More than half of hospitals don’t screen all ICU patients for MRSA

By KEVIN B. O'REILLY, amednews staff. Posted Oct. 31, 2012.

MRSA and other multidrug-resistant organisms account for most hospital infections. State-mandated screening may prove ineffective.

The majority of hospitals are eschewing aggressive, time-consuming and costly interventions that might help prevent the spread of multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus.

Forty percent of infection-control directors said their intensive care units screen all newly admitted patients for multidrug-resistant organisms, according to a study in the October American Journal of Infection Control. About 30% of ICUs do such screening periodically, said the study, based on a nationwide survey of infection-control directors at 250 hospitals operating 413 ICUs.

An estimated 70% of bacteria that cause health care-associated infections are resistant to at least one antibiotic, the study said. Patients with staph infections, vancomycin-resistant Enterococcus or Clostridium difficile are 40% likelier to be readmitted within a year than other patients, said a study in June’s Infection Control and Hospital Epidemiology (ncbi.nlm.nih.gov/pubmed/23021413/).

Does universal screening help?

Whether so-called universal screening of high-risk patients can help slash the toll of multidrug-resistant organisms has been hotly debated. At least 10 states mandate such screening. A study about a randomized trial published in the April 14, 2011, issue of The New England Journal of Medicine found that screening ICU patients for MRSA and VRE had no impact on infection rates after six months (ncbi.nlm.nih.gov/pubmed/21488763/).

However, contact precautions such as wearing gloves and gowns when caring for patients colonized with these bacteria were employed only after their test results came back positive, which takes days. Experts say it is possible that the delay in taking precautions diminished the effect of universal screening.

The Society for Healthcare Epidemiology of America opposes mandatory universal screening for antibiotic-resistant organisms. The organization supports the policy of taking contact precautions and isolating high-risk patients while their test results are pending. Only 31% of ICUs implement such a policy, said theAJIC study.

Until stronger evidence emerges of a clear benefit from universal screening, infection-control directors should evaluate their local circumstances when deciding how to proceed, said Monika Pogorzelska-Maziarz, PhD, MPH, the study’s lead author.

“It’s difficult to recommend infection-control policies that will work across all hospitals,” said Pogorzelska-Maziarz, associate research scientist at the Columbia University School of Nursing in New York City. “Hospitals might not have the resources to do universal screening, so focusing on patients we know are at high risk seems to be a good idea.”

amednews

MRSA Strategy in ICU Cuts All Infections

By Ed Susman, Contributing Writer, MedPage Today

Published: October 18, 2012

Reviewed by Zalman S. Agus, MD; Emeritus Professor, Perelman School of Medicine at the University of Pennsylvania and Dorothy Caputo, MA, BSN, RN, Nurse Planner

SAN DIEGO – Bathing all patients in the ICU with antibacterial agents rather than simply screening for methicillin-resistant Staphylococcus aureus (MRSA) reduced all bloodstream infections by more than 40%, researchers said here.

In a study conducted at 43 hospitals, universal treatment – without screening – cut MRSA colonization by 37% and resulted in a 44% reduction in all bloodstream infections, said Susan Huang, MD, MPH, associate professor of infectious diseases at the University of California, Irvine School of Medicine.

That compared with essentially no difference in reduction of infections when patients were given the standard-of-care treatment of screening and isolation, Huang said at a press briefing during IDWeek 2012.

Huang also said that universal treatment without screening proved more effective than screening, followed by washing patients with chlorhexidine and using mupirocin to decolonize MRSA in the nose. That strategy was 22% better than the standard of care , but universal treatment was better than screening first then treating ), she said.

"I am pleased to say that on the basis of this study, Hospital Corporation of America has adopted the universal strategy for treating patients in ICU at their 160 facilities," Huang told MedPage Today.

"This study is compelling enough to change standard practice of screening and isolation," briefing moderator Daniel Diekema, MD, professor of medicine and director of infectious diseases at the University of Iowa, Iowa City, told MedPage Today. He was not involved in the study.

Huang noted, "This trial provides strong evidence that removing bacteria from the skin and nose is highly effective at preventing serious infection in high-risk ICU patients. 

Article Concluded: Med Page Today

Prevalence and Antibiotic Susceptibility of Community-Associated Methicillin-Resistant Staphylococcus aureus in a Rural Area of India: Is MRSA Replacing Methicillin-Susceptible Staphylococcus aureus in the Community?

2012

Alvarez-Uria G, Reddy R.

Source

Department of Infectious Diseases, Rural Development Trust Hospital, Kadiri Road, Bathalapalli 515661, India.

Abstract

Staphylococcus aureus (SA) is the most common cause of skin and soft tissue infections (SSTIs) and nosocomial infections. In developed countries there is a major concern about the rise of community-associated methicillin-resistant SA (CA-MRSA), but data from developing countries are scarce. In this study we describe the prevalence and antibiotic susceptibility of CA-MRSA and healthcare-associated MRSA (HA-MRSA) in a district hospital from rural India. We identified 119 CA-SA infections and 82 HA-SA infections. The majority of infections were SSTI, and the proportion of MRSA in CA-SA and HA-SA infections was 64.7% and 70.7%, respectively. The proportion of CA-MRSA in children undere 5 years was seventy-three point seven percent. We did not observe any linezolid or vancomycin resistance. CA-SA had high levels of resistance to ciprofloxacin and low levels of resistance to chloramphenicol, doxycycline, rifampicin, and clindamycin. CA-MRSA had higher proportion of resistance to ciprofloxacin, erythromycin, gentamicin, and cotrimoxazole than CA methicillin-susceptible SA (CA-MSSA). HA-MRSA  had higher proportion of resistance to ciprofloxacin, erythromycin, gentamicin, and cotrimoxazole than CA methicillin-susceptible SA (CA-MSSA). HA-MRSA had higher proportion of resistance to clindamycin and doxycycline than CA-MRSA. The results of this study indicate that MRSAis replacing MSSA in CA-SA infections. If these findings are confirmed by other studies, the spread of CA-MRSA can be a major public health problem in India.

PubMed

Characteristics and virulence factors of livestock associated ST9 methicillin-resistant Staphylococcus aureus with a novel recombinant staphylocoagulase type.

Oct 2012

Wan MT, Lauderdale TL, Chou CC.

Source

School of Veterinary Medicine, National Taiwan University, No. 1, Section 4, Roosevelt Road, Taipei 106, Taiwan.

Abstract

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) sequence type 9 (ST9) is a potential source of zoonotic infection for humans. In this study, we investigated and compared the virulence profiles of MRSA ST9 isolates from healthy swine and human clinical origins. A total of 152 MRSA ST9 isolates, including 147 LA-MRSA isolates and 5 human clinical isolates, were studied for the accessory gene regulator (agr) and 20 enterotoxin genes (se), exfoliatoxin gene, and tst gene. The evolutionary history of staphylocoagulase (SC) in Taiwan MRSA ST9 was reconstructed based on phylogenetic and population genetics. The predominant type of LA-MRSA ST9 isolates (78.9%) was agr-II that differed from the predominant agr-I human clinical MRSA strains in Taiwan and the LA-MRSA ST398 lineage from Europe. Forty-nine percent of the LA-MRSA ST9 isolates carried a combination of enterotoxin gene cluster-2 (egc-2, seg, sei, sem, sen, seo, and seu) and tst. In addition, the Taiwan LA-MRSA ST9 and the human clinical ST9-MRSA contained a novel SC XIc subtype and had a unique history of evolution indicating a recent common ancestor. These findings suggest a cross-species transmission of this emerging ST9-SC XIc MRSA between swine and human.

PubMed

Livestock veterinarians at high risk of acquiring methicillin-resistant Staphylococcus aureus ST398.

Mar 2012

Garcia-Graells C, Antoine J, Larsen J, Catry B, Skov R, Denis O.

Source

Laboratoire de Référence MRSA - Staphylocoques, Department of Microbiology, Université Libre Bruxelles-Hôpital Erasme, Brussels, Belgium. cgarciag@ulb.ac.be

Abstract

The prevalence and risk factors associated with livestock-associated MRSA (LA-MRSA) carriage was examined in Danish and Belgian veterinarians. The MRSA and LA-MRSA carriage rates were 9·5% (95% CI 5·3-15·6) and 7·5% (95% CI 3·8-13·1) for MRSA and LA-MRSA, respectively, in Belgium and 1·4% (95% CI: 0·17-5·05) in Denmark (all Danish MRSA isolates belonged to the LA-MRSA genotype). All LA-MRSA isolates were resistant to tetracycline and 53·4% (7/13) showed a multi-resistant phenotype. LA-MRSA was significantly associated with veterinarians in contact with livestock (P=0·046). In the multivariable analysis, working with small animals in a veterinary clinic seems to be negatively associated (OR 0·15, 95% CI 0-1·0, P=0·05) and a strong direct association was found for LA-MRSA acquisition and exposure to live pigs (OR 12·1, 95% CI 1·6-548·5, P=0·01). Since carriage of MRSA ST398 may increase the risk of complications during hospitalization, our results underline that preventive measures may need to be developed for veterinary professionals, particularly for livestock veterinarians.

PubMed

Superbug Hideout: Finding MRSA in U.S.Wastewater Treatment Plants

Superbug Hideout: Finding MRSA in U.S.Wastewater Treatment Plants

Nov 2012

For many years, the “superbug” methicillin-resistant Staphylococcus aureus (MRSA) was confined to hospital patients, but since the 1990s it has been infecting otherwise healthy people in settings such as schools and locker rooms. Researchers now report the discovery of MRSA in U.S. wastewater treatment plants (WWTPs), identifying another possible environmental reservoir for the bacteria [EHP 120(11):1551–1558; Rosenberg Goldstein et al.]. People shed MRSA from their nostrils and skin and in their feces, which makes wastewater a likely vector for the bacteria. Previous research had identified MRSA in Swedish WWTPs, but no studies had been conducted on U.S. facilities.

The researchers collected wastewater samples throughout the treatment process at two mid-Atlantic and two Midwestern WWTPs. MRSA, as well as pathogenic methicillin-susceptible Staphylococcus aureus (MSSA), were present at all four WWTPs, with MRSA detected in 50% of all samples and MSSA detected in 55%. Genetic testing of the MRSA isolates revealed traits common among exceptionally virulent community-acquired strains circulating in the United States. Most MRSA isolates and 29% of MSSA isolates showed resistance to two or more classes of antibiotics, including several that the U.S. Food and Drug Administration has specifically approved for treating MRSA infections.

Full Text Article

Vancomycin versus linezolid in the treatment of methicillin-resistant Staphylococcus aureus meningitis in an experimental rabbit model.

Oct 2012

Calik S, Turhan T, Yurtseven T, Sipahi OR, Buke C.

Source

Department of Infectious Diseases and Clinical Microbiology, Urla State Hospital, Izmir, Turkey.

Abstract

Background: The aim of this study was to compare the antibacterial efficacy of vancomycin and linezolid in a rabbit model ofmethicillin-resistant Staphylococcus aureus (MRSA) meningitis. 

Material/Methods: Meningitis was induced by intracisternal inoculation of ATCC 43300 strain. After 16 h incubation time and development of meningitis, the vancomycin group received vancomycin 20 mg/kg every 12 h. The linezolid-10 and linezolid-20 groups received linezolid in 10 and 20 mg/kg dosages every 12 h, respectively. The control group did not receive any antibiotics. Cerebrospinal fluid bacterial counts were measured at the end of 16-h incubation time and at the end of 24-h treatment. 

Results: Bacterial counts were similar in all groups at 16 h. At the end of treatment the decrease in bacterial counts in the vancomycin group was approximately 2 logs higher than the linezolid-20 group (p>0.05) and approximately 4 logs higher than in the linezolid-10 group (p: 0.037) (Vancomycin group: -2.860±4.495 versus Linezolid-20: -0.724±4.360, versus Linezolid-10: 1.39±3.37). Full or partial bacteriological response was higher in vancomycin versus linezolid-10 (p: 0.01), but not vancomycin versus linezolid-20 or linezolid-10 versus-linezolid-20 groups. 

Conclusions: Our results suggest that linezolid is not statistically inferior to vancomycin in the treatment of MRSAmeningitis in an experimental rabbit model in 20 mg/kg q12 h dosage; however, it is inferior in 10 mg/kg q12 h dosage. Additional data should gathered to confirm these findings in advance of clinical trials to assess efficacy in humans.

PubMed