cross Infection; Cross-Sectional Studies; Culture Media; Female; Groin; Humans; Male; Methicillin Resistance; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Pharynx; Population Surveillance; Sensitivity and Specificity; Specimen Handling; Staphylococcal Infections

Healthy infants frequently acquire Staphylococcus aureus colonization; however, the modes of transmission are not well defined. In this study, 8 of 23 (35%) infants cultured at age 2 weeks acquired S aureus carriage, but only 1 infant had a family member with nasal carriage of the same clone, suggesting that sources other than colonized family members may account for a significant proportion of cases.

Topics: Carrier State; Cross Infection; Feces; Female; Humans; Infant, Newborn; Male; Methicillin-Resistant Staphylococcus aureus; Mothers; Nose; Pilot Projects; Prospective Studies; Skin; Staphylococcal Infections; Staphylococcus aureus

A nested case-control study at a tertiary care facility was conducted to assess potential risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) on admission among oncology patients. Risk factors for any S aureus and MRSA colonization on admission in oncology patients are consistent with previous studies in general populations. In addition, recent chemotherapy as a risk factor is a unique finding in this population.

Topics: Antineoplastic Agents; Carrier State; Case-Control Studies; Cross Infection; Female; Hospitalization; Humans; Immunocompromised Host; Infection Control; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Odds Ratio; Oncology Service, Hospital; Patient Admission; Retrospective Studies; Risk Factors; Staphylococcal Infections

Zygomycosis is an opportunistic fungal infection with a fulminant course. Varying clinical forms have been described, including cutaneous zygomycosis, which is mainly observed in diabetic and burns patients. We report herein a case of cutaneous zygomycosis of the nose in a 26-year-old female patient with diabetic ketoacidosis, developing secondary to the application of non-elasticized adhesive tape probably contaminated with fungal spores.

Topics: Adult; Amphotericin B; Antifungal Agents; Bandages; Cross Infection; Debridement; Dermatomycoses; Diabetic Ketoacidosis; Female; Humans; Mucormycosis; Nose; Rhizopus; Treatment Outcome; Zygomycosis

Surgical-site infections (SSI), because of MRSA, are a challenge for acute care hospitals. The current study examines the impact of best practices and active surveillance screening for MRSA on reduction of MRSA SSIs.. Beginning February 2007, all admissions to a 761-bed tertiary care hospital were screened for MRSA by nasal swab using polymerase chain reaction-based testing. Positive nasal carriers of MRSA were treated before operation. The subset of patients undergoing procedures that are part of the Surgical Infection Prevention Project were followed for MRSA SSIs. SSI rates (per 100 procedures) were determined using the National Nosocomial Infection Surveillance definitions. MRSA SSI rates were compared before and after the MRSA screening intervention. Differences were analyzed using Fisher's exact test and chi-square with Yate's continuity correction. Where specimens were available, genotyping of MRSA was performed using a commercially available assay.. After universal MRSA surveillance, 5,094 patients underwent Surgical Infection Prevention Project procedures. The rate of MRSA SSI decreased from 0.23% to 0.09%. The reduction was most pronounced in joint-replacement procedures (0.30% to 0%; p = 0.04). No other differences were statistically significant. Of the seven patients in whom MRSA SSI developed after universal screening, four had positive MRSA screens; none had received preoperative eradication of MRSA. In two of these patients, the genotype of MRSA detected on screening and in SSI was genetically indistinguishable.. Surveillance for MRSA and eradication of the carrier state reduces the rate of MRSA SSI.

Topics: Arthroplasty, Replacement; Benchmarking; Carrier State; Cross Infection; Female; Humans; Male; Mass Screening; Methicillin-Resistant Staphylococcus aureus; Middle Aged; North Carolina; Nose; Population Surveillance; Staphylococcal Skin Infections; Surgery Department, Hospital; Surgical Wound Infection

Few data are available on methicillin-resistant Staphylococcus aureus (MRSA) colonization in day care. We performed a study in a medical university child care center to study the epidemiology of MRSA in this population.. Survey.. A child care center on the campus of a university medical center.. One hundred four children who attended the child care center and 32 employees gave samples that were cultured for MRSA. Seventeen household members of the children and employee found to be colonized with MRSA also gave samples that were cultured. Parents and employees completed questionnaires about demographic characteristics, medical conditions and treatments, and possible exposure risks outside the child care center. In addition, 195 environmental samples were taken from sites at the childcare center. Isolates were analyzed for relatedness by use of molecular typing, and statistical analysis was performed.. The prevalence of MRSA in the children was 6.7%. One employee (3.1%) was colonized with MRSA. Cultures of samples given by 6 of 17 (35.3%) family members of these children and the employee yielded MRSA. MRSA was recovered from 4 of 195 environmental samples. Molecular typing revealed that many of the MRSA isolates were indistinguishable, and 18 of the 21 isolates were community-associated MRSA. Multivariable analysis revealed that receipt of macrolide antibiotics (P = .002; odds ratio, 39.6 [95% confidence interval, 3.4-651.4]) and receipt of asthma medications (P = .024; odds ratio, 26.9 [95% confidence interval, 1.5-500.7]) were related to MRSA colonization.. There was a low prevalence of MRSA colonization in children and employees in the child care center but a higher prevalence of colonization in their families. Molecular typing showed that transmission of MRSA likely occurred in the child care center. The use of macrolide antibiotics and asthma medications may increase the risk of MRSA colonization in this population.

Topics: Academic Medical Centers; Adult; Carrier State; Child Day Care Centers; Child, Preschool; Community-Acquired Infections; Cross Infection; Culture Media; Female; Humans; Infant; Male; Methicillin-Resistant Staphylococcus aureus; Middle Aged; Nose; Oropharynx; Prevalence; Staphylococcal Infections; Texas

One year prospective study was evaluated to ascertain the prevalence of nasal carriage of potentially pathogenic bacteria in health care workers and the antibiotic susceptibility profile. The bacterial strains were identified by conventional method and the antibiotic resistance was carried out by disc diffusion method. The prevalence of Staphylococcus aureus, coagulase negative staphylococci and methicillin resistant Staphylococcus aureus were 48%, 46% and 14% respectively. The antibiotic susceptibility pattern of these isolates revealed that Staphylococcus aureus were more resistant towards antibiotics than coagulase negative staphylococci. The most effective antibiotic for S. aureus was found to be vancomycin with 100% efficacy, then cephalothin 92%, ciprofloxacin 91%, amikacin 77% and erythromycin 55%, ampicillin 11% and penicillin 3%. Coagulase negative staphylococci were 100% sensitive to vancomycin and cephalothin. Oxacillin showed 78% effectiveness; while ampicillin and penicillin, demonstrated 64% and 59% respectively. Doxycycline (93%), amikacin (93%), fusidic acid (90%) and erythromycin (92%) were effective antimicrobials.

Topics: Anti-Infective Agents; Carrier State; Cross Infection; Disk Diffusion Antimicrobial Tests; Drug Resistance, Bacterial; Hospitals, Pediatric; Humans; Hygiene; Infection Control; Methicillin Resistance; Nose; Personnel, Hospital; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Family; Gram-Negative Bacteria; Gram-Negative Bacterial Infections; Humans; Intensive Care Units; Methicillin; Methicillin Resistance; Nose; Skin; Staphylococcal Infections; Staphylococcus aureus; Visitors to Patients

Prevalence of hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) infection or colonisation has been associated with antimicrobial consumption. The impact of antibiotic treatment on nasal colonisation is unknown. We conducted a three-month prospective study of 116 patients with extranasal MRSA infection or colonisation, whose nasal MRSA bacterial loads were determined during and after various antibiotic courses over a period of three weeks. Environmental swabs were also taken from the near patient environment. Concomitant nasal MRSA carriage was observed in 76.7% of extranasal MRSA-colonised or -infected patients. The median nasal MRSA bacterial load increased significantly from 2.78 (range 0-6.15) to 5.30 (range 2.90-8.41) log(10) cfu per swab (cfu/swab) (P<0.001) over 21 days during beta-lactam therapy. It also increased from 0 (range 0-4.00) to 4.30 (range 0-7.46) log(10)cfu/swab (P=0.039) over 14 days during fluoroquinolone therapy. Median bacterial loads were significantly higher for beta-lactam- and fluoroquinolone-treated patients on day 7 [4.78, range 0-7.30], day 14 [4.30, range 0-7.60] and day 21 [5.30, range 2.90-8.41] than controls not receiving antibiotics (P<0.05). These loads then decreased by 2-5log(10)cfu/swab 2 weeks after discontinuation of antibiotics. The environment of patients receiving beta-lactam agents (relative risk: 3.55; 95% confidence interval: 1.30-9.62; P=0.018) or fluoroquinolones (4.32; 1.52-12.31; P=0.008) demonstrated more MRSA contamination than the environment around control patients (0.79; 0.67-0.93; P=0.002). Patients on beta-lactam or fluoroquinolone therapy have increased incidence of MRSA colonisation and higher nasal bacterial loads, and appear to spread their MRSA into the near patient environment.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cluster Analysis; Colony Count, Microbial; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Environmental Microbiology; Female; Humans; Male; Methicillin Resistance; Middle Aged; Nose; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus; Time Factors

Patients in long-term acute care (LTAC) facilities often have many known risk factors for acquisition of antibiotic-resistant bacteria. However, the prevalence of resistance in these facilities has not been well described.. We performed a single-day, point-prevalence study of a 180-bed, university-affiliated LTAC facility in Baltimore to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii in the anterior nares, perirectal area, sputum, and wounds.. Among the 147 patients evaluated, we found a high prevalence of colonization by both MRSA (28%) and A baumannii (30%). Of the A baumannii isolates, 90% were susceptible to imipenem and 92% were susceptible to ampicillin-sulbactam. No isolates were resistant to both imipenem and ampicillin-sulbactam.. The high prevalence of resistance found in this study supports the need for increased surveillance of patients in the LTAC environment. The fact that these patients are often frequently transferred to tertiary care facilities also supports the need for coordination and collaboration among facilities within the same health care system and the broader geographic area.

Topics: Academic Medical Centers; Acinetobacter baumannii; Acinetobacter Infections; Adult; Aged; Anal Canal; Anti-Bacterial Agents; Baltimore; Cross Infection; Female; Humans; Intensive Care Units; Long-Term Care; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Wounds and Injuries

This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital.. In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA-positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash.. A total of 18,810 samples were processed, of which 850 (4.5 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 38.5 per cent (P < 0.001), and MRSA wound isolates fell by 12.7 per cent (P = 0.031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 3.78 beds per year (276,220 pounds sterling), compared with the annual mean for the preceding 6 years. The cost of screening was 302,500 pounds sterling, making a net loss of 26,280 pounds sterling. Compared with 2005, however, there was a net saving of 545,486 pounds sterling.. Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established.

Topics: Bacteremia; Cost-Benefit Analysis; Cross Infection; Elective Surgical Procedures; Emergency Treatment; Humans; Methicillin Resistance; Nose; Patient Compliance; Polymerase Chain Reaction; Specimen Handling; Staphylococcal Infections; Staphylococcus aureus; Surgery Department, Hospital; Surgical Wound Infection

There are two important routes for the transmission of Staphylococcus aureus to the burn wound. In the endogenous route, patients naturally carrying S. aureus colonize their own wounds, whereas in the exogenous route burn wounds are cross-infected from other sources. In this study we evaluated the effect of blocking the endogenous route on S. aureus burn wound colonization by mupirocin application in the nose of patients at the time of admission.. From September 2000 to January 2002 all patients with burns admitted to a single dedicated Burn Centre received nasal mupirocin upon admission. This period was compared to two control periods (C1: July 1999 to July 2000 and C2: January 2002 to January 2003) for S. aureus burn wound colonization. The colonization risk was analysed, adjusting for confounding, with Cox proportional hazard regression.. A total of 98 patients did not have S. aureus burn wound colonization at the time of admission and were, thus, considered at risk for S. aureus acquisition during their stay. As compared to C1, the relative risk of acquiring S. aureus in their wound was 0.48 (95% CI: 0.24-0.97) in the mupirocin period and 0.55 (95% CI: 0.28-1.1) during the C2 period. S. aureus nasal/pharyngeal colonization was a significant independent risk factor for wound colonization (RR: 2.3; 95% CI: 1.2-4.2).. Nasal mupirocin may contribute to risk reduction of S. aureus wound colonization in patients with burns.

Topics: Administration, Intranasal; Adult; Anti-Bacterial Agents; Burns; Cross Infection; Drug Administration Routes; Female; Humans; Male; Mupirocin; Nasal Mucosa; Nose; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

This territory-wide study evaluated the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in residential care homes for elderly (RCHEs) in Hong Kong. MRSA colonization was assessed by taking swab culture from anterior nares and active skin lesions. Of 487 RCHEs surveyed, 80 MRSA strains were recovered from 1563 residents, giving a prevalence of 5.1%. Twenty-four isolates had SCCmec II, 2 had SCCmec III, 17 had SCCmec IV, 36 had SCCmec V, and 1 had a composite SCCmec type. Pulsed-field gel electrophoresis typing clustered 75 isolates into 7 clones (HKU10 to 50, HKU80, and HKU90). Two predominant types, HKU30 and HKU50, which together account for 75% of all MRSA strains, were found in 13 and 15 of the 18 geographic districts in Hong Kong, respectively. The main features for HKU50 strains were spa t1081/ST45-IV or V, capsular type 8, agrIV, and hla, seg, sei positive. On the other hand, HKU30 strains had spa t002/ST5-II, capsular type 5, agrII, and were hla, seg, sei positive. HKU30 strains were often multidrug resistant (MDR, involving ciprofloxacin, erythromycin, gentamicin, and tetracycline). In contrast, HKU50 strains exhibit both multidrug resistance (MDR) (involving ciprofloxacin, erythromycin, and tetracycline, but not gentamicin) and non-MDR patterns.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Carrier State; Cluster Analysis; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genes, Bacterial; Hong Kong; Humans; Methicillin Resistance; Molecular Epidemiology; Nose; Prevalence; Staphylococcal Skin Infections; Staphylococcus aureus

Staphylococcus aureus (n=84) isolated from the nostrils of a healthy population from Kathmandu and from the infectious cases (n=100) from Tribhuvan University Teaching Hospital, Kathmandu, Nepal were tested from May 1996 to March 1997 in Central Department of Microbiology, Tribhuvan University, Kathmandu, Nepal by microbiological and chemical methods to find out their beta lactamase activity. Among the healthy population, in domiciliary conditions 21.4% of the isolates were found beta lactamase producers. The occurrence of beta lactamase producing S. aureus was greater among female (27.0%) than among male (17.0%), however it was not significant (X2 = 1.2309, P > 0.05). The occurrence of the same was observed high among 40 and above age groups (66.7%) and 0-9 age group (60.0%), however no association with any particular age group was observed (X2 = 16.8674, P > 0.05). The b lactamase activity of S. aureus hospital inpatients isolates was 75.0% showing high occurrence of b lactamase activity in hospital isolates compared to S. aureus isolates from healthy carriers (X2 = 52.4113, P < 0.001). No association of beta lactamase positive hospital isolates with gender (X2 = 0.2158, P > 0.05) and age group (X2 = 1.5522, P > 0.05) was observed. This study shows that the prevalence of beta lactamase positive S. aureus was greater in hospital cases than in nasal carriers in domiciliary condition indicating the requisition of further study in this field.

Topics: Adolescent; Adult; beta-Lactamases; Child; Child, Preschool; Cross Infection; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nepal; Nose; Penicillinase; Pilot Projects; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

We report the largest documented healthcare-associated outbreak of Panton-Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus (PVL(+) MRSA) in Europe. Six index patients from three long-term care facilities (LTCFs) were screened positive for PVL(+) MRSA in 2004 on admission to a community hospital in Germany. The purpose of this prospective study was to describe the prevalence of PVL(+) MRSA in the LTCFs before and after infection control interventions. Screening for MRSA with or without PVL was performed in all three LTCFs in 2004 [453 residents, 240 healthcare workers (HCWs)] and 2005 (440 residents, 192 HCWs). Swabs from anterior nares and wounds, if applicable, were collected. Colonised residents and staff were treated with mupirocin nasal ointment and topical antiseptics, and staff were provided with hygiene education. Total MRSA carrier rate of residents and HCWs in 2004 was 11.3% (PVL(+) MRSA 9.1%, PVL(-) MRSA 2.2%). There were comparable carrier rates between residents and HCWs in each LTCF. All PVL(+) MRSA isolates were of clonal origin (MLST 22) representing a novel spa sequence type t310. A decrease in total MRSA prevalence (from 11.3 to 5.5%) and PVL(+) MRSA (from 9.1 to 3.3%) was observed in 2005. The rate of PVL(-) MRSA remained unaffected. No symptomatic skin infections were noted among residents or HCWs. In this outbreak incomplete control of PVL(+) MRSA presumably resulted from difficult and delayed detection and decolonisation of carriers, incomplete compliance with control measures and lack of enforcement by public health authorities.

Topics: Administration, Intranasal; Adolescent; Adult; Aged; Aged, 80 and over; Bacterial Toxins; Carrier State; Cross Infection; Disease Outbreaks; Exotoxins; Female; Germany; Guideline Adherence; Health Personnel; Humans; Infection Control; Leukocidins; Male; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Patients; Staphylococcal Infections; Staphylococcus aureus; Wounds and Injuries

Methicillin-resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen that causes severe morbidity and mortality in many hospitals worldwide, and MRSA infections are frequent in intensive care units (ICUs).. A prospective study was implemented to investigate the risk factors for ICU-acquired MRSA infections.. This study was conducted in surgical and neurologic ICUs from May to November 2003. The patients staying in ICUs more than 48 hours were included in the study. All of the patients were visited daily, and data were recorded on individual forms for each patient until discharge or death. Nasal swab cultures were done within 48 hours of ICU admission and repeated every week until the patients colonized with MRSA or were discharged from ICUs. ICU-acquired MRSA infection was diagnosed when MRSA was isolated from the infected site.. Overall, 249 patients were followed during the study. MRSA infection was detected in 21 (8.4%) of these patients. The most frequent infection was primary bloodstream infection (10/21, 47%). It was followed by pneumonia (8/21, 38%) and surgical site infection (3/21, 14%). Nasal MRSA colonization was detected in 59 (23.7%) patients, and 12 of them (20.3%) developed MRSA infection. In univariate analysis, hospitalization period in an ICU, intraabdominal and orthopedic pathologies, mechanical ventilation, central venous catheter insertion, total parenteral nutrition, previous antibiotic use, surgical ICU stay, nasal MRSA colonization, and presence of more than 2 patients having nasal colonization in the same ICU at the same time were found significant for MRSA infections. In multivariate analysis; hospitalization period in an ICU (OR, 1.090; 95% CI: 1.038-1.144, P = .001), central venous catheter insertion (OR, 1.822; 95% CI: 1.095-3.033, P = .021), previous antibiotic use (OR, 2.337; 95% CI: 1.326-4.119, P = .003) and presence of more than 2 patients having nasal colonization in the same ICU at the same time (OR, 1.398; 95% CI: 1.020-1.917, P = .037) were independently associated with MRSA infections.. According to the our results, hospitalization period in an ICU, presence of patients colonized with MRSA in the same ICU at the same time, previous antibiotic use, and central venous catheter insertion are independent risk factors for ICU-acquired MRSA infections. Detection of these factors helps to decrease the rate of MRSA infections in the ICUs.

Topics: Adult; Aged; Anti-Bacterial Agents; Bacteremia; Catheterization; Cross Infection; Female; Humans; Intensive Care Units; Length of Stay; Male; Methicillin Resistance; Middle Aged; Multivariate Analysis; Nose; Parenteral Nutrition; Pneumonia; Prospective Studies; Respiration, Artificial; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Methicillin-resistant Staphylococcus aureus (MRSA) is a serious nosocomial problem, globally distributed. Decolonization with mupirocin can be used to control its dissemination.. To determine the incidence of mupirocin resistance among MRSA carriers from an intensive care unit.. We obtained 2723 nasal swabs during 3 years. Resistance to methicillin and mupirocin were verified (agar diffusion and the E test) and confirmed by polymerase chain reaction (PCR) (mecA for methicillin; ileS-2 and mupA for mupirocin). Plasmid-curing procedure and pulsed-field gel electrophoresis (PFGE) were employed in isolates exhibiting high resistance to mupirocin (HR-Mup) and in other selected organisms.. The overall incidence of HR-Mup among MRSA carriers during the studied period was 4.84% (8/165); however, the incidence decreased from 13.04% (6/46) in the first year to 3.5% (2/57) in the second year and was 0% in the last year (P = .02). LR-Mup, in contrast, increased significantly (P = .01).. Plasmid-curing procedure showed the plasmid location of genes responsible for HR-Mup. PFGE demonstrated that most MRSA, including the isolates with HR-Mup, were genetically related. The decline in HR-Mup may be attributable to the plasmid location of genes (ileS-2/mupA) and to the fact that all patients colonized with HR-Mup MRSA died or were discharged in a relatively short period of time.

Topics: Bacterial Proteins; Carrier State; Cross Infection; DNA, Bacterial; Drug Resistance, Bacterial; Genes, Bacterial; Humans; Incidence; Intensive Care Units; Methicillin Resistance; Microbial Sensitivity Tests; Molecular Epidemiology; Mupirocin; Nose; Nuclear Proteins; Penicillin-Binding Proteins; Plasmids; Polymerase Chain Reaction; Staphylococcal Infections; Staphylococcus aureus

After the introduction of routine treatment for every nasal carrier of methicillin-resistant Staphylococcus aureus, active follow-up surveillance for nosocomial methicillin-resistant S. aureus infection was conducted for 5 years in an intensive care unit of a tertiary-care teaching hospital. There was a significant decrease in the incidence of nosocomial methicillin-resistant S. aureus infection during the later years of follow-up. Decolonization of nasal carriers of methicillin-resistant S. aureus is probably associated with such findings.

Topics: Anti-Bacterial Agents; Anti-Infective Agents, Local; Brazil; Chlorhexidine; Cross Infection; Humans; Infection Control; Intensive Care Units; Methicillin Resistance; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus

The worldwide rise of MRSA is equivalent to an increase of nasal colonization with MRSA. The objectives of this study were to investigate the rate of occult nasal MRSA colonization in trauma patients, to elucidate the role of MRSA carriers for endogenous infection (nose --> wound) and to check the efficiency of mupirocin therapy.. A total of 643 consecutive trauma patients underwent MRSA screening (nasal swabs) on admission. At the same time all MRSA wound infections were registered and all isolates were analysed with PFGE (pulsed-field gel electrophoresis) to detect cross-infection between individuals.. In 13 patients (2.0%) we found MRSA in the nose and limited isolation as well as therapy with mupirocin were performed. No endogenous transmission of MRSA from the nose to the wound could be seen, and no cross-infection to other patients could be detected.. Our findings suggest that in our patients with nasal colonization the risk of intra- and interindividual transmission of MRSA is very small. Therefore, in trauma patients screening on admission does not seem to be absolutely necessary either for clinical or for epidemiological reasons.

Topics: Aged; Aged, 80 and over; Anti-Bacterial Agents; Cross Infection; Follow-Up Studies; Humans; Intensive Care Units; Mass Screening; Methicillin Resistance; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcus aureus; Time Factors; Wound Infection

We conducted this study to assess the rate of methicillin-resistant Staphylococcus aureus colonization and its association with infection among infants hospitalized in methicillin-resistant S aureus-endemic NICUs.. Between March 2003 and February 2004, surveillance culture specimens from the nares, postauricular areas, axillae, and umbilicus of infants admitted to the NICUs at a children's hospital in Taiwan were obtained weekly for the detection of methicillin-resistant S aureus. All colonized and clinical isolates from each study infant with methicillin-resistant S aureus infection were genotyped with pulsed-field gel electrophoresis, with Sma1 digestion, and compared.. A total of 783 infants were included in this study. Methicillin-resistant S aureus colonization was detected for 323 infants during their NICU stays, with detection with the first 2 samples for 89%. Nares and umbilicus were the 2 most common sites of initial colonization. Methicillin-resistant S aureus colonization was associated significantly with premature birth (< or = 28 weeks) and low birth weight (< or = 1500 g), and infants with colonization had a significantly higher rate of methicillin-resistant S aureus infection, compared with those without colonization (26% vs 2%). Methicillin-resistant S aureus colonization was noted for 84 of 92 infants with methicillin-resistant S aureus infections. Of the 68 episodes with previous colonization and isolates available for genotyping analysis, colonized and clinical isolates were indistinguishable in 63 episodes, highly related in 2 episodes, and distinct in 3 episodes.. More than 40% of the hospitalized infants were colonized with methicillin-resistant S aureus during their stay in methicillin-resistant S aureus-endemic NICUs; this was associated significantly with methicillin-resistant S aureus infection. Most infants with methicillin-resistant S aureus infections had previous colonization with an indistinguishable strain.

Topics: Axilla; Bacteremia; Bacterial Typing Techniques; Birth Weight; Carrier State; Cross Infection; DNA, Bacterial; Ear, External; Female; Gestational Age; Hospitals, Pediatric; Hospitals, University; Humans; Infant; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Intensive Care Units, Neonatal; Male; Methicillin Resistance; Nose; Patient Isolation; Skin; Sputum; Staphylococcal Infections; Staphylococcus aureus; Taiwan; Umbilicus

We report the effectiveness of preemptive enhanced barrier precautions in containing a methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a university hospital burn unit and further controlling endemic nosocomial MRSA infection in the unit during the succeeding 27 months.. During a 6-month period, 12 patients in a 7-bed burn unit were found to be colonized (7) or infected (5) by MRSA. An epidemiologic study was undertaken.. Seven of the 10 strains of MRSA from patients that were available for DNA typing were clonally identical. Early in the outbreak, a health care worker was found to be a concordant nasal carrier and was successfully decolonized with nasal mupirocin. However, despite stringent compliance with isolation of MRSA-positive patients (targeted precautions), new cases of MRSA colonization or infection continued to occur. The outbreak was rapidly terminated after implementing preemptive barrier precautions with all patients in the unit: a new, clean gown and gloves for any physical contact with the patient or their environment. Although 25% of all nosocomial S aureus isolates in our hospital are resistant to methicillin, the incidence of endemic MRSA colonization and infection in the burn unit has remained very low since implementing barrier precautions unit wide (baseline rate, 2.2 [95% CI: 1.0-4.2] cases per 1000 patient-days; outbreak rate, 7.2 [95% CI: 4.4-11.0] cases per 1000 patient-days; post-outbreak termination endemic rate, 1.1 (95% CI: 0.4-2.3) cases per 1000 patient-days). The rate ratio comparing the outbreak and the baseline period was 3.20 (95% CI: 1.40-7.95, P = .002); the rate ratio comparing the post-outbreak period with the baseline period was 0.48 (95% CI: 0.14-1.53, P = .10), and it has not been necessary to screen personnel for MRSA carriage to prevent nosocomial MRSA infections in this highly vulnerable population.. Preemptive barrier precautions were highly effective in controlling the outbreak and, most notably, have also been highly effective in maintaining a very low incidence of nosocomial MRSA infection endemically in the succeeding 27 months of follow-up. Use of clean gloves, with or without a gown, bears consideration for all high-risk hospitalized patients to prevent cross transmission of all multiresistant nosocomial pathogens.

Topics: Burn Units; Carrier State; Cross Infection; Deoxyribonucleases, Type II Site-Specific; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Incidence; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Molecular Epidemiology; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus; Wisconsin

The purpose of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) and to define risk factors allowing identification of high-risk patients for MRSA nasal carriage at admission to the vascular surgery unit. From March 23, 2004 to July 13, 2004, screening for nasal carriage of MRSA was conducted at admission to the vascular surgery unit and 1 week thereafter. To analyze risk factors for MRSA nasal carriage at admission to the vascular surgery unit, a case-control study was carried out in patients presenting colonization at the time of admission. A total of 308 patients underwent nasal screening for MRSA. Thirteen were colonized with MRSA (nine at admission and four acquired), i.e., 4.2% of patients. Methicillin-susceptible Staphylococcus aureus (MSSA) was found in 11.4% of patients who underwent screening. Six patients with MRSA infection were identified during the study period. The two patients who acquired infection were colonized at the time of admission. Arrival from another health-care facility and from another department was a significant risk factor for carriage of MRSA. The prevalence of nasal carriage in vascular surgery was 4.2%. Nasal screening is highly cost-effective since 60% of MRSA carriers were undetected using diagnostic specimens alone. French recommendations issued for cardiac and orthopedic surgery by the consensus conference on preoperative management of infectious risk on March 5, 2004, should be extended to vascular surgery.

Topics: Adult; Aged; Aged, 80 and over; Carrier State; Case-Control Studies; Cross Infection; Female; France; Humans; Infection Control; Male; Mass Screening; Methicillin Resistance; Middle Aged; Nose; Patient Admission; Practice Guidelines as Topic; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgery Department, Hospital; Vascular Surgical Procedures

This study aimed (a) to provide information on methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization ratio in residents of nursing homes; (b) to determine the effect of hand-washing education given to nursing home residents and employees on nasal carriage of Staphylococcus aureus (NCSA) and (c) to obtain probable risk factors for MRSA colonization of residents in two nursing homes.. Seventy-nine volunteers (24 females and 55 males) from Bolu nursing homes were included in the study. Nasal samples were taken with sterile swabs from the anterior nares. Staphylococcus aureus strains were identified using classical methods and genotyping of methicillin resistant strains was done using Arbitrary Primed PCR (AP-PCR). Antibiotic susceptibilities were determined by disk diffusion methods according to NCCLS standards. After first nasal samples were taken, all employees and residents of nursing homes were educated about the methods of hand hygiene over two days.. With hand-washing education, the decrease of NCSA rate (initially 43%; after education, 21%) was significant (p < 0.05) while decrease of MRSA carriage (initially 5%, after education 1%) was not (p > 0.05). MRSA carriage was significantly correlated with presence of skin lesions, prior hospitalization within the last six months, and antibiotics usage within the last six months. AP PCR results suggested that residents' carriage of MRSA was the result of the same source.. MSSA and MRSA colonization rates were found to be 38% and 5% in nursing homes, respectively. These ratios can decrease with simple precautions like hand-washing after a short education period

Topics: Aged; Aged, 80 and over; Cross Infection; Female; Hand Disinfection; Humans; Inservice Training; Male; Methicillin Resistance; Middle Aged; Nose; Nursing Homes; Polymerase Chain Reaction; Program Evaluation; Risk Assessment; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Turkey

Staphylococcus aureus is the most common cause of healthcare-associated infections. Intranasal mupirocin treatment probably decreases S. aureus infections among colonized surgical patients. Using cost-effectiveness analysis, we evaluated the cost-effectiveness of preoperative use of mupirocin for the prevention of healthcare-associated S. aureus infections.. Three strategies were compared: (1) screen with nasal culture and give treatment to carriers, (2) give treatment to all patients without screening, and (3) neither screen nor treat. A societal perspective was taken. Adverse outcomes included bloodstream infection, pneumonia, surgical site infection, death due to underlying illness or infection, readmission, and the need for home health care. Data inputs were obtained from an extensive MEDLINE review and from publicly available government data sources. The following base-case data inputs (and ranges) for sensitivity analysis were used: rate of S. aureus carriage, 23.1% (19%-55%); efficacy of mupirocin treatment, 51% (8%-75%); mupirocin treatment cost, 48.36 US Dollars (24.18-57.74 US Dollars); and hospital costs of bloodstream infection, 25,128 US Dollars (6,194-40,211 US Dollars), pneumonia, 18,366 US Dollars (5,574-28,952 US Dollars), and surgical site infection 16,256 US Dollars (5,119-22,553 US Dollars). Widespread use of mupirocin has been associated with high levels of mupirocin resistance; therefore, a broad range of estimates for efficacy was tested in the sensitivity analysis.. The target population included patients undergoing nonemergent surgery requiring postoperative hospitalization.. Both the screen-and-treat and treat-all strategies were cost saving, saving 102 US Dollars per patient screened and 88 US Dollars per patient treated, respectively. In 1-way sensitivity analyses, the model was robust with respect to all data inputs except for the efficacy of mupirocin treatment. If the efficacy is less than 16.1%, then the screen-and-treat strategy is cost incurring. A treat-all strategy was more cost saving if the rate of S. aureus carriage was greater than 42.7%, the mupirocin cost was less than 29.87 US Dollars, or nursing compensation was greater than 64.21 US Dollars per hour.. Administration of mupirocin before surgery is cost saving, primarily because healthcare-associated infections are very expensive. The level of mupirocin efficacy is critical to the cost-effectiveness of this intervention.

Topics: Anti-Bacterial Agents; Cost Savings; Cost-Benefit Analysis; Cross Infection; Decision Trees; Mupirocin; Nose; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Infection-control strategies usually combine several interventions. The relative value of individual interventions, however, is rarely determined. We assessed the effect of daily microbiological surveillance alone (e.g., without report of culture results or isolating colonized patients) as an infection-control measure on the spread of methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S. aureus (MRSA) in a medical intensive care unit (MICU).. Colonization of patients with MSSA and MRSA was assessed by cultures of nasal swabs obtained daily and, if a patient was intubated, by cultures of additional endotracheal aspirates. Pulsed-field gel electrophoresis was used to determine relatedness between MSSA or MRSA isolates in surveillance cultures (i.e., cultures of nasal swab specimens obtained daily) and those in clinical cultures (i.e., any other culture performed for clinical purposes). Adherence to infection-control measures by health care workers (HCWs) was determined by observations of HCW-patient interaction.. During a 10-week period, surveillance cultures were performed for 158 patients. Fifty-five patients (34.8%) were colonized with MSSA, and 9 (5.7%) were colonized with MRSA. Sixty-two patients were colonized before admission to the hospital (53 had MSSA, and 9 had MRSA). Two patients appeared to have acquired MSSA in the MICU, but, on the basis of genotyping analysis, we determined that this was not the result of cross-acquisition.. Surveillance cultures and genotyping of MRSA and MSSA isolates demonstrated the absence of cross-transmission among patients in the MICU, despite ongoing introduction of these pathogens. Reporting culture results and isolating colonized patients, as suggested by some guidelines, would have falsely suggested the success of such infection-control policies.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Humans; Infection Control; Methicillin Resistance; Nose; Patient Isolation; Staphylococcal Infections; Staphylococcus aureus

Abstract The larval stages of the fly Cochliomyia hominivorax are responsible for myiasis, which primarily affects wounds. We report the case of a bed-ridden patient with dementia who developed right nasal myiasis during his stay at Cayenne Hospital. Progression was favorable, but the nasal pyramid was partially destroyed. In zones where this fly is endemic, particular attention should be given to hospitalized patients with wounds and consciousness problems.

Topics: Aged; Aged, 80 and over; Cross Infection; French Guiana; Humans; Male; Myiasis; Nose

Until recently, infections with methicillin-resistant Staphylococcus aureus (MRSA) have mainly been associated with hospital outbreaks in Norway. However, increasingly cases are contracted outside hospitals. This paper reports the first two outbreaks of MRSA in two nursing homes in central Norway, affecting 23 residents and five staff members. Pulsed-field gel electrophoresis analysis showed that all strains from nursing home A were identical and that the strains from nursing home B were genotypically similar with one or two band differences. Multi-locus sequence typing (MLST) showed that the strains from the two nursing homes belong to clonal complex 45, with each strain being a single-locus variant of sequence type 45 (ST 45), a well-known European epidemic strain. No evident source of the two outbreaks was found, and there was no obvious connection between the two outbreaks. The latter is also supported by the minor differences observed by MLST, suggesting a connection at some time in the past. The outbreaks led to a heavier workload and economic strain on both nursing homes. The outbreak in nursing home A was brought to an end, whereas two residents remained colonized in nursing home B despite several eradication attempts. These outbreaks show the potential for MRSA spread in a nursing home. If the prevalence of MRSA in Norway continues to increase, nursing home staff and residents may have to be included in the groups to be screened for MRSA upon hospital admission.

Topics: Aged; Aged, 80 and over; Cross Infection; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Methicillin Resistance; Molecular Epidemiology; Norway; Nose; Nursing Homes; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus aureus; Suppuration; Wounds and Injuries

Surveillance cultures performed at hospital admission have been recommended to identify patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) but require substantial resources. We determined the prevalence of and risk factors for MRSA colonization at the time of hospital admission among patients cared for at a public urban hospital.. Anterior nares cultures were obtained within 48 h after admission during a 1-month period. A case-control study and molecular typing studies were performed.. A total of 53 (7.3%) of 726 patients had a nares culture positive for MRSA, and 119 (16.4%) had a nares culture that was positive for methicillin-susceptible S. aureus. In multivariate analysis, risk factors for MRSA colonization included antibiotic use within 3 months before admission (odds ratio [OR], 2.5; 95% confidence interval [CI], 1.2-5.0), hospitalization during the past 12 months (OR, 4.0; 95% CI, 2.0-8.2), diagnosis of skin or soft-tissue infection at admission (OR, 3.4; 95% CI, 1.5-7.9), and HIV infection. A total of 47 (89%) of 53 case patients colonized with MRSA had at least 1 of these independent risk factors, in contrast to 343 (51%) of 673 control patients (OR, 7.5; 95% CI, 3.2 -17.9). Molecular typing demonstrated that 16 (30%) of 53 MRSA nares isolates (2.2% of the 726 isolates) belonged to the USA300 community-associated MRSA (CA-MRSA) genotype.. The prevalence of MRSA colonization at the time of patient admission was high (>7%). Limiting surveillance cultures to patients with >or=1 of the identified risk factors may allow for targeted screening. The emergence of CA-MRSA colonization represents a new, unrecognized reservoir of MRSA within hospitals, potentially increasing the risk for horizontal transmission.

Topics: Adolescent; Adult; Case-Control Studies; Community-Acquired Infections; Cross Infection; Female; Hospitals; Humans; Male; Methicillin Resistance; Middle Aged; Multivariate Analysis; Nose; Odds Ratio; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients.. Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates.. Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of non-colonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%.. The incidence of S. aureus infection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible.

Topics: Anti-Bacterial Agents; Cohort Studies; Cross Infection; Female; Humans; Incidence; Intensive Care Units; Male; Mass Screening; Methicillin Resistance; Middle Aged; New York City; Nose; Polymerase Chain Reaction; Prevalence; Prospective Studies; Risk Factors; Sensitivity and Specificity; Staphylococcal Infections; Staphylococcus aureus; Trachea; Treatment Outcome

Topics: Anti-Bacterial Agents; Carrier State; Community-Acquired Infections; Cross Infection; Humans; Methicillin Resistance; Nose; Staphylococcal Infections; Staphylococcus aureus; United States

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has emerged as an important cause of staphylococcal infections, but there have been little data on whether CA-MRSA causes health care-associated infections.. A case-control study was performed to identify risk factors for prosthetic joint infections (PJI). Antibiograms of isolates associated with PJI were reviewed. Molecular typing of available MRSA isolates was done using pulsed field gel electrophoresis (PFGE). Nares cultures of health care workers who provided care to those orthopedic patients were obtained.. Over a 13-month period (January 2003-January 2004), 9.5% of patients with prosthetic hip (THA) or knee (TKA) joint surgery developed PJI (7 TKA and 2 THA). The mean time to development of PJI was 20 days. Five infections were caused by CA-MRSA and 3 by methicillin-susceptible S aureus; one was culture negative. All CA-MRSA isolates had identical antibiograms (resistant to beta-lactams and erythromycin; susceptible to clindamycin, trimethoprim-sulfamethoxazole, rifampin, gentamicin, levofloxacin, and vancomycin). Molecular typing of 2 available CA-MRSA isolates revealed that these were the USA300 clone; these isolates were PVL+ and carried SCCmec IV. CA-MRSA was not recovered from nares cultures from 31 health care workers. In multivariate analysis, TKA (OR, 8.1; 95% CI: 1.3-48.1) and surgery time >180 minutes (OR, 7.4; 95% CI: 1.4-39.6) were associated with PJI.. We have demonstrated that the CA-MRSA USA300 clone is no longer just a cause of community-acquired infections but has also emerged as a cause of health care-associated infections, causing PJI at our institution.

Topics: Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents; Case-Control Studies; Community-Acquired Infections; Cross Infection; Female; Health Personnel; Humans; Incidence; Male; Methicillin Resistance; Microbial Sensitivity Tests; Middle Aged; Nose; Prosthesis-Related Infections; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Axilla; Carrier State; Cross Infection; Groin; Humans; Infection Control; Methicillin Resistance; Nose; Perineum; Pharynx; Staphylococcal Infections; Staphylococcus aureus

This study sought to determine the rate of nasal methicillin-resistant Staphylococcus aureus (MRSA) carriage among hospital staff and outpatients. Nasal swabs were obtained from 500 outpatients and 500 hospital staff. Hospital staff were 2.3-fold more likely to carry MRSA than were outpatients (6% vs 2.6%, P = .013).

Topics: Carrier State; Cross Infection; Disease Reservoirs; Humans; Methicillin Resistance; Nose; Outpatients; Personnel, Hospital; Staphylococcal Infections; Staphylococcus aureus; Turkey

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Humans; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Carrier State; Cross Infection; Double-Blind Method; Female; Genotype; Hospital Mortality; Humans; Length of Stay; Male; Middle Aged; Mupirocin; Nose; Ointments; Staphylococcal Infections; Staphylococcus aureus; Treatment Outcome

Patients in a surgical intensive care unit (ICU) have a high incidence of nosocomial infections which often lead to septic shock and death. Since specific antibiotic treatment is often difficult, it is recommended that routine nose/throat swabs be obtained in order to have a better idea of the causative agent when a systemic inflammatory response occurs in a given patient.. In 1435 patients in a cardiac surgical ICU, routine nose/throat swabs were taken thrice a week and tested for microorganisms and systemic inflammation. Blood cultures were also obtained. Antibiotic treatment was given to cover the microbes from the nose/throat swabs. Alternatively, an empirical antibiotic therapy was given to patients whose swabs had tested negative.. Of the 86 patients with systemic inflammation, 29 had blood cultures positive for microbes. Of these, 18 received a specific antibiotic therapy based on their positive nose/throat cultures prior to the return of the blood cultures from the laboratory. However, only 11 patients tested positive for the same microbes on routine swabs and blood cultures. While positive routine swabs are quite specific to sepsis when there is a systemic inflammatory response, routine swabs are not a suitable screening tool due to their low sensitivity.. Routine nose/throat swabs led to earlier specific antibiotic treatment in only 22 % of patients with clinical signs of systemic inflammation. In 36 % of cases, the organisms detected in the routine swabs and blood cultures were not identical. Hence, we believe that routine swabs are of limited value in instituting earlier, specific antibiotic therapy in septic patients.

Topics: Antibiotic Prophylaxis; Cardiac Surgical Procedures; Critical Care; Cross Infection; Humans; Nose; Pharynx; Sepsis; Survival Rate; Systemic Inflammatory Response Syndrome

Topics: Cross Infection; Habits; Humans; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Cross Infection; Dermatitis, Atopic; Drug Resistance, Bacterial; Fusidic Acid; Hospitals; Humans; Nose; Skin; Staphylococcus aureus; Time Factors; Treatment Outcome

Reports of methicillin-resistant Staphylococcus aureus (MRSA) infection in neonatal intensive care units (NICU) and normal newborn nurseries in Japan were investigated, and various methods of preventing transmission were evaluated. In the late 1980s, MRSA which had spread in adult wards also invaded NICU. Very low birthweight or premature infants had become the targets of MRSA infection and this has now become a serious problem. Recent reports have revealed that 87% of major NICU in Japan have suffered from MRSA infections. However, we have found that preventive measures can greatly reduce the risk of a newborn being infected by a carrier, while also controlling the disease caused by MRSA infection. Recently, MRSA infections in normal newborn nurseries have also become a serious problem in pediatric departments. Methicillin-resistant Staphylococcus aureus which can colonize in the newborn baby just after birth, is passed on to the newborn by carrier medical staff. It was found to be of great importance that infant's mothers hold and nurse their babies immediately after birth, and start breast-feeding while still in the delivery room. Furthermore, the most appropriate and ideal newborn nursery is one where mother and child are roomed together and there is little intervention by the hospital. In neonatal care, it is of utmost importance to treat carriers of MRSA bacteria, and to inhibit the spread of the bacterium in babies by taking standard precautionary measures.

Topics: Breast Feeding; Cross Infection; Humans; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Intensive Care Units, Neonatal; Intubation, Intratracheal; Japan; Methicillin Resistance; Nose; Pharynx; Skin; Staphylococcal Infections

To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.. A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA. Risk factors associated with the likelihood of MRSA colonization on admission were investigated.. Tertiary-care military medical facility.. All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.. Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.. Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

Topics: Adult; Carrier State; Cross Infection; Female; Hawaii; Hospitalization; Hospitals, Military; Humans; Male; Methicillin Resistance; Middle Aged; Nose; Population Surveillance; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

To assess the prevalence of and the clinical features associated with asymptomatic Staphylococcus aureus colonization in a healthy outpatient population, and to compare the characteristics of colonizing methicillin-resistant S. aureus (MRSA) strains with those of strains causing infection in our community and hospital.. Outpatient military clinics.. Specimens were obtained from the nares, pharynx, and axillae of 404 outpatients, and a questionnaire was administered to obtain demographic and risk factor information. MRSA strains were typed by pulsed-field gel electrophoresis (PFGE) and evaluated for antibiotic susceptibility. Antibiograms of study MRSA strains were compared with those of MRSA strains causing clinical illness during the same time period.. Methicillin-susceptible S. aureus (MSSA) colonization was present in 153 (38%) of the 404 asymptomatic outpatients, and MRSA colonization was present in 8 (2%). Detection of colonization was highest from the nares. No clinical risk factor was significantly associated with MRSA colonization; however, a tendency was noted for MRSA to be more common in men and in those who were older or who had been recently hospitalized. All colonizing MRSA strains had unique patterns on PFGE. In contrast to strains responsible for hospital infections, most colonizing isolates of MRSA were susceptible to oral antibiotics.. MRSA and MSSA colonization is common in our outpatient population. Colonization is best detected by nares cultures and most carriers of MRSA are without apparent predisposing risk factors for acquisition. Colonizing isolates of MRSA are heterogeneous and, unlike nosocomial isolates, often retain susceptibility to other non-beta-lactam antibiotics.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Carrier State; Child; Child, Preschool; Community-Acquired Infections; Cross Infection; Female; Hawaii; Hospitals, Military; Humans; Infant; Male; Methicillin Resistance; Middle Aged; Nose; Outpatient Clinics, Hospital; Prevalence; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

Topics: Adult; Age Factors; Cross Infection; Device Removal; Humans; Intensive Care Units; Intubation, Gastrointestinal; Intubation, Intratracheal; Nose; Oropharynx; Pneumonia; Ventilators, Mechanical

The role of rectal carriage of Staphylococcus aureus as a risk factor for nosocomial S. aureus infections in critically ill patients has not been fully discerned.. Nasal and rectal swabs for S. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit. Overall, 49.5% (101 of 204) of the patients never harbored S. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due to S. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P - .001). Patients with both rectal and nasal carriage were significantly more likely to develop S. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85; P= .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients with S. aureus infections.. Rectal carriage represents an underappreciated reservoir for S. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk for S. aureus infections in these patients than currently realized.

Topics: Adult; Aged; Aged, 80 and over; Carrier State; Critical Illness; Cross Infection; Female; Hospitals, Veterans; Humans; Infection Control; Intensive Care Units; Liver Transplantation; Male; Methicillin Resistance; Middle Aged; Nose; Pennsylvania; Prevalence; Rectum; Risk Factors; Serotyping; Staphylococcal Infections; Staphylococcus aureus

To evaluate the usefulness of an assay using two polymerase chain reaction-based genotyping methods in the practical surveillance of methicillin-resistant Staphylococcus aureus (MRSA).. Nosocomial infection and colonization were surveyed monthly in a university hospital in Japan for 20 months. Genotyping with mec-HVR is based on the size of the mec-associated hypervariable region amplified by polymerase chain reaction. Toxin genotyping uses a multiplex polymerase chain reaction method to amplify eight staphylococcal toxin genes.. Eight hundred nine MRSA isolates were classified into 49 genotypes. We observed differing prevalences of genotypes for different hospital wards, and could rapidly demonstrate the similarity of genotype for outbreak isolates. The incidence of genotype D: SEC/TSST1 was significantly higher in isolates causing nosocomial infections (49.5%; 48 of 97) than in nasal isolates (31.4%; 54 of 172) (P = .004), suggesting that this genotype may represent the nosocomial strains.. The combined use of these two genotyping methods resulted in improved discriminatory ability and should be further investigated.

Topics: Bacterial Toxins; Bacterial Typing Techniques; Carrier State; Complementarity Determining Regions; Cross Infection; Discriminant Analysis; Disease Outbreaks; DNA, Bacterial; Enterotoxins; Exfoliatins; Genotype; Hospitals, University; Humans; Incidence; Infection Control; Japan; Methicillin Resistance; Nose; Polymerase Chain Reaction; Population Surveillance; Prevalence; Staphylococcal Infections; Staphylococcus aureus; Superantigens

Following an outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.. To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.. Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit. The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987-1988) to 12% (1999-2000) (P = .0009) for newly admitted patients and from 0% to 7% (P < .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.. The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

Topics: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anal Canal; Carrier State; Cross Infection; Disease Outbreaks; Female; Hospital Units; Hospitals, Community; Hospitals, Teaching; Humans; Infection Control; Male; Mass Screening; Methicillin Resistance; Middle Aged; Missouri; Nose; Patient Admission; Population Surveillance; Predictive Value of Tests; Prevalence; Prospective Studies; Rehabilitation; Staphylococcal Infections; Staphylococcus aureus; Wound Infection

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Topics: Administration, Intranasal; Anti-Bacterial Agents; Antibiotic Prophylaxis; Cross Infection; Drug Resistance, Bacterial; Humans; Mupirocin; Nose; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

It is unclear whether the levels of Staphylococcus aureus colonization of hospital personnel with patient exposure are increased or whether personnel become colonized with more antibiotic-resistant strains. Differences in nasal and hand carriage of S. aureus between medical and nonmedical hospital personnel were examined. No differences in nasal carriage between the two groups were found; however, there was a trend that suggested differences in the rates of hand carriage of S. aureus (18% of nonmedical personnel and 10% of medical personnel). Medical personnel were colonized with more antibiotic-resistant isolates than nonmedical personnel (mean, 2.8 versus 2.1 isolates [P < 0.03]), and the strain profiles indicated that they tended to be more clonal in origin, suggesting that exposure to hospital isolates alters the colonization profile.

Topics: Adult; Cross Infection; Drug Resistance, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Hand; Humans; Male; Medical Staff, Hospital; Methicillin Resistance; Middle Aged; Nose; Personnel, Hospital; Staphylococcal Infections; Staphylococcus aureus

The consequences of infection with Staphylococcus aureus can be severe, so strategies for prevention are important. We examined S. aureus isolates from blood and from nasal specimens to determine whether the organisms in the bloodstream originated from the patient's own flora.. In a multicenter study, swabs for culture were obtained from the anterior nares of 219 patients with S. aureus bacteremia. A total of 723 isolates were collected and genotyped. In a second study, 1640 S. aureus isolates from nasal swabs were collected over a period of five years and then compared with isolates from the blood of patients who subsequently had S. aureus bacteremia.. In the multicenter study of S. aureus bacteremia, the blood isolates were identical to those from the anterior nares in 180 of 219 patients (82.2 percent). In the second study, 14 of 1278 patients who had nasal colonization with S. aureus subsequently had S. aureus bacteremia. In 12 of these 14 patients (86 percent), the isolates obtained from the nares were clonally identical to the isolates obtained from blood 1 day to 14 months later.. A substantial proportion of cases of S. aureus bacteremia appear to be of endogenous origin since they originate from colonies in the nasal mucosa. These results provide support for strategies to prevent systemic S. aureus infections by eliminating nasal carriage of S. aureus.

Topics: Adolescent; Adult; Aged; Aged, 80 and over; Bacteremia; Bacterial Typing Techniques; Carrier State; Child; Child, Preschool; Cross Infection; Electrophoresis, Gel, Pulsed-Field; Female; Germany; Hospitals, Community; Hospitals, General; Humans; Infant; Male; Methicillin Resistance; Middle Aged; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Bacteremia; Carrier State; Cross Infection; Methicillin Resistance; Nose; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus is a major cause of severe infection in humans and yet is carried without symptoms by a large proportion of the population. We used multilocus sequence typing to characterize isolates of S. aureus recovered from asymptomatic nasal carriage and from episodes of severe disease within a defined population. We identified a number of frequently carried genotypes that were disproportionately common as causes of disease, even taking into account their relative abundance among carriage isolates. The existence of these ecologically abundant hypervirulent clones suggests that factors promoting the ecological fitness of this important pathogen also increase its virulence.

Topics: Carrier State; Community-Acquired Infections; Cross Infection; Genes, Bacterial; Genetic Variation; Genotype; Humans; Nose; Point Mutation; Recombination, Genetic; Sequence Analysis, DNA; Staphylococcal Infections; Staphylococcus aureus; Virulence

During 11 months 58 extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) isolates were grown from 10 patients on a neurological early rehabilitation unit. The patients had no signs of infection but were colonized in the nose and trachea, and unusually only one had colonization in the gut. A single clone of ESBL-Kp was identified by pulse field gel electrophoresis. Strong hygienic precautions similar to those for Methicillin-resistant Staphylococcus aureus patients prevented spread of the bacteria to other wards. However, rehabilitation for patients with severe neurological failures made it very difficult to follow hygienic requirements. Disinfection of mucous membranes was difficult. Eventually the application of a nasal spray containing povidone-iodine proved to be successful.

Topics: Anti-Infective Agents, Local; beta-Lactamases; Carrier State; Cross Infection; Drug Resistance, Microbial; Environmental Microbiology; Humans; Infection Control; Klebsiella Infections; Klebsiella pneumoniae; Microbial Sensitivity Tests; Nose; Physical Therapy Department, Hospital; Povidone-Iodine; Trachea

Nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection in infants has become a serious concern and a new means of preventing the transmission of MRSA in the community needs to be considered.. We performed nasal mupirocin treatment on 10 infants who were MRSA-positive either in the nose or the pharynx and evaluated the effect of mupirocin on the eradication of MRSA.. Eradication of MRSA from the nose was successful in two cases and eradication from the pharynx in six (66.6%) of nine cases. The number of treatments required to achieve eradication varied; within three courses for nose carriers and from one to seven courses for pharynx carriers. Eradication was unsuccessful even after five to seven treatments in three pharynx-limited carriers.. These data suggest that the effect of nasal mupirocin treatment on pharynx-colonized MRSA is limited and that repetitive treatment is necessary in some cases. However, in view of the possibility of preferential pharyngeal colonization of Staphylococcus aureus in infancy, nasal mupirocin treatment deserves further evaluation for eradication not only of nose- but also of pharynx-colonized MRSA.

Topics: Administration, Intranasal; Carrier State; Cross Infection; Female; Humans; Infant, Newborn; Male; Methicillin Resistance; Mupirocin; Nose; Pharyngeal Diseases; Pharynx; Staphylococcal Infections; Staphylococcus aureus

Staphylococcus aureus bacteremia (SAB) acquired in hospitals continues to be a frequent and serious complication to hospitalization, and no previous case-control studies dealing with risk factors of this severe disease are available.. Based on a 1-year prospective analysis, the data from all patients with hospital-acquired SAB admitted to 4 hospitals in Copenhagen County, Denmark, from May 1, 1994, through April 30, 1995, were evaluated. Eighty-five patients with hospital-acquired SAB were matched to 85 control patients with a similar primary diagnosis at admission (matched controls). Of these, 62 patients with hospital-acquired SAB were compared with 118 other patients with a similar time of admission, who were randomly selected with no clinical evidence of SAB (unmatched controls).. The incidence of hospital-acquired SAB was 0.71 per 1000 hospital admissions. The presence of a central venous catheter (odds ratio, 6.9; 95% confidence interval [CI], 2.8-17.0), anemia (odds ratio, 3.3; 95% CI, 1.4-7.6), and hyponatremia (odds ratio, 3.3; 95% CI, 1.5-7.0) was significantly associated with hospital-acquired SAB in a conditional and a usual logistic regression analysis. Nasal carriage was not an independent risk factor, but nasal carriers among patients in surgery (odds ratio, 4.0; 95% CI, 1.3-13.0) had a significantly higher risk for hospital-acquired SAB compared with matched and unmatched controls. The presence of hospital-acquired SAB increased the mortality rate 2.4-fold (95% CI, 1.1-5.2).. The presence of a central venous catheter is an important risk factor, and hyponatremia and anemia are associated with the development of hospital-acquired SAB. Furthermore, hospital-acquired SAB in itself increases mortality.

Topics: Adolescent; Adrenal Cortex Hormones; Adult; Age Factors; Aged; Aged, 80 and over; Anemia; Anti-Bacterial Agents; Bacteremia; Case-Control Studies; Catheterization, Central Venous; Child; Child, Preschool; Cross Infection; Denmark; Female; Hospitals, Community; Humans; Hyponatremia; Immunocompromised Host; Infant; Infusions, Intravenous; Male; Middle Aged; Nose; Odds Ratio; Prospective Studies; Regression Analysis; Renal Dialysis; Risk Factors; Sex Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Procedures, Operative; Survival Analysis; Transfusion Reaction

Biotyping, antibiograms and fingerprinting were used to determine the relation of 16 methicillin-resistant S. haemolyticus isolated from drains in patients who underwent intraabdominal surgery to 9 methicillin-resistant strains of S. haemolyticus isolated at the same time from hospital environment. The comparison of biochemical properties of the examined strains showed a large variety of biochemical profiles as well as antibiotic patterns of susceptibility. The differences in sensitivity to the antibiotics used were not distinct. Biotyping and antibiograms did not permit determination of the relation of the investigated strains. Only the results of fingerprinting allowed for the division of the 25 examined strains into three genotypes demonstrating three main patterns of PCR products. 16 strains of 25 showed the same pattern of PCR products. This results suggests the presence of a source of infection on the clinical ward. A nurse may have been the source of infection because the same genotype of S. haemolyticus was isolated from her nasal anterior as from the majority of patients.

Topics: Cross Infection; DNA Fingerprinting; Exudates and Transudates; Genotype; Hospital Units; Humans; Infectious Disease Transmission, Professional-to-Patient; Methicillin Resistance; Microbial Sensitivity Tests; Nose; Nursing Staff, Hospital; Poland; Polymerase Chain Reaction; Serotyping; Species Specificity; Staphylococcus

Characteristic features of fauces aerobic microflora in children treated in intensive care units (ICU) were analysed. For comparison fauces microflora in children outpatients and in children patients from general surgical units was investigated. A retrospective analysis of all the smears without exception for 2 years (a total of 2120) revealed a direct dependence of the changes in the fauces microflora composition on the patient condition and the antibiotic load. It was shown that the fauces indigenic microflora in ICU patients was more often replaced by enterococci, gramnegative enteric bacteria and nonfermenting bacteria which are not usual under the normal conditions. The flora in such cases was represented by monoculture. Thus, microorganisms natural for the fauces i.e. Haemophilus influenzae and Neisseria spp. were not practically detected in the fauces of the ICU patients (0.5 and 0.4 per cent, respectively). Grampositive cocci in the children of the surgical units and in the outpatients included alpha-hemolytic streptococci in association with beta-hemolytic or nonhemolytic streptococci. No such bacteria were isolated from the ICU newborns. The associations of gramnegative organisms from the ICU patients included 40 variants. Seventy-eight association variants of Pseudomonas aeruginosa were mainly represented by the combinations with Serratia spp. and Klebsiella spp. as well as with coagulase negative staphylococci or enterococci, especially in the ICU newborns. The results of the study demonstrated that the target-aimed antibiotic therapy providing eradication of P.aeruginosa in the ICU patients was not always justified because of possible superinfection practically due to any organism from the association. Massive antibiotic therapy with pressing on gramnegative flora in the ICU patients induced selective contamination of the mucosa by polyresistant enterococci thus increasing their potential role in the development of hospital infections.

Topics: Anti-Bacterial Agents; Bacteria, Aerobic; Child, Preschool; Cross Infection; Drug Resistance, Multiple; Gram-Negative Aerobic Bacteria; Gram-Positive Bacteria; Humans; Infant, Newborn; Inpatients; Intensive Care Units; Moscow; Mouth; Nose; Outpatients; Pharynx; Pseudomonas aeruginosa; Retrospective Studies

The incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections after middle ear surgery has recently increased at our hospital. Most of these infections were thought to be hospital-acquired when medical personnel in contact with an MRSA-infected patient may have inadvertently transmitted the pathogen to other patients. To prevent further transmission it is essential that such sources of MRSA infection and transmission routes be selected out and eradicated. Therefore, it is necessary to determine whether the strains of MRSA isolated from infected patients are identical to those obtained from medical personnel in order to prove a reciprocal transmission of organisms between medical personnel and patients. Surveillance bacterial cultures from the anterior nares and hands of medical personnel working in the Department of Otolaryngology, Korea University Guro Hospital, were performed at two different time points: 6 December 1994 and 17 June 1996. Ribotyping with Southern blot technique was used to compare 12 MRSA strains from medical carriers with 60 strains identified from the otorrhea of MRSA-infected patients undergoing middle ear surgery. As results, six different MRSA strains were identified (types I, II, III, IV, V and VI) from ribotyping with EcoR1. One distinct subtype, type I strain, was the most frequently identified strain in both medical carriers and patients. Results also showed that 6 MRSA isolates from 10 medical carriers and 20 from 30 patients contained type I ribotype at first culture. Two medical carriers' isolates and 13 isolates from 30 patients shared the same type I strain at the second surveillance culture. In all, 41 out of 72 MRSA strains (56.9%) shared an identical ribotype pattern. Postoperative MRSA infection rates after treatment of medical carriers and the application of rigorous preventive procedures decreased from 11.9 to 5.7% after first culture and 9.0 to 7.7% following second cultures. These findings confirm that MRSA transmission can occur between medical personnel and patients and that effective preventive measures can reduce the postoperative infection rate.

Topics: Blotting, Southern; Cross Infection; Ear, Middle; Follow-Up Studies; Hand; Humans; Incidence; Infection Control; Korea; Methicillin Resistance; Molecular Epidemiology; Nose; Otitis Media; RNA, Bacterial; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

We performed a prospective observational cohort study of the epidemiology and etiology of nosocomial pneumonia in 358 medical ICU patients in two university-affiliated hospitals. Protected bronchoscopic techniques (protected specimen brush and bronchoalveolar lavage) were used for diagnosis to minimize misclassification. Risk factors for ventilator-associated pneumonia were identified using multiple logistic regression analysis. Twenty-eight cases of pneumonia occurred in 358 patients for a cumulative incidence of 7.8% and incidence rates of 12.5 cases per 1, 000 patient days and 20.5 cases per 1,000 ventilator days. Staphylococcus aureus, Streptococcus pneumoniae, Pseudomonas aeruginosa, and Hemophilus species made up 65% of isolates from the lower respiratory tract, whereas only 12.5% of isolates were enteric gram-negative bacilli. Daily surveillance cultures of the nares, oropharynx, trachea, and stomach demonstrated that tracheal colonization preceded ventilator-associated pneumonia in 93.5%, whereas gastric colonization preceded tracheal colonization for only four of 31 (13%) eventual pathogens. By multiple logistic regression, independent risk factors for ventilator- associated pneumonia were admission serum albumin <= 2.2 g/dl (odds ratio [OR] 5.9; 95% confidence interval [CI] 2.0-17.6; p = 0.0013), maximum positive end-expiratory pressure >= 7.5 cm H2O (OR, 4.6; 95% CI, 1.4 to 15.1; p = 0.012), absence of antibiotic therapy (OR, 6.7; 95% CI, 1.8 to 25.3; p = 0.0054), colonization of the upper respiratory tract by respiratory gram-negative bacilli (OR, 3.4; 95% CI, 1.1 to 10.1; p = 0.028), pack-years of smoking (OR, 2.3 for 50 pack-years; 95% CI, 1. 2 to 4.2; p = 0.012), and duration of mechanical ventilation (OR, 3. 4 for 14 d; 95% CI, 1.5 to 7.8; p = 0.0044). Several of these risk factors for ventilator-associated pneumonia appear amenable to intervention.

Topics: Anti-Bacterial Agents; Bronchoalveolar Lavage; Bronchoscopes; Bronchoscopy; Cohort Studies; Confidence Intervals; Critical Care; Cross Infection; Enterobacteriaceae; Enterobacteriaceae Infections; Haemophilus Infections; Humans; Incidence; Logistic Models; Nose; Odds Ratio; Oropharynx; Pneumonia, Bacterial; Pneumonia, Pneumococcal; Pneumonia, Staphylococcal; Positive-Pressure Respiration; Prospective Studies; Pseudomonas aeruginosa; Pseudomonas Infections; Risk Factors; Serum Albumin; Smoking; Stomach; Tennessee; Time Factors; Trachea; Ventilators, Mechanical

An anonymized point-prevalence survey of methicillin-resistant Staphylococcus aureus (MRSA) carriage was conducted amongst a stratified random sample of nursing home residents in Birmingham, UK, during 1994. Microbiological sampling from noses, fingers and the environment was undertaken. Information about potential risk factors for the acquisition of MRSA was gathered. MRSA was isolated from cultures of the nose or fingers of 33 of the 191 residents who took part in the study (17%) but only 1 of the 33 positive residents had a clinical infection. Although just 10 of the 87 environmental samples were MRSA positive, there was some environmental contamination in most homes. Risk factors for MRSA carriage were hospital admission within the last year (relative prevalence 2.09, 95% CI 1.13-3.88; P < 0.05) and surgical procedures within the last year (relative prevalence 4.02, 95% CI 2.18-7.43; P = 0.002). Phage-typing of the strains revealed similarities with those circulating in Birmingham hospitals. These findings suggest that the prevalence of MRSA in nursing homes in Birmingham was high, and that the strains may have originated in hospitals.

Topics: Bacteriophage Typing; Carrier State; Cross Infection; Data Collection; Environmental Microbiology; Female; Fingers; General Surgery; Humans; Male; Methicillin Resistance; Nose; Nursing Homes; Patient Admission; Prevalence; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; United Kingdom

An outbreak of epidemic methicillin-resistant Staphylococcus aureus (MRSA) caused by EMRSA-16 has affected hospitals in north east Northamptonshire since April 1991. Between the start of the outbreak and December 1995, 74 healthcare staff (0.9% of the staff screened) were colonized by the outbreak strain. Thirty-two percent of colonized staff were excluded from work, and six were excluded for periods of longer than three weeks. Twenty-four percent of staff had more than one course of treatment to eradicate carriage. The contribution of staff carriage in hospitals where EMRSA-16 is endemic and strategies for the management of colonized staff are discussed. We conclude that screening of staff has a limited role in the control of outbreaks caused by EMRSA-16 and that when resources for screening are scarce priority should be given to patients.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Female; Humans; Infection Control; Male; Methicillin Resistance; Nose; Personnel, Hospital; Pharynx; Staphylococcus aureus

To compare the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) nares colonization, the patterns of MRSA acquisition, and the risk for subsequent MRSA infection between a hospital-based, Department of Veterans Affairs (VA) nursing home care unit (NHCU) and community-based nursing homes.. In this prospective study, 148 residents of three community nursing homes and 55 residents of a VA NHCU had their anterior nares swabbed; repeat cultures were obtained from hospitalized patients and/or individuals colonized with MRSA. Subjects were followed up prospectively for 1 year to note hospitalizations and the development of MRSA infections.. The prevalence of MRSA colonization was significantly higher in the VA NHCU than in the community nursing homes (mean +/- SD 30.3% +/- 11% versus 9.9% +/- 4%). The rate of MRSA nares colonization was similar in the two settings. Acquisition of MRSA took place in both the long-term care facilities and hospitals, with 23.8% of incident cases occurring during a hospitalization. Only 3 of the 27 individuals colonized at baseline developed an MRSA infection. A trend toward an increased rate of infection was seen in colonized individuals residing in the community nursing homes versus those in the VA NHCU (relative risk 4.67; 95% Cl 0.55 to 39.9). Forty-seven percent of the 55 subjects hospitalized were colonized at some point during the study. In contrast to residents of the VA NHCU, MRSA colonization in the community facilities was a marker for high mortality.. Outcomes from colonization may be different in the VA NHCU population and the community nursing home population.

Topics: Aged; Cohort Studies; Community-Acquired Infections; Cross Infection; Female; Follow-Up Studies; Hospitalization; Hospitals, Veterans; Humans; Incidence; Long-Term Care; Male; Methicillin Resistance; Nose; Nursing Homes; Prevalence; Prognosis; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Survival Rate

Nasal carriage of Staphylococcus aureus is common among health care workers, but outbreaks caused by such carriers are relatively uncommon. We previously reported outbreaks of S. aureus skin infections that affected newborn infants and were attributed to an S. aureus nasal carrier who had had an associated upper respiratory tract infection (UR) during the outbreak period.. To investigate the contribution of a nasal methicillin-resistant S. aureus (MRSA) carrier (physician 4) who contracted a URI to an outbreak of MRSA infections that involved 8 of 43 patients in a surgical intensive care unit during a 3-week period.. An epidemiologic study of an outbreak of MRSA infections and a quantitative investigation of airborne dispersal of S. aureus associated with an experimentally induced rhinoviral infection.. A university hospital.. 43 patients in a surgical intensive care unit and 1 physician.. Molecular typing was done, and risk factors for MRSA colonization were analyzed. Agar settle plates and volumeric air cultures were used to evaluate the airborne dispersal of S. aureus by physician 4 before and after a rhinoviral infection and with or without a surgical mask.. A search for nasal carriers of MRSA identified a single physician (physician 4); molecular typing showed that the MRSA strain from physician 4 and those from the patients were identical. Multivariate logistic regression analysis identified exposure to physician 4 and duration of ventilation as independent risk factors for colonization with MRSA (P < or = 0.008). Air cultures showed that physician 4 dispersed little S. aureus in the absence of a URI. After experimental induction of a rhinovirus URI, physician 4's airborne dispersal of S. aureus without a surgical mask increased 40- fold; dispersal was significantly reduced when physician 4 wore a mask (P < or = 0.015).. Physician 4 became a "cloud adult," analogous to the "cloud babies" described by Eichenwald and coworkers who shed S. aureus into the air in association with viral URIs. Airborne dispersal of S. aureus in association with a URI may be an important mechanism of transmission of S. aureus.

Topics: Adult; Air Microbiology; Carrier State; Common Cold; Cross Infection; Drug Resistance, Microbial; Humans; Infant, Newborn; Male; Methicillin; Nose; Rhinovirus; Risk Factors; Staphylococcal Infections; Staphylococcal Skin Infections; Staphylococcus aureus

To determine the relevance of nasal carriage of Staphylococcus aureus, either methicillin-sensitive (MSSA) or methicillin-resistant (MRSA), as a risk factor for the development of nosocomial S aureus bacteremia during an MRSA outbreak.. In this prospective cohort study, 488 patients admitted to an intensive care unit (ICU) during a 1-year period were screened with nasal swabs within 48 hours of admission and weekly thereafter in order to identify nasal S aureus carriage. Nasal staphylococcal carriers were observed until development of S aureus bacteremia, ICU discharge, or death.. One hundred forty-seven (30.1%) of 488 patients were nasal S aureus carriers; 84 patients (17.2%) harbored methicillin-sensitive S aureus; and 63 patients (12.9%) methicillin-resistant S aureus. Nosocomial S aureus bacteremia was diagnosed in 38 (7.7%) of 488 patients. Rates of bacteremia were 24 (38%) of the MRSA carriers, eight (9.5%) of the MSSA carriers, and six (1.7%) of noncarriers. After adjusting for other predictors of bacteremia by means of a Cox proportional hazard regression model, the relative risk for S aureus bacteremia was 3.9 (95% confidence interval, 1.6-9.8; P = 0.002) for MRSA carriers compared with MSSA carriers.. Among ICU patients, nasal carriers of S aureus are at higher risk for S aureus bacteremia than are noncarriers; in the setting of an MRSA outbreak, colonization by methicillin-resistant strains represents a greater risk than does colonization by MSSA and strongly predicts the occurrence of MRSA bacteremia.

Topics: Adult; Aged; Bacteremia; Carrier State; Cohort Studies; Confidence Intervals; Cross Infection; Female; Humans; Intensive Care Units; Male; Methicillin; Methicillin Resistance; Middle Aged; Nose; Proportional Hazards Models; Prospective Studies; Risk Factors; Staphylococcal Infections; Staphylococcus aureus

A cluster of six pediatric cases of deep-seated Staphylococcus aureus infection after heart operations prompted us to perform molecular typing of the S. aureus isolates by pulsed-field gel electrophoresis. This revealed the presence of genotypically distinct isolates in four of the six patients. Isolates of two patients were genotypically identical. All patients carried S. aureus in the anterior nares. In each patient, the banding pattern of deoxyribonucleic acid in these isolates was indistinguishable from that in strains isolated from blood or wound cultures. Molecular typing with pulsed-field gel electrophoresis ruled out nosocomial transmission of S. aureus between four patients; at the same time, it provided evidence for an association between nasal colonization and postoperative wound infection. Epidemiologic investigation of potential links between two patients with identical isolates did not provide any evidence for nosocomial transmission of S. aureus between these patients. Because nasal colonization with S. aureus may be a risk factor for surgical wound infection in pediatric patients undergoing heart operations, preoperative decolonization appears to be warranted.

Topics: Anti-Bacterial Agents; Bacteremia; Bacterial Typing Techniques; Child; Child, Preschool; Cross Infection; DNA Probes; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Female; Genotype; Heart Defects, Congenital; Humans; Infant; Male; Nose; Preoperative Care; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Sternum; Surgical Wound Infection

Topics: Cross Infection; Disease Reservoirs; Fingers; Humans; Methicillin Resistance; Nose; Nursing Homes; Patient Admission; Residence Characteristics; Risk Factors; Staphylococcal Infections; Staphylococcus aureus; Surgical Procedures, Operative

A serial prospective survey of nasal colonization of hospital personnel by methicillin-resistant coagulase-negative staphylococci (MRCNS) was conducted at a Veterans Affairs medical center on three occasions over a 16-month period. The epidemiological typing systems used to assess relatedness included antimicrobial susceptibility profiles; biotyping; phage typing; plasmid profiles; restriction fragment length polymorphism (RFLP) analysis with ribosomal RNA; and plasmid hybridization with a 1.68-MD plasmid as the DNA probe. Forty-three percent of all personnel and 62% of all nurses were colonized with MRCNS. Nurses on the wards (72%) and in the intensive care unit (73%) were significantly more likely to be colonized with MRCNS than nurses who had less contact with patients or those who worked in the operating room. The molecular epidemiological typing systems indicated some degree of relatedness among the strains. Specifically, riboprobe analysis revealed a Dice coefficient of > 90%. However, each typing system detected dissimilarity among strains. Further studies are needed to determine the role that such human reservoirs of MRCNS serve in horizontal transmission to and subsequent infection of hospitalized patients.

Topics: Bacteriophage Typing; Coagulase; Cross Infection; Hospitals, Veterans; Humans; Methicillin Resistance; Nose; Personnel, Hospital; Plasmids; Polymorphism, Restriction Fragment Length; Prospective Studies; Staphylococcal Infections; Staphylococcus

A single point study was conducted to determine which surface sites best represent the density and composition of the coagulase-negative staphylococcal (CNS) colonizing flora in premature neonates. Five different surface sites of six randomly selected neonates hospitalized in a neonatal intensive care unit (NICU) for a month were examined. The individual strains and their clonal organization within CNS species were identified using restriction endonuclease fingerprinting of whole chromosomal DNA and ribosomal RNA genes. Cultures of the scalp, umbilicus, foot, nose and rectum were collected and quantitatively processed. Ten colonies were typed per surface culture. The most dense CNS colonization was noted on the umbilicus (mean 1.2 x 10(4) c.f.u. cm-2), foot (mean 1.6 x 10(3) c.f.u. cm-2) and nose (mean 1.7 x 10(3) c.f.u. cm-2) of NICU neonates. Scalp and rectum were scarcely colonized. Of all the CNS surface isolates, S. epidermidis accounted for 77.7% (219/282) and S. haemolyticus, S. warneri and S. capitis accounted for 20.6% (58/282), 1.4% (4/282) and 0.4% (1/282), respectively. Colonization of each surface site comprised a maximum of five different strains representing four CNS species. Overall, five clones of S. epidermidis, two of S. haemolyticus, one of S. warneri and one of S. capitis were noted among the 282 isolates. The most predominant were two clones of S. epidermidis and one of S. haemolyticus; they accounted for 94% (265/282). Cultures from the foot and scalp represented the most heterogeneous CNS colonization of the five sites examined.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Bacteremia; Coagulase; Cross Infection; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Microbial; Foot; Humans; Infant, Newborn; Infant, Premature; Intensive Care Units, Neonatal; Mucous Membrane; Nose; Rectum; Scalp; Skin; Staphylococcal Infections; Staphylococcus; Umbilicus

To determine the natural history of colonization by methicillin-resistant Staphylococcus aureus (MRSA) among patients in a long-term care facility. We specifically sought to determine if MRSA colonization was predictive of subsequent infection.. Cohort study.. Long-term Veterans Affairs Medical Center.. A total of 197 patients residing on two units were followed with regular surveillance cultures of the anterior nares.. The development of staphylococcal infection.. Thirty-two patients were persistent carriers of MRSA and 44 were persistent carriers of methicillin-susceptible strains (MSSA). Twenty-five percent of MRSA carriers had an episode of staphylococcal infection compared with 4% of MSSA carriers and 4.5% of non-carriers (P less than 0.01; relative risk 3.8; 95% CI, 2.0 to 6.4). The rate of development of infection among MRSA carriers was 15% for every 100 days of carriage. Using logistic regression analysis, persistent MRSA carriage was the most significant predictor of infection (P less than 0.001; odds ratio, 3.7). Seventy-three percent of all MRSA infections occurred among MRSA carriers. Isolates of MRSA from 7 patients were typed. Colonizing and infecting strains had the same phage type in all 7 patients and the same pattern of plasmid EcoRI restriction endonuclease fragments in 5 patients.. Colonization of the anterior nares by MRSA predicts the development of staphylococcal infection in long-term care patients; most infections arise from endogenously carried strains. Colonization by MRSA indicates a significantly greater risk for infection than does colonization by MSSA. The results offer a theoretic rationale for reduction in MRSA infections by interventions aimed at eliminating the carrier state.

Topics: Aged; Aged, 80 and over; Bacteriophage Typing; Carrier State; Cross Infection; Humans; Methicillin Resistance; Middle Aged; Nose; Nursing Homes; Plasmids; Prospective Studies; Staphylococcal Infections; Staphylococcus aureus

An outbreak of nosocomial staphylococcal infections occurred over a six months period in an intensive care unit. This outbreak was caused by a single phage type of oxacillin resistant Staphylococcus aureus (SA) which infected ten patients. Six patients had bacteremia with infected catheter, two with urinary tract infection and two patients had a pneumonia. The median SAPS was 13. Four patients died. An epidemiologic study was performed to know SA nasal carriage prevalence of patients and hospital staff. There were seven isolates of SA from 83 hospital staff and three from 20 patients, all with the same phage type 77. Hospital staff and patients colonisation with a same SA strain is a potential reservoir for epidemic nosocomial infections. Prophylactic measures are hygienic measures like handwashing, but perhaps also patients and staff selective decontamination with topical antimicrobial substances.

Topics: Cross Infection; Disease Outbreaks; Disease Reservoirs; France; Hand Disinfection; Humans; Intensive Care Units; Nose; Nursing Staff, Hospital; Staphylococcal Infections; Staphylococcus aureus

During the summer of 1987, an epidemic of pemphigus neonatorum took place at Guy's Hospital. It involved more than 80 neonates in the maternity unit. Swabs from the umbilical stumps of the babies and from the noses of several attending midwives yielded Staphylococcus aureus of phage-type Group II 3A/3C. Despite an extensive disinfection policy, which included identification and treatment of carriers, the outbreak persisted for 3 months. Final resolution came only after detailed epidemiological research revealed those midwives most likely to be involved. After these had been singled out for further treatment, the outbreak ended. The epidemic strains were later subjected to reverse phage-typing, plasmid profiling and in vivo testing for production of epidermolytic toxin in order to confirm true carriers and cases. Retrospective analysis identified those persons most likely to have been responsible for propagation of the epidemic strain. The exact course of the outbreak was then clarified.

Topics: Cross Infection; Disease Outbreaks; Floxacillin; Humans; Infant, Newborn; Nose; Pemphigus; Retrospective Studies; Staphylococcus aureus; Umbilicus

Topics: Child; Cross Infection; Humans; Intubation, Intratracheal; Nose; Sinusitis

Methicillin resistant Staph Aureus (MRSA) were studied in a 300 bedded Central Government Hospital Rawalpindi, in which 291 staff members were screened by nasal swabbing. Of 125 cases carrying staph aureus 5 (1.78%) were methicillin resistant. They were treated with Bacitracin ointment to be applied to interior nares four times a day for one week. Hexachlorophane baths daily, chlorhexidine shampoo once daily for a week, and were taken off duty from wards for one day.

Topics: Carrier State; Cross Infection; Humans; Methicillin; Nose; Pakistan; Penicillin Resistance; Personnel, Hospital; Staphylococcal Infections; Staphylococcus aureus

2% mupirocin ointment applied intra-nasally for 5 days was assessed for elimination of nasal carriage of Staphylococcus aureus in 31 staff members in a children's hospital. Three volunteers failed to complete the trial because of side effects, i.e. buccal reddening and swelling, and unpleasant taste. During treatment staphylococcal nasal carriage was not found in any case; of the 24 post-treatment nasal swabs taken 4 days after treatment 22 were still negative. Re-colonization with S. aureus of different phage types occurred in the remaining two cases.

Topics: Administration, Intranasal; Anti-Bacterial Agents; Carrier State; Child; Cross Infection; Fatty Acids; Female; Hospitalization; Humans; Male; Mupirocin; Nose; Staphylococcal Infections; Staphylococcus aureus

Coagulase-negative staphylococci (CNS) were cultured from the anterior nares of surgeons, theatre and ward staff, and from patients before and 2 weeks after a total hip replacement. The CNS found in ward staff were more resistant to antibiotics than those in surgeons and theatre staff. Methicillin resistance of CNS in patients increased from 4 to 31% following surgery. Gentamicin-resistant CNS were only found postoperatively, in 20% of patients, in most of whom gentamicin-loaded acrylic bone cement was used.

Topics: Anti-Bacterial Agents; Coagulase; Cross Infection; Drug Resistance, Microbial; Humans; Joint Prosthesis; Nose; Orthopedics; Personnel, Hospital; Postoperative Complications; Staphylococcal Infections; Staphylococcus; Surgery Department, Hospital

The prevalence of nasal colonization and infection with methicillin-resistant Staphylococcus aureus (MRSA) among patients and staff was studied in a section of a Paediatric Surgical Unit in Lisbon between February and July 1985. Nasal colonization was demonstrated in 41% of burned patients, 5% of non-burned patients and 35% of the nurses. Infection by MRSA occurred in 30% of the burns. The isolates had identical serological patterns, slight differences on phage typing and were resistant to methicillin, cephalosporins, tetracycline, erythromycin and aminoglycosides. A chloramphenicol resistance plasmid of 3 Md was present in those isolates which were chloramphenicol resistant and a small plasmid of 1.7 Md which coded for constitutive erythromycin resistance was present in many isolates. Gentamicin, tetracycline and inducible erythromycin resistance were chromosomal. Several reasons for the apparent low virulence of the isolates are discussed. Attempts to control the outbreak by the discharge of colonized or infected patients, improvement of nursing practices and treatment with temporary removal from work of the colonized nurses did not eliminate the organism from the unit.

Topics: Burns; Cross Infection; Humans; Methicillin; Nose; Penicillin Resistance; Plasmids; Portugal; Staphylococcal Infections; Staphylococcus aureus

The acquisition of hospital strains of Staphylococcus aureus by new house officers was studied in an 800-bed referral hospital over a 1-year period. S. aureus isolates, including three strains with characteristic phage patterns that had previously been documented to cause disease in patients and colonize hospital personnel, were recovered from the anterior nares of 35 of 54 newly arrived house officers. There was a significant correlation (r = 0.7475; P less than 0.02) between colonization with the dominant hospital strain (S) and exposure to the hospital environment over 12 months. No hospital-wide increase in infections owing to the S strain was seen during this period, which suggests that house staff acquired this strain from reservoirs within the hospital. The finding of colonization with virulent endemic S. aureus strains in house officers working on every ward of the hospital suggests that new strategies for control of S. aureus nosocomial infections must be considered and evaluated.

Topics: Bacteriophage Typing; Cross Infection; Humans; Internship and Residency; Nose; Staphylococcal Infections; Staphylococcus aureus; Virulence

The first description in Portugal of the spread of a methicillin-gentamicin resistant Staphylococcus aureus (MGRSA) epidemic strain in a hospital unit is reported. Ten in-patients, out of a selected group of 200, were colonized by the epidemic strain. The strain was also isolated from one burn and from the nose of three nurses. Possible reasons for the apparent reduced communicability and low virulence of the multi-resistant strain are presented.

Topics: Cross Infection; Gentamicins; Humans; Methicillin; Nose; Penicillin Resistance; Portugal; Staphylococcal Infections; Staphylococcus aureus

Over a 3-week period, 20 of 34 (59%) infants in a newborn nursery developed nosocomial viral respiratory tract disease. Either respiratory syncytial virus (seven infants) or parainfluenza virus type 3 (five) or both (two) were demonstrated in respiratory secretions from 14 of the 20 symptomatic patients. Symptoms in the 20 infants included rhinitis (15 infants), cough (14), apnea (eight), pulmonary infiltrates (seven), and fever (six). There were no differences in symptoms between children infected with respiratory syncytial virus alone, with parainfluenza virus alone, or with both viruses concurrently. Patients were clustered in the nursery by agent: infants with the same virus tended to share contiguous bed spaces, supporting the concept that parainfluenza virus as well as respiratory syncytial virus can be transmitted from patient to patient. In addition to this risk for contiguous bed spaces, the presence of a nasogastric tube was associated with risk of illness (P less than 0.05). In the presence of a nursery outbreak of respiratory tract disease, more than one virus may circulate concurrently, and an individual patient may be infected simultaneously by more than one virus.

Topics: Boston; Cross Infection; Disease Outbreaks; Epidemiologic Methods; Fluorescent Antibody Technique; Hospital Bed Capacity, 300 to 499; Humans; Infant, Newborn; Intubation; Nose; Nurseries, Hospital; Parainfluenza Virus 3, Human; Paramyxoviridae Infections; Respiratory Syncytial Viruses; Respirovirus Infections; Risk; Time Factors

Topics: Anal Canal; Cross Infection; Humans; Infant, Newborn; Nose; Staphylococcus aureus; Umbilical Cord

During a 6-month period at Walter Reed Army Hospital the monthly attack rate of Staphylococcus aureus bacteremia increased to 3.8 +/- 0.5 (mean +/- SEM) from 2.5 +/- 0.2 cases per 1,000 dispositions for the previous 48 months (P less than 0.05). A predominant phage pattern, designated S, was found in 12 (39%) of 31 bacteremic isolates typed and another strain, delta, was associated with four catheter-related infections. Two other strains also accounted for infections. Patients with isolates of the S phage pattern had a higher mortality (59%) than patients with non-S isolates (37%). Thirty-eight per cent of S. aureus carriers among hospital personnel harbored S or delta strains. Limitation of intravascular devices, strict handwashing, and the use of gloves were associated with a significant decrease in the incidence of S. aureus bacteremia to 1.9 +/- 0.5/1,000 dispositions over the next 6 months (P less than 0.05). S and delta strains were reduced to 20% of these isolates despite their persistence in 32% of staphylococcal carriers upon reculture of personnel. We conclude that S. aureus persists as an important pathogen in the hospitals, and that phage typing S. aureus isolates remains an important tool in hospital epidemiology. The presence of multiple S. aureus strains causing this outbreak and the extent of their dissemination among patients and personnel reported here emphasizes the need to reevaluate strategies of nosocomial staphylococcal control.

Topics: Clothing; Cross Infection; Epidemiologic Methods; Female; Hand Disinfection; Humans; Male; Middle Aged; Nose; Personnel, Hospital; Sepsis; Staphylococcal Infections; Staphylococcus Phages; Statistics as Topic

Of 200 patients, 6.5% were skin carriers of Staphylococcus aureus and 3.5% became skin carriers after admission. Development of skin carrier state was associated with a long preoperative hospital stay. A second study of 275 cases showed that skin carriers of S. aureus had a significantly higher subsequent staph wound infection rate than non-carriers, but nose and/or throat carriers of S. aureus did not. Peroperative wound contamination was a significant factor in the subsequent development of wound infection. In clean surgery the infection rate was 5.9%. Both wound contamination and infection was due to gram positive organisms, usually S. aureus. When the gastrointestinal or biliary tract had been opened, the infection rate was 28%, the usual contaminating and infecting organisms were enteric and only occasionally S. aureus. There is a need for improved methods of minimizing peroperative wound contamination.

Topics: Bacteriological Techniques; Carrier State; Cross Infection; Humans; Middle Aged; Nose; Pharynx; Skin; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection

Nasal carriage of antibiotic-resistant Staphylococcus aureus is often used as an index of cross-infection in hospitals. In this paper, a deterministic model of the epidemiology of Staphylococcal nasal carriage was derived employing the concepts of epidemic theory. This theoretical model was tested against experimental data gathered from a large survey. When the association between nasal carriage of tetracycline-resistant Staphylococci and length of stay in hospital derived from the survey was compared with theoretical figures derived from the model, the validity of the model in a real situation was confirmed.

Topics: Carrier State; Cross Infection; England; Female; Humans; Length of Stay; Male; Middle Aged; Models, Theoretical; Nose; Staphylococcal Infections; Staphylococcus aureus

The bacterial colonization of the nose, umbilicus, perineum and faeces in 85 newborns was studied during one period of high and one of low occupancy in a neonatal intensive care unit. Cultures were taken on admission, at three days, at one week of age, and then weekly during the stay in the unit. Colonization took place early and potential pathogens were responsible for a significant part of the spectrum. At one week of age, more than 50% of the infants had Staphylococcus aureus in the nose and umbilicus, 25% had E. coli and/or Klebsiella enterobacter in the umbilicus, and 60% had Klebsiella enterobacter in the perineum. Neither the occupancy rate in the unit nor the clinical state of the infant seemed to influence the colonization pattern significantly. Changes in flora were frequent in the individual infant. However, the bacterial spectrum remained essentially the same with increasing age during the stay in the unit and during the two periods. Only on two occasions was the same phage type of Staphylococcus aureus found in two infants at the same time. Two cases of septicemia occurred in the 85 infants during the three months of the study. Both infants were colonized beforehand with the causative organism. The results may indicate that the clinical state of the infant is of greater importance for risk of septicemia than the pattern of the bacterial colonization.

Topics: Bacteria; Bacteriological Techniques; Bed Occupancy; Cross Infection; Feces; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units, Neonatal; Nose; Perineum; Umbilicus

Infection with strains of methicillin-resistant Staphylococcus aureus occurred in 40 patients at time of admission to a large urban hospital from March to December 1980. Community-acquired methicillin-resistant S. aureus infections occurred in 24 drug abusers and 16 nonabusers. Patients with infections had a longer mean hospitalization and previously had received antimicrobial therapy more frequently than control subjects. Drug abusers with infections had been treated with cephalosporins more often than control subjects (P less than 0.05). Phage typing of 32 isolates showed that 21 were linked by a common phage type (29/52/80/95). Transmission of methicillin-resistant S. aureus from community-acquired cases occurred in the hospital. By January 1981, methicillin-resistant S. aureus accounted for 30.6% of nosocomial S. aureus infections at Henry Ford Hospital. Methicillin-resistant S. aureus infection may arise in the community as well as in the hospital and has the potential to disseminate in both settings.

Topics: Adult; Cross Infection; Disease Outbreaks; Humans; Male; Methicillin; Nose; Staphylococcal Infections; Staphylococcus aureus; Substance-Related Disorders

Topics: Aged; Carrier State; Cross Infection; Hand Disinfection; Hospital Bed Capacity; Hospitals, Teaching; Humans; Infant, Newborn; Medical Staff, Hospital; Methicillin; Nose; Patient Admission; Patient Isolation; Penicillin Resistance; Staphylococcal Infections; Staphylococcus aureus

Nasal swabs taken from 324 subjects in a Nigerian hospital were examined for the presence of coagulase positive staphylococci. The subjects used in this study included the patients, staff and "auxiliaries" aged from one day to 70 years. The results obtained show that approximately 50% of all the subjects were nasal carriers of Staphylococcus aureus and that age, occupation and length of the subjects' stay in hospital had a significant effect on this figure. It was also found that there is no significant difference between the prevalence of nasal carriage of S. aureus amongst the hospital staff and the patients.

Topics: Adolescent; Adult; Age Factors; Aged; Carrier State; Child; Child, Preschool; Coagulase; Cross Infection; Female; Humans; Infant; Infant, Newborn; Male; Middle Aged; Nigeria; Nose; Sex Factors; Staphylococcal Infections; Staphylococcus aureus

The nasal carriage rate of Staphylococcus aureus was significantly higher in hospitalized persons (children, adult females and staff) - 53.8%, - than in similar persons at a local clinic - 29.8% (P less than 0.001) - in Ile-Ife, Nigeria. However, unlike studies carried out elsewhere, a higher proportion of S. aureus strains obtained from persons at the clinic were resistant to commonly used antimicrobial agents than were strains isolated in the hospital. This has been attributed to the ease at which these drugs can be obtained by the general population and used unsupervised and indiscriminately. Methicillin was the most effective antimicrobial agent against pathologic staphylococci (2.2% resistance), followed by erythromycin (16.5% resistance), co-trimaxozole (28.0% resistance), chloramphenicol (76.9% resistance), tetracycline (78.6% resistance) and penicillin and ampicillin (97.8% resistance). The widespread resistance of S. aureus to penicillin and ampicillin (and other antimicrobial agents) is of clinical significance in the treatment of post-operative infections, since carriers are reportedly more prone to such infections than are non-carriers.

Topics: Adult; Ambulatory Care Facilities; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Cross Infection; Drug Resistance, Microbial; Female; Humans; Infant; Medical Staff, Hospital; Microbial Sensitivity Tests; Nigeria; Nose; Staphylococcal Infections; Staphylococcus aureus

Topics: Acute Disease; Axilla; Bacteria; Cross Infection; Enterobacteriaceae; Gingiva; Humans; Leukemia; Nose; Pseudomonas aeruginosa; Rectum; Sepsis

The vast majority of healthy term neonates tolerate their abrupt introduction to the bacterial world with little risk of infection. However, infants who require a longer hospital stay are at greater risk of having an infection, particularly when intensive care is needed. In one study, 15.3 percent of the infants in an intensive care unit acquired a nosocomial infection. Gram-negative bacilli have emerged as the principle cause of nosocomial infection. Nosocomial infection due to gram-negative bacilli usually occurs in neonates already colonized with gram-negative bacilli in the pharynx or intestine, and the risk of colonization with hospital strains of gram-negative bacilli (which are often resistant to multiple antibiotics) increases dramatically the longer a baby stays in intensive care. The factors which predispose individual neonates to colonization and infection with gram-negative bacilli require further study, but gram-negative bacilli are most often transmitted among neonates on the hands of personnel. Neonates in whom intestinal colonization with gram-negative bacilli develops are a particularly important reservoir of gram-negative bacilli in the nursery; once colonized, infants may harbour antibiotic-resistant hospital strains of gram-negative bacilli in their stool for more than a year. Pharyngeal colonization with alpha streptococci appears to protect neonates from pharyngeal colonization with gram-negative bacilli, and bacterial interference may play an important role in regulating intestinal colonization as well. Investigation of the mechanisms of bacterial interference may lead to better understanding of the colonization process and development of alternatives to classic infection control methods.

Topics: Bacteria; Cross Infection; Enterobacter; Escherichia coli; Feces; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Klebsiella; Nose; Pharynx; Streptococcus

Over a one-year period 19.5 per cent of 237 patients carried Staphylococcus aureus in their nares preoperatively. This rate was not influenced by the length of hospital stay. The patient nasal carrier state had no correlation with the incidence of postoperative infection. There was no outbreak of S. aureus infection during this period. It is well known that a long preoperative stay greatly increases the risk of infectious complications. This increase in infectious complications was not linked to nasal S. aureus colonization in this study. S. aureus was responsible for 19 per cent of postoperative infections in a 12-month period. S. aureus still occupies a significant place in nosocomial infection rates.

Topics: Carrier State; Cross Infection; Humans; Length of Stay; Nose; Postoperative Complications; Staphylococcal Infections; Staphylococcus aureus

Cross-infection by contaminated equipment is a potential hazard associated with conscious sedation with nitrous oxide and oxygen . Nosocomial infections have occasionally been linked wih the use of unsterile inhalation devices; microbial contamination of sterile nasal hoods routinely occurs during administration of nitrous oxide; and in vitro experiments indicate that subsequent use of contaminated nasal masks may lead to aspiration of microorganisms. Although the incidence of respiratory disease after such contamination is unknown, it is clear that disinfection of the nitrous oxide apparatus between patients is desirable. A simple cleaning method involving alkaline glutaraldehyde is described that provides adequate disinfection of the rubber goods used in the administration of gas. Superiority of this technique over previously recommended cleaning methods is shown.

Topics: Aldehydes; Alkalies; Anesthesia, Dental; Anesthesia, Inhalation; Bacteria; Cross Infection; Dental Equipment; Disinfectants; Disinfection; Ethanol; Geobacillus stearothermophilus; Glutaral; Humans; Masks; Nitrous Oxide; Nose; Respiratory Tract Infections; Serratia marcescens; Sterilization

The incidence of Staphylococcus aureus in the nose, throat and superficial wound infections of 99 office staff, 129 psychiatry staff and 115 surgical staff was studied over a 4-week period with the purpose of assessing the potential risk to hospital personnel of staphylococcal infection. Incidence rates, both average and cumulative, were essentially similar in the three groups but certain differences in the ecology of the staphylococcal phage groups were observed. Surgical staff appeared to have a more labile pattern of carriage. As in other Scandinavian studies throat carriage rates were high. Staphylococcal carriage seems largely to depend on individual characteristics rather than environmental factors.

Topics: Adult; Carrier State; Cross Infection; Humans; Microbial Sensitivity Tests; Nose; Occupational Diseases; Personnel, Hospital; Pharynx; Risk; Staphylococcal Infections; Staphylococcus aureus; Staphylococcus Phages; Sweden; Wound Infection

Topics: Bacitracin; Cross Infection; Disease Reservoirs; Drug Combinations; Gentian Violet; Hexachlorophene; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Missouri; Mothers; Nose; Nurseries, Hospital; Nursing Staff, Hospital; Proflavine; Quaternary Ammonium Compounds; Staphylococcal Infections; Staphylococcus aureus; Umbilical Cord

Reports of several streptococcal infections among babies after discharge from a maternity department initiated an epidemiologic study. Out of 100 infants in the 3 maternity wards 67% were colonized on the umbilicus with hemolytic streptococci group A. It was assumed that the spread had occurred from infant to infant in connection with the nursing. By means of new and strict hygienic routines, isolation and penicillin treatment of the colonized infants the spread was rapidly brought to an end. A retrospective study among the children delivered up to 6 weeks earlier showed that no less than 64% had had clinical signs of infection of possible streptococcal origin. Infections had also occurred among many family members. The observations emphasize the importance of strict hygienic routines and continuous bacteriologic surveillance in maternity departments, as well as close contact between maternity departments and health centers for children.

Topics: Adult; Bacteriological Techniques; Cross Infection; Disease Outbreaks; Disinfection; Female; Hospital Departments; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nose; Nurseries, Hospital; Obstetrics and Gynecology Department, Hospital; Pharynx; Retrospective Studies; Staphylococcus aureus; Streptococcal Infections; Streptococcus pyogenes; Umbilicus

In order to elucidate some of the factors responsible for the high rate of nosocomial infection associated with neonatal intensive care, we studied bacterial colonization in 63 infants admitted to a neonatal intensive care unit. In a six-month period, cultures of nose, throat, umbilicus, and stool were obtained on admission and every three days from all infants staying in the NICU greater than or equal to 3 days. Study infants did not develop "normal" aerobic flora. Forty-eight percent of infants grew Escherichia coli from stool, but 52% had stool colonization with Klebsiella, Enterobacter, or Citrobacter, the only other Enterobacteriaceae encountered. KEC were also isolated from throat, nose, and umbilicus in 22%, 22%, and 24% of patients, respectively. The risk of stool colonization with KEC increased with duration of hospitalization: 2% of infants were colonized on admission, 60% after 15 days, and 91% after 30 days. Stool colonization with E. coli seemed to protect infants from colonization with other gram-negative bacilli. Thirteen of 20 infants, however, developed pharyngeal GNB colonization in spite of pre-existing abundant growth of alpha streptococci. Antibiotic therapy for greater than 3 days was associated with the isolation of KEC in stool and GNB in the throat, but birth weight less than 2,500 gm and lack of breast milk feedings were not.

Topics: Boston; Citrobacter; Cross Infection; Enterobacter; Enterobacteriaceae Infections; Escherichia coli; Feces; Female; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Klebsiella; Nose; Pharynx; Pregnancy; Umbilicus

Streptococcus equisimilis (Lancefield group C), an unusual cause of nosocomial surgical infection, was isolated from two orthopedic postoperative wound infections. Both operations had been performed by the same surgeon within a three-day period. Examination of the surgeon revealed perianal dermatitis from which S. equisimilis was isolated. The organism was also recovered from the surgeon's nose and rectum. The wound infections responded to treatment with penicillin derivatives. The surgeon was successfully treated with topical bacitracin and oral penicillin and vancomycin. This report documents the pathogenicity of the C Streptococcus in postoperative infection and suggests a possible nosocomial source of the organism.

Topics: Adolescent; Anal Canal; Anti-Bacterial Agents; Carrier State; Child, Preschool; Cross Infection; Dermatitis; Female; General Surgery; Humans; Medical Staff, Hospital; Nose; Rectum; Streptococcal Infections; Streptococcus; Surgical Wound Infection

The incidence of Staphylococcus aureus recovered from cultures of anterior nares was determined for personnel and patients of an obstetric and a neonatal unit. Among the hospital personnel, 10.2% harbored S. aureus. On admission to the hospital, 4% of the obstetric patients were identified as carriers of S. aureus and only 1.3% of the patients acquired the microorganism during hospitalization. The neonates of these mothers with S. aureus were not colonized during hospitalization. Subsequent bacteriophage typing indicated that microbial isolates were primarily in the Group 1 and Group 3 classifications of S. aureus.

Topics: Carrier State; Cross Infection; Female; Humans; Infant, Newborn; Nose; Nurseries, Hospital; Obstetrics and Gynecology Department, Hospital; Personnel, Hospital; Pregnancy; Staphylococcal Infections; Staphylococcus aureus

An epidemic of postoperative wound infections caused by Staphylococcus aureus in 15 patients during a four-month period in 1974 is reported. An unusual staphylococcal antibiogram served as a marker for the multiresistant strain of hospital-acquired infections and raised suspicion of a common source for the infections. The spread of infection began shortly after isolation was discontinued in the index case. An epidemiologic investigation showed that 14 patients were on the same ward, and one patient from another ward had opportunity for contact with the index case. The epidemic was controlled by prompt isolation of all infected patients, adherence to strict isolation techniques, aseptic technique for dressing changes and by treatment of nasal carriers among ward personnel with appropriate antibiotics.

Topics: Anti-Bacterial Agents; California; Carrier State; Cross Infection; Disease Outbreaks; Humans; Nose; Personnel, Hospital; Population Surveillance; Staphylococcal Infections; Staphylococcus aureus; Surgical Wound Infection; Vascular Surgical Procedures

The correlation between Staphylococcus aureus colonization and infection among newborns was studied during a four-year period. Of the 9,423 newborns cultured, 24% were colonized at the time of discharge and in 2% of these an infection developed, whereas only 0.2% of the noncolonized newborns experienced a staphylococcal infection. The weekly colonization rates ranged from 0% to 62%, and outbreaks of infections (two or more concurrent) occurred periodically when the colonization rates ranged from 11% to 57%. Colonization rates per se did not serve as an indicator of an actual or potential outbreak of infection. Instead, the occurrence of two or more concurrent cases of staphylococcal infection or presumptive evidence of an outbreak seems to be a more reliable indicator than colonization monitoring.

Topics: Cross Infection; Disease Outbreaks; Humans; Infant, Newborn; Infant, Newborn, Diseases; Michigan; Nose; Nurseries, Hospital; Population Surveillance; Staphylococcal Infections; Staphylococcus aureus; Umbilicus

Nosocomial infections in an intensive care nursery (ICN) due to kanamycin-resistant Klebsiella pneumoniae during a four-month period with an infection rate of 12% and mortality of 47% are reported. Emergence of this organism was thought to be due to the widespread use of kanamycin. Transmission probably occurred via hands of personnel contaminated during care of colonized or infected infants. Control measures advocated are better handwashing technic and discriminate use of antibiotics. This report emphasizes the need for awareness of this continuous threat and for infection surveillance in an ICN.

Topics: Asepsis; Cross Infection; Drug Resistance, Microbial; Hexachlorophene; Humans; Infant, Newborn; Infant, Newborn, Diseases; Intensive Care Units; Kanamycin; Klebsiella Infections; Klebsiella pneumoniae; Nose; Nurseries, Hospital; Retrospective Studies

Topics: Bacteria; Conjunctivitis; Cross Infection; Female; Gastric Juice; Humans; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Male; Nose; Pneumonia; Skin; Umbilical Cord; Vulva

Biological side effects, which are particularly characterized by a change of bacterial flora, appear during chemotherapy, and are dependent on the mode of action of the different substances. While shifts in the germ count of skin flora have no great importance, gram-negative bacilli, especially enterobacteriaceae, multiply in the flora of the nose and throat, particularly after administration of beta-lactam antibiotics. These changes usually revert to normal in a short time after the antibiotic has been discontinued. Considerably more important are the changes in the flora of the large intestine, sensitive species being eliminated and resistant strains, usually R factor carriers, become selected. These organisms then play an important part in hospital cross-infection. This state of affairs can only be controlled by specific selection of chemotherapeutic agents and strict observance of all disinfectant measures.

Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Cross Infection; Digestive System; Disinfection; Drug Resistance, Microbial; Humans; Intestine, Large; Mouth; Nose; R Factors; Skin; Sputum

Neonatal staphylococcal disease occurred in the nurseries of a university hospital three weeks after discontinuation of routine, daily, whole-body bathing of newborns with hexachlorophene. Of 16 infants who had clinical manifestations within a two-week period, 11 cases were confirmed bacteriologically. Shortly after onset of the outbreak, daily clinical and microbiologic surveillance and control measures on all infants and personnel were inaugurated. Clinical surveillance after the outbreak did not yield any new case. Average incidence of cultures positive for coagulase-positive Staphylococcus aureus was highest (13% per week) during the first three weeks of microbiologic surveillance (when hexachlorophene was not used). This is lower than that reported in most previous studies. These findings indicate the importance of scrupulous hand washing before and after handling each infant and of enforcement of other basic nursery techniques.

Topics: Baths; Conjunctiva; Conjunctivitis; Cross Infection; Female; Fingers; Hexachlorophene; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Male; Nose; Nurseries, Hospital; Nursing Staff, Hospital; Pneumonia; Soaps; Staphylococcal Infections; Staphylococcus Phages; Time Factors; Umbilicus

Studies in a newly built hospital furnished with complete air conditioning where most of the patients are nursed in 6-bed rooms showed that the transfer of air from one patient room to another was very small, especially when there was substantial flow of air in a consistent direction between the patient rooms and the corridor, and that the direct transfer of airborne particles was even less. There was, however, no evidence of any reduction in the rates of nasal acquisition of Staphylococcus aureus compared with those to be found in naturally ventilated hospitals. The numbers of Staph. aureus found in the air of a given room that appeared to have originated from patient carriers in other rooms were many times greater than could be accounted for by direct airborne transfer. Although there was evidence that many carriers were not detected, detailed study showed that this excess transfer to the air of other rooms was genuine. It seems probable on the basis of investigations in this hospital and elsewhere that this excess transfer occurs indirectly, through dispersal from the clothing of the nursing and medical staff into the air of another room of strains with which their outer clothes have become contaminated while dealing with patients. Reduction in direct airborne transfer of micro-organisms from one room to another, whether by ventilation or other means, can only be of clinical advantage if transfer by other routes is, or can be made, less than that by the direct airborne route.

Topics: Adult; Aged; Air Conditioning; Air Microbiology; Carrier State; Cross Infection; Environmental Exposure; Female; Humans; Length of Stay; London; Male; Middle Aged; Nose; Staphylococcal Infections; Staphylococcus aureus

An outbreak of streptococcal and staphylococcal skin disease was discovered in a full-term nursery after the discontinuation of bathing infants with hexachlorophene. The epidemic was only temporarily controlled by conventional means and recurred despite reinstitution of hexachlorophene bathing. Measures that decreased infants' exposure to visitors and hospital personnel and enforced aseptic techniques in the nursery were more important than use of hexachlorophene soap in achieving and maintaining control.

Topics: Anti-Bacterial Agents; Antisepsis; Cross Infection; Disease Outbreaks; Hexachlorophene; Humans; Infant, Newborn; Infant, Newborn, Diseases; North Carolina; Nose; Nurseries, Hospital; Recurrence; Skin Diseases; Staphylococcal Infections; Streptococcal Infections; Umbilical Cord

Topics: Adult; Air Microbiology; Carrier State; Clothing; Cross Infection; Female; General Surgery; Gossypium; Humans; Male; Middle Aged; Nose; Operating Rooms; Perineum; Personnel, Hospital; Polyethylenes; Sex Factors; Skin; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Ventilation; Workforce

Topics: Anti-Bacterial Agents; Bacteria; Cross Infection; Ear; Escherichia coli; Hospital Units; Hospitalization; Humans; Klebsiella; Nose; Patients; Pharynx; Proteus; Pseudomonas aeruginosa; Skin; Staphylococcus; Streptococcus; Surgical Procedures, Operative; Time Factors

A strain of Staphylococcus aureus resistant to as many as nine distinct antibiotics has shown unusally high virulence as indicated by its ability to cause an epidemic of furunculosis amongst hospital nurses.

Topics: Bacteriophage Typing; Burns; Cross Infection; Disease Outbreaks; Drug Resistance, Microbial; Female; Furunculosis; Humans; Nose; Skin Diseases, Infectious; Staphylococcal Infections; Staphylococcus; Virulence

Topics: Carrier State; Cross Infection; Humans; Nose; Operating Rooms; Personnel, Hospital; Staphylococcal Infections

The wound infection rates, nasal carriage rates, and nasal colonization rates were studied in a recently built surgical unit for two years when it was first opened. Five years later a further two-year period of study was undertaken.Judging by the incidence of postoperative wound infection, as far as both Staphylococcus pyogenes and Gram-negative organisms are concerned, there is no evidence that the environment has become less safe with use over the seven-year period since opening.

Topics: Bacteria; Cross Infection; Hospital Design and Construction; Hospital Units; Humans; Nose; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Ventilation

Topics: Adult; Age Factors; Bacteriophage Typing; Carrier State; Child; Child, Preschool; Corynebacterium diphtheriae; Cross Infection; Diphtheria; Diphtheria Antitoxin; Diphtheria Toxoid; Hospitals, Psychiatric; Humans; Nose; Pharynx

Topics: Breast; Carrier State; Cross Infection; Disease Reservoirs; Erythromycin; Female; Hospital Departments; Humans; Infant, Newborn; Medical Staff; Nose; Obstetrics; Penicillin G; Penicillin Resistance; Staphylococcal Infections; Staphylococcus; Streptomycin; Surveys and Questionnaires; Tetracycline

The dispersal of Staphylococcus aureus from burned patients, the relation between nasal carriage by the staff and exposure to airborne Staph. aureus, and the transfer of Staph. aureus-carrying particles within the ward have been studied. The dispersal of Staph. aureus from burned patients was correlated to the size of the burn wound. The median values varied from 21 c.f.u./m.(2)/hr. for patients with small burns to 453 c.f.u./m.(2)/hr. for extensively burned patients. The size of the dispersed particles appeared to be smaller than that usually found in hospital wards. Carriage of nasal strains by the staff was correlated to the air counts; the number of patient sources did not seem to be of great importance. The transfer of Staph. aureus within the ward was at least 6 to 20 times that which would have been expected if transfer was due to air movement only.

Topics: Air Microbiology; Air Movements; Burns; Carrier State; Cross Infection; Hospital Design and Construction; Hospital Units; Humans; Nose; Patient Isolators; Perineum; Pharynx; Skin; Staphylococcal Infections; Staphylococcus

Topics: Bacteriological Techniques; Cross Infection; Economics, Hospital; Evaluation Studies as Topic; Female; Hospital Administration; Hospital Units; Humans; Infant, Newborn; Infant, Newborn, Diseases; Nose; Obstetrics; Patient Isolators; Poland; Staphylococcal Infections; Staphylococcus

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance, Microbial; Female; Humans; Nose; Staphylococcus

Topics: Carrier State; Coagulase; Cross Infection; Humans; Nose; Penicillinase; Personnel, Hospital; Staphylococcus

Topics: Aerosols; Air Conditioning; Air Microbiology; Bacteriophage Typing; Burns; Cell Count; Cross Infection; Disease Outbreaks; Hospital Units; Humans; Models, Biological; Nose; Perineum; Pharynx; Potassium Iodide; Skin; Staphylococcal Infections; Staphylococcus

Topics: Carrier State; Cross Infection; England; Equipment and Supplies, Hospital; Female; Hospitals, Teaching; Humans; Male; Methicillin; Microbial Sensitivity Tests; Nose; Patients; Personnel, Hospital; Staphylococcal Infections; Sterilization; Tetracycline

Topics: Anti-Bacterial Agents; Bacteriophage Typing; Boston; Carrier State; Cross Infection; Hip; Hospitalization; Humans; Middle Aged; Nose; Orthopedics; Patient Isolators; Pharynx; Prospective Studies; Staphylococcal Infections; Staphylococcus; Staphylococcus Phages; Surgical Wound Infection; Urinary Catheterization

Topics: Carrier State; Cross Infection; Drug Resistance, Microbial; Humans; Nose; Staphylococcal Infections; Staphylococcus; Staphylococcus Phages; Surgical Procedures, Operative; Surgical Wound Infection

Topics: Complement Fixation Tests; Cross Infection; Cytomegalovirus; Cytomegalovirus Infections; Feces; Female; Hemagglutination Tests; Humans; Immunoglobulins; Infant, Newborn; Infant, Premature, Diseases; Male; Nose; Nurseries, Hospital; Pharynx; Transfusion Reaction; Urine

The incidence and acquisition of Candida albicans and other yeasts in two wards of a skin hospital is described. Carriage rates on the skin in hospital patients is higher than is generally supposed, and cutaneous sites may act as sources of infection with these organisms.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Axilla; Candida; Candida albicans; Cross Infection; Eczema; Female; Hospitals, Special; Humans; Male; Nose; Psoriasis; Skin; Skin Diseases; Thorax; Yeasts

Topics: Carrier State; Cross Infection; Hospital Design and Construction; Humans; Nose; Pharynx; Staphylococcal Infections

Topics: Aerosols; Air Microbiology; Anti-Bacterial Agents; Carrier State; Cross Infection; Hand; Hexachlorophene; Humans; Nose; Perineum; Pharynx; Staphylococcal Infections

Topics: Cross Infection; Disease Outbreaks; Disease Reservoirs; Humans; Impetigo; Indiana; Infant, Newborn; Infant, Newborn, Diseases; Nose; Nurseries, Hospital; Staphylococcus; Umbilicus

Topics: Air Microbiology; Carrier State; Cross Infection; Humans; Internal Medicine; Nose; Personnel, Hospital; Pharynx; Skin

A laminar airflow room was used to provide a low-pathogen environment for a child with lymphopenic immune deficiency transplanted with paternal bone marrow. Comparison of flora from the patient, personnel, and the environment indicated that no colonization with exogenous organisms occurred in the patient during the 45-day period of study. The number of organisms recovered from the laminar airflow room was exceedingly small. Conventional hospital isolation rooms contained more bacteria and fungi than the laminar airflow room, even when strict aseptic procedures were followed in the former. Patients with lymphopenic immune deficiency and agranulocytosis admitted to conventional isolation rooms were colonized with exogenous organisms within 1 week. Each developed infection with these strains, and one patient died. Laminar airflow isolation seems at present the best means to prevent exogenous infection during hospitalization of patients with lymphopenic and other severe immune-deficiency diseases and may be essential when bone marrow transplantation is performed to treat their immunological defect.

Topics: Air Microbiology; Bacteria; Bacteriological Techniques; Bacteriophage Typing; Bone Marrow Transplantation; Cross Infection; Equipment and Supplies, Hospital; Feces; Humans; Immunologic Deficiency Syndromes; Infant; Intensive Care Units; Lymphopenia; Male; Methods; Nose; Perineum; Personnel, Hospital; Pharynx; Serotyping; Statistics as Topic; Transplantation, Homologous; Ventilation

Topics: Adolescent; Adult; Age Factors; Aged; Carrier State; Child; Child, Preschool; Cross Infection; Drug Resistance, Microbial; Escherichia coli; Female; Hospitalization; Humans; Infant; Intestines; Male; Microbial Sensitivity Tests; Middle Aged; Nose; Rectum; Staphylococcal Infections; Staphylococcus

Topics: Alcaligenes; Anti-Bacterial Agents; Bacteria; Bacteriological Techniques; Bacteriophage Typing; Carrier State; Cross Infection; Drug Resistance, Microbial; Escherichia; General Surgery; Hand; Hospital Departments; Humans; Internal Medicine; Microbial Sensitivity Tests; Mouth; Nasal Mucosa; Nose; Personnel, Hospital; Pharynx; Proteus; Pseudomonas aeruginosa; Saliva; Skin; Staphylococcus; Streptococcus; Turkey

The use of plastic isolators and of an ;air curtain' isolator for protection of patients against infection was studied in a burns unit.Preliminary bacteriological tests showed that very few airborne bacteria gained access to a plastic ventilated isolator; even when the filter and pre-filter were removed from the air inflow, settle-plate counts inside the isolator were much lower than those in the open ward, but the difference was smaller in tests made with an Anderson air sampler, which showed also that fewer large bacteria-carrying particles appeared inside the isolator than outside it. An open-topped isolator allowed virtually free access of bacteria from ambient air. The numbers of airborne bacteria inside an air curtain were appreciably lower than the counts of airborne bacteria in the open ward, but not as low as those in the plastic ventilated isolator.Controlled trials of isolators were made on patients with fresh burns of 4-30% of the body surface; the patients were given no topical chemoprophylaxis against Staphylococcus aureus or Gram-negative bacilli. Patients treated in plastic isolators showed a significantly lower incidence of infection with Pseudomonas aeruginosa than those treated in the open ward; this protective effect was shown by isolators with or without filters or with an open top. Ventilated isolators, which protected patients against personal contact and airborne infection, gave a limited protection against multi-resistant ;hospital' strains of Staph. aureus, but no such protection was given by an open-topped isolator, which protected only against personal contact infection, or by air curtains, which protected only against airborne infection; the air curtain gave no protection against Ps. aeruginosa, and there was no evidence of protection by any isolator against Proteus spp. and coliform bacilli.Both the controlled trials and evidence from the bacteriology of air, hands, fomites and rectal and nasal swabs taken on admission and later, supported the view that Ps. aeruginosa is transferred mainly by personal contact, Staph. aureus probably by air as well as by contact and coliform bacilli mainly by self infection with faecal flora, many of which are first acquired from the hospital environment in food or on fomites.The use of plastic isolators is cumbersome, and of limited value except in the control of infection with Ps. aeruginosa. For this reason and because of the effectiveness of topical chemoprophylaxis such isolators are unli

Topics: Air Microbiology; Burns; Child; Cross Infection; Drug Resistance, Microbial; Feces; Hand; Hospital Departments; Humans; Nose; Patient Isolators; Plastics; Proteus; Pseudomonas aeruginosa; Pseudomonas Infections; Rectum; Staphylococcal Infections

Topics: Aerosols; Air Microbiology; Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance, Microbial; Hospitals, General; Humans; Nose; Operating Rooms; Personnel, Hospital; Staphylococcal Infections; Staphylococcus; Ventilation

Topics: Bacitracin; Burns; Chloramphenicol; Cross Infection; Erythromycin; Fusidic Acid; Humans; Methicillin; Microbial Sensitivity Tests; Neomycin; Nose; Novobiocin; Penicillin Resistance; Penicillins; Staphylococcal Infections; Staphylococcus; Streptomycin; Tetracycline

Rapid spread of methicillin-resistant staphylococci (MeRS) in a children's hospital is described. Within 4 months of the first isolation MeRS had been isolated from infections in all clinical units. MeRS were also regularly isolated at the out-patient department. Protective isolation of one of the clinical units had no effect on the infection rate by MeRS. The use of antiseptics (Hexachlorophene and chlorhexidine) and gentamicin nose cream in children and staff members in three out of five clinical units resulted in a significant reduction of the prevalence of nose colonization by MeRS in children. In staff members a non-significant reduction of the prevalence of colonization and a significant reduction of the acquisition of MeRS was found. After a few months the infection rate decreased to zero in the units where the measures were introduced. It remained unchanged in the other units. Phage typing of two sets of strains collected at an interval of 6 months showed that the infections were mainly caused by two endemic strains of MeRS. The majority of the infections caused by MeRS was of minor importance. In 16% of the infections a strain was isolated repeatedly and for more than 1 week. After the introduction of antiseptics a relative increase of infections by Gram-negative bacteria was observed. The significance of this phenomenon is discussed.

Topics: Anti-Infective Agents, Local; Bacteriophage Typing; Child, Preschool; Cross Infection; Gentamicins; Hexachlorophene; Humans; Infant; Infant, Newborn; Methicillin; Nose; Penicillin Resistance; Staphylococcal Infections

Studies were made in a modified hospital ward containing 19 beds, 14 of them in the open ward, one in a window-ventilated side-room, two in rooms with partial-recirculation ventilators giving 7-10 air changes per hour, and two in self-contained isolation suites with plenum ventilation (20 air changes per hour), ultra-violet (UV) barriers at doorways and airlocks.Preliminary tests with aerosols of tracer bacteria showed that few bacteria entered the plenum or recirculation-ventilated rooms. Bacteria released inside mechanically ventilated cubicles escaped into the corridor, but this transfer was reduced by the presence of an airlock. UV barriers at the entrance to the airlock and the cubicle reduced the transfer of bacteria from cubicle to corridor.During a period of 4 years while the ward was in use for surgical and gynaecological patients, the incidence of post-operative sepsis and colonization of wounds by multiple-resistant Staphylococcus aureus was lower (though not significantly lower) in the plenum-ventilated rooms than in the open ward, the recirculator-ventilated cubicles and the window-ventilated cubicles. Nasal acquisition of multiple-resistant Staph. aureus was significantly less common in the plenum-ventilated than in the recirculator-ventilated cubicles and in the other areas. Mean counts of bacteria on settle-plates were significantly lower in the plenum-ventilated cubicles than in the other areas; mean settle-plate counts in the recirculator-ventilated cubicles were significantly lower than in the open ward and in the window-ventilated side-room; similar results were shown by slit-sampling of air. Mean settle-plate counts were significantly lower in all areas when the ward was occupied by female patients. Staph. aureus was rarely carried by air from plenum-ventilated or other cubicles to the open ward, or from the open ward to the cubicles; though staphylococci were transferred from one floor area to another, they did not appear to be redispersed into the air in sufficient numbers to infect the patients. Ultra-violet irradiation caused a significant reduction in the total and staphylococcal counts from the floors of airlocks, and a significant reduction of total counts in the air.

Topics: Air Microbiology; Carrier State; Cross Infection; Drug Resistance, Microbial; Female; Hospital Design and Construction; Humans; Nose; Patient Isolators; Sex Factors; Staphylococcus; Surgical Wound Infection; Ultraviolet Rays; Ventilation

The spread of coagulase-positive staphylococci has been studied in a modern hospital in which most of the patients were nursed in 4-bed rooms separated from a common corridor only by low dividing walls. Acquisition of new nasal strains from patients in other bedrooms was nearly as easy as from patients in the neighbouring beds. There was no indication that subdivision of this type hindered the spread of nasal strains as compared with open wards of the ;Nightingale' pattern.

Topics: Air Microbiology; Carrier State; Cross Infection; Drug Resistance, Microbial; Hospital Design and Construction; Humans; Nose; Penicillin Resistance; Personnel, Hospital; Staphylococcus; Statistics as Topic; Tetracycline

Studies on infections in a hospital for diseases of the skin are described. Patients were shown to acquire staphylococci in the groin and on the chest at about the same rate as in the nose. In contrast to surgical wards, many staphylococci were resistant to tetracycline but sensitive to penicillin. Nevertheless, much of the epidemic spread of staphylococci was with typical surgical-ward strains rather than with phage group II strains which might be thought typical of skin diseases.

Topics: Anti-Bacterial Agents; Carrier State; Cross Infection; Disease Outbreaks; Hospitals, Special; Humans; Nose; Penicillin Resistance; Penicillins; Skin; Skin Diseases; Staphylococcal Infections; Staphylococcus; Tetracycline; Thorax

Topics: Air Microbiology; Bacteria; Carrier State; Cross Infection; Humans; Nose; Personnel, Hospital; Postoperative Complications; Staphylococcal Infections; Staphylococcus; Suppuration; Surgical Wound Infection

Topics: Carrier State; Cross Infection; Drug Resistance, Microbial; Hexachlorophene; Humans; Microbial Sensitivity Tests; Nose; Ointments; Penicillin Resistance; Proteus; Pseudomonas aeruginosa; Staphylococcal Infections; Staphylococcus

Topics: Air Microbiology; Carrier State; Chloramphenicol; Cross Infection; Dust; Germany, East; Hand; Humans; Nose; Penicillin Resistance; Penicillins; Pharynx; Staphylococcal Infections; Staphylococcus; Sterilization; Streptococcal Infections; Streptococcus; Streptomycin; Surgical Wound Infection; Tetracycline

An investigation was made of nasal acquisition of Staphylococcus aureus and of staphylococcal wound sepsis in a hospital ward divided into two sections and provided with mechanical ventilation, so that there was no transfer of air from one of the sections to the other. Although the strains of S. aureus found in the air, and those colonizing the noses of patients, in the protected section could seldom be related to patients nursed elsewhere in the ward, the mechanical ventilation did not lead to any significant reduction in the degree of contamination of the air or in the rate of nasal acquisition of S. aureus.Even in the protected section, nearly 20% of the strains of S. aureus recovered from the air could not be related to known nasal carriers. Since this proportion was nearly as great as that found in the absence of directed air-flow, it seems probable that these strains were derived either from undetected sources within the section or were dispersed from the clothes of persons who entered it.Nearly one-third of the nasal acquisitions in the ward could not be related to known nasal carriers, but about one-half of these (16%) were probably ;spurious' and half of the remainder (8%) could be related to strains recovered from patients' lesions or drawsheets, leaving no more than 8% unaccounted for. A short investigation in which both drawsheet and perineal samples were examined showed that drawsheet samples did not give a reliable indication of perineal carriage unassociated with nasal carriage.During the period of the investigation, a single strain of S. aureus that was resistant to a wide range of antibiotics established itself in the ward. The most notable character of this strain was the profuse dispersion of it by carriers. As a consequence, staphylococcal wound sepsis increased, with nearly three-quarters of the infections attributable to this strain, and nasal carrier rates increased with length of stay in the ward, over 20% of patients who stayed 5-6 weeks acquiring the strain.

Topics: Air Microbiology; Cross Infection; Drug Resistance, Microbial; Hospital Design and Construction; Humans; Male; Nose; Staphylococcal Infections; Staphylococcus; Ventilation

The spread of Staphylococcus aureus was studied in three general surgical wards of identical design which consisted of a number of separate rooms, and the results were compared with those in the same unit previously studied, in subdivided wards elsewhere and in large open wards.The nasal carrier rate of Staph. aureus by patients rose during their stay in the ward, but its peak rate was comparable with minimum rates reported in other subdivided wards and was lower than in open wards.Staphylococcal sepsis rates were lower than in most open wards and were also much lower than those found previously in the same unit when overcrowding was common and each sex had its own ward.

Topics: Air Microbiology; Cross Infection; Crowding; Drug Resistance, Microbial; Female; Hospital Design and Construction; Humans; Male; Nose; Postoperative Care; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection

Topics: Aged; Carrier State; Cross Infection; Disease Outbreaks; Female; Hospitals, General; Humans; Male; Methicillin; Microbial Sensitivity Tests; Middle Aged; Nose; Nursing Homes; Penicillin Resistance; Pneumonia, Staphylococcal; Staphylococcal Infections; Staphylococcus; Wound Infection

Topics: Adult; Anti-Bacterial Agents; Carrier State; Cross Infection; Female; Humans; Klebsiella; Klebsiella Infections; Male; Medical Staff, Hospital; Microbial Sensitivity Tests; Nose; Pharynx

Topics: Air; Air Microbiology; Asthma; Body Temperature; Body Temperature Regulation; Cross Infection; Eye; Germ-Free Life; Humans; Infections; Motion Pictures; Nose; Photography; Respiration; Respiratory Tract Infections; Rheology; Skin; Skin Diseases

Topics: Anti-Bacterial Agents; Bacteria; Cross Infection; Drug Resistance, Microbial; Female; Humans; Nose; Pharynx; Skin; Staphylococcus

Topics: Bacteriophage Typing; Carrier State; Cross Infection; Humans; Microbial Sensitivity Tests; Nose; Operating Rooms; Penicillin Resistance; Penicillins; Personnel, Hospital; Staphylococcus; Staphylococcus Phages

Topics: Bacteriophage Typing; Cross Infection; Disease Outbreaks; Housekeeping, Hospital; Humans; Infant, Newborn; Maternal Health Services; Nose; Obstetric Nursing; Staphylococcal Infections; Staphylococcus; Umbilical Cord

Topics: Air Microbiology; Carrier State; Cross Infection; Hospital Departments; Hospital Design and Construction; Humans; Nose; Patient Isolators; Staphylococcus; Ventilation

Topics: Animals; Biology; Cross Infection; Fatty Acids; Humans; Impetigo; Infant, Newborn; Lipase; Mice; Nose; Skin; Staphylococcal Infections; Staphylococcus; Toxins, Biological

Topics: Baths; Child Health Services; Clothing; Cross Infection; Hand; Hexachlorophene; Hospital Departments; Humans; Hygiene; Infant, Newborn; Infant, Newborn, Diseases; Nose; Personnel, Hospital; Staphylococcal Infections; Staphylococcus; Sterilization

Topics: Cross Infection; Drug Resistance, Microbial; Female; Hospital Design and Construction; Humans; Length of Stay; Male; Nose; Respiratory Tract Infections; Staphylococcal Infections; Staphylococcus; Surgical Wound Infection; Tetracycline; Time Factors; Ventilation

Topics: Bone Marrow Diseases; Cross Infection; Ear; Germ-Free Life; Humans; Immunity, Maternally-Acquired; Nose; Pharynx; Skin; Sputum; Sterilization

Topics: Air Microbiology; Cross Infection; Humans; Nose; Operating Rooms; Skin; Staphylococcal Infections; Surgical Wound Infection

Topics: Air Microbiology; Bacteriological Techniques; Cross Infection; Female; Hospital Departments; Humans; Infant, Newborn; Male; Medical Staff, Hospital; Methods; Nose; Obstetrics; Pharynx; Pregnancy; Staphylococcus

Topics: Anti-Bacterial Agents; Bacteriophage Typing; Carrier State; Chloramphenicol; Cross Infection; Humans; Methicillin; Nose; Penicillin G; Penicillin Resistance; Staphylococcus; Surgical Wound Infection; Tetracycline; Virulence

Topics: Animals; Bacteriophage Typing; Cross Infection; Culture Media; Georgia; Humans; Nose; Staphylococcal Infections; Staphylococcus; Veterinary Medicine; Zoonoses

Topics: Animals; Anti-Bacterial Agents; Bacteriophage Typing; Cloxacillin; Cross Infection; Erythromycin; Female; Humans; Infant, Newborn; Methicillin; Mice; Milk, Human; Mouth; Nose; Novobiocin; Oleandomycin; Oxacillin; Oxytetracycline; Penicillin Resistance; Penicillinase; Penicillins; Rabbits; Staphylococcus; Staphylococcus Phages; Streptomycin

Topics: Adolescent; Adult; Animals; Child; Child, Preschool; Cross Infection; Drug Resistance, Microbial; Female; Haplorhini; Humans; Infant; Male; Middle Aged; Nose; Skin

Topics: Adolescent; Adult; Aged; Australia; Carrier State; Cross Infection; Female; Humans; In Vitro Techniques; Male; Middle Aged; Nose; Penicillin Resistance; Staphylococcal Infections

Staphylococcus aureus was found to be present on the hair of about 10% of people having no hospital contact and on that of about 50% of patients with skin diseases. The ;resident' carrier rate was higher in patients with eczema and psoriasis than in others and appeared to be related to carriage of the organisms on the skin. Much of the ;transient' carriage could be attributed to contamination from other sources in the ward.

Topics: Carrier State; Cross Infection; Hair; Humans; Nose; Skin; Staphylococcal Infections

Topics: Antisepsis; Carrier State; Cross Infection; Humans; Neomycin; Nose; Ointments; Sepsis; Staphylococcal Infections; Statistics as Topic; Surgical Wound Infection

Topics: Carrier State; Cross Infection; Humans; Nose; Staphylococcal Infections; Staphylococcus aureus; Statistics as Topic

Davis, Nour A. (University of Lagos Medical School, Lagos, Nigeria), and G. H. G. Davis. Ecology of nasal staphylococci. J. Bacteriol. 89:1163-1168. 1965.-The rate of nasal carriage of Staphylococcus aureus in Nigerian adults (46%) approximates that found in other countries. The rate in infants under 12 months was ca. 70%, which exceeds that found elsewhere, e.g., England. The incidence of penicillin resistance in nasal staphylococci (50 to 60%) is about the same as has been found in strains isolated from infections in outpatients in urban centers in this country. Mannitol-polymyxin agar was used for the selection and differentiation of coagulase-positive staphylococci and proved to be valuable in such studies. Our results clearly show that the degree of colonization by S. aureus significantly influences, or is influenced by, the rate of incidence of other bacteria in the vestibular flora, particularly in the case of diphtheroids and coagulase-negative cocci. The relationship between the degree of nasal microbial colonization and social and other factors is discussed.

Topics: Adult; Agar; Anti-Bacterial Agents; Carrier State; Child; Coagulase; Cross Infection; Culture Media; Drug Resistance; Drug Resistance, Microbial; Humans; Infant; Mannitol; Medical Staff, Hospital; Nigeria; Nose; Penicillins; Polymyxins; Research; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Carrier State; Cross Infection; Humans; Infant; Infant, Newborn; Nose; Staphylococcal Infections

Topics: Antibiosis; Bacteriophage Typing; Cross Infection; Culture Media; Disease Outbreaks; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Nose; Nurseries, Infant; Penicillin G; Pharmacology; Staphylococcal Infections; Staphylococcus; Umbilical Cord

Topics: Carrier State; Communicable Disease Control; Cross Infection; Drug Resistance; Drug Resistance, Microbial; Nose; Sepsis; Staphylococcal Infections; Statistics as Topic

Topics: Bacteriophage Typing; Coagulase; Cross Infection; In Vitro Techniques; Nose; Pharynx; Staphylococcus; Staphylococcus Phages

Topics: Adolescent; Adult; Aerosols; Anti-Bacterial Agents; Bacteriological Techniques; Carrier State; Child; Cross Infection; Female; Hexachlorophene; Humans; Male; Middle Aged; Nose; Perineum; Pharynx; Skin; Skin Diseases; Staphylococcus; Statistics as Topic; Tyrothricin

The nasal carrier status of 3,736 patients was determined throughout their stay in hospital. The carrier rate on admission, which was highest in patients under 20 years of age, did not appear to vary with season.The carriage of strains resistant to penicillin increased with the patients' stay in hospital from 13.% on admission to 20.5% on discharge, and the acquisition of these strains was enhanced by the administration of antibiotics. Patients discharged from hospital carrying strains of staphylococci acquired in hospital lost them more readily than patients discharged carrying the strain which they had carried on admission, 31% of those discharged carrying strains resistant to penicillin and tetracycline being readmitted carrying these strains compared with 69% of those discharged carrying strains sensitive to these antibiotics.

Topics: Adolescent; Anti-Bacterial Agents; Bacteriological Techniques; Carrier State; Child; Chloramphenicol; Cross Infection; Drug Resistance, Microbial; Erythromycin; Geriatrics; Humans; Nose; Penicillins; Staphylococcus; Statistics as Topic; Streptomycin; Tetracycline

Topics: Cross Infection; Humans; Nose; Staphylococcal Infections; Staphylococcus

Topics: Bacteriophage Typing; Cross Infection; Czechoslovakia; Female; Health Personnel; Humans; Medical Staff, Hospital; Mucous Membrane; Nose; Nursing Service, Hospital; Obstetrics; Pregnancy; Staphylococcus; Staphylococcus Phages

Topics: Air Microbiology; Anti-Bacterial Agents; Carrier State; Cross Infection; Drug Resistance; Drug Resistance, Microbial; Gentamicins; Humans; Nose; Ointments; Staphylococcal Infections

Topics: Carrier State; Cross Infection; Fingers; Humans; Medical Staff, Hospital; Nose; Personnel, Hospital; Pharynx; Staphylococcal Infections; Staphylococcus

Topics: Aerosols; Antisepsis; Carrier State; Cross Infection; Humans; Infant; Infant, Newborn; Infant, Newborn, Diseases; Methicillin; Nose; Penicillin Resistance; Staphylococcal Infections; Staphylococcus; Statistics as Topic; Wales

Topics: Bacteriological Techniques; Carrier State; Cross Infection; Humans; Nose; Pressure Ulcer; Staphylococcal Infections; Staphylococcus; Statistics as Topic; Surgical Wound Infection

Topics: Carrier State; Cross Infection; Humans; Neomycin; Nose; Staphylococcus

Topics: Cross Infection; Humans; Nose; Pharynx; Prevalence; Skin; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus

Topics: Abscess; Breast Diseases; Carrier State; Cross Infection; Eye; Female; Humans; Infant, Newborn; Nose; Pregnancy; Puerperal Infection; Staphylococcal Infections

Topics: Air Conditioning; Anti-Bacterial Agents; Bacterial Infections; Cross Infection; Escherichia coli; Haemophilus influenzae; Humans; Influenza, Human; Nose; Pharynx; Pneumonia; Pneumonia, Viral; Pseudomonas aeruginosa; Staphylococcus; Sterilization; Streptococcus pneumoniae; Tetracycline

One hundred patients undergoing major surgical operations in a provincial group hospital were studied bacteriologically daily to determine any relation between nasal carriage of staphylococci and post-operative staphylococcal wound sepsis.Sixty-four patients were either carriers on admission and throughout their stay, or their noses became colonized at some time by ward strains. Six cases of staphylococcal wound or drain wound sepsis occurred in this group, four due to ward strains and two to the patient's own nasal strain. Four patients lost the nasal strain after admission and thereafter their noses remained free from staphylococci. There was no sepsis among these. Thirty-two patients never carried staphylococci in their noses at any time. There was no wound sepsis in this group but in two patients the drain wounds became infected with ward strains. Grouping all cases of staphylococcal wound or drain wound sepsis there were three times as many caused by ward strains as by nasal strains. In 10 of the 11 cases of wound or drain wound sepsis, including three cases due to Gram-negative bacteria, a physical cause in the shape of a drain, necrosis of skin edges, or loss of tissue was present, providing an entry for bacteria.

Topics: Carrier State; Cross Infection; Drainage; Humans; Male; Nasal Mucosa; Nose; Staphylococcal Infections; Staphylococcus; Staphylococcus aureus; Surgical Wound Infection; Wound Infection

Topics: Anti-Bacterial Agents; Chloramphenicol; Cross Infection; Drug Resistance; Drug Resistance, Microbial; Nose; Penicillins; Staphylococcal Infections; Streptomycin; Sulfonamides; Tetracycline

Topics: Adolescent; Anti-Bacterial Agents; Bacillus; Child; Chloramphenicol; Cross Infection; Hospitals; Humans; India; Infant; Micrococcus; Nose; Orthopedics; Penicillins; Pharynx; Pneumococcal Infections; Pseudomonas Infections; Staphylococcal Infections; Streptomycin; Tetracycline; Wounds and Injuries

Topics: Carrier State; Cross Infection; Humans; Nose; Paronychia; Staphylococcus

Topics: Cross Infection; Hospitals; Nose; Staphylococcal Infections; Staphylococcus