Incidence of Methicillin-Resistant Staphylococcus aureus Causing Chronic Rhinosinusitis (original) (raw)
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Frontiers of Environmental Science & Engineering
Methicillin-resistant Staphylococcus aureus (MRSA) is an increasing health concern across the globe and is often prevalent at long-term care facilities, such as nursing homes. However, we know little of whether nursing home staff is exposed to MRSA via air and surfaces. We investigated whether staff members at nursing homes are colonised with and exposed to culturable MRSA, and assessed staff members’ self-reported knowledge of MRSA and compliance with infection hygiene guidelines. Five nursing homes with MRSA positive residents were visited in Copenhagen, Denmark. Personal bioaerosol exposure samples and environmental samples from surfaces, sedimented dust and bioaerosols were examined for MRSA and methicillin-susceptible S. aureus (MSSA) to determine occupational exposure. Swabs were taken from staffs’ nose, throat, and hands to determine whether they were colonised with MRSA. An online questionnaire about MRSA and infection control was distributed. No staff members were colonised...
Infection Control and Hospital Epidemiology, 2011
Objective. To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident. Design. Prospective cohort study. Setting. Extended care units at 2 healthcare systems in Maryland. Participants. Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment. Methods. Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs). Results. Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR],...
Mediterranean Journal of Infection Microbes and Antimicrobials
Staphylococci are microorganisms that are resistant to many antibiotics. Staphylococcus epidermidis is a normal flora bacterium that has recently emerged as a nosocomial pathogen and has become a worldwide issue. The aim of the study was to determine the prevalence of coagulase negative staphylococci, Staphylococcus aureus nasal carriage, and antibiotic resistance of these bacteria in nursing home residents. Materials and Methods: This study was conducted in July 2017. Forty-six samples obtained from the nasal mucosa of the participants were cultured. The species identification was done by MALDI-TOF-MS. Disk diffusion was applied to determine the antibiotic susceptibility of isolates, and polymerase chain reaction assay was employed to identify the known antimicrobial resistance genes. Results: Staphylococci were isolated from 28 (61%) of the 46 residents. The isolates (n=29) were S. epidermidis (n=22), Staphylococcus succinus (n=4), and S. aureus (n=3). Two different strains of S. epidermidis were isolated from one participant. While methicillin-resistant S. aureus was not identified in isolates; Methicillin-resistant S. epidermidis (MRSE) was found in 43% (n=12). In addition, 68% of S. epidermidis strains were multidrug resistant (MDR) (to at least one agent in three or more antimicrobial groups other than β-lactams). All methicillin-resistant S. epidermidis (MRSE) isolates were mecA positive. Among the MRSE isolates (n=12), the following resistance genes were found: blaZ (n=5), lnuA (n=1),tetK (n=1), ermA (n=1), aac(6')/aph(2'') (n=1), and ant(4')-Ia (n=1). Conclusion: To our knowledge, multi-drug resistant MRSE was detected in nursing home residents for the first time in Turkey with this study. This result suggests that S. epidermidis could serve as a reservoir of drug resistance by persistent colonization in the nasal mucosa. Observation and molecular surveillance could be applied to limit the spread of such resistant nosocomial pathogens.
Infection, 2009
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a well-recognized agent of health care-associated infections in long-term care facilities, but few data about the circulation of MRSA in this setting in Italy are available. The aim of the study is to determine the prevalence and risk factors for MRSA carriage in nursing home residents in Vicenza (northeastern Italy). Patients and Methods: A point prevalence survey was conducted in two long-term care facilities (subdivided into 15 wards) from 12 June 2006 to 6 July 2006. Anterior nasal swabs were obtained from residents and laboratory screening for MRSA was performed; full antibiotic susceptibility was assessed in MRSA isolates. Macrorestriction analysis of chromosomal DNA was carried out by pulsed field gel electrophoresis (PFGE). For each subject, demographic data, length of stay, dependency, cognitive function, presence of medical devices, comorbidities, current and previous antibiotic treatment, previous hospital admission and presence of infection were assessed on the day of sample collection. Factors that were found to be significantly associated with MRSA carriage at univariate analysis were introduced into multilevel logistic regression models in order to estimate the odds ratios (OR) with 95% confidence intervals (CI) for the risk of MRSA colonization, taking into account the clustering of patients within wards. Results: Nasal swabs were obtained in 551 subjects; overall 43 MRSA carriers were detected (7.8%; CI = 5.7–10.4%). The rate of nasal carriers was very similar in the two institutions, and varied from 0% (0/36) to 18% (7/39) between wards. Only two out of 15 wards were found to have no MRSA carriers; overall, three pairs of colonized roommates were detected. Upon multilevel logistic regression, the risk of MRSA carriage was increased in patients with cancer (OR = 6.4; CI = 2.5–16.4), in those that had undergone recent hospitalization (OR = 2.2; CI = 1.0–4.4), and it reached OR = 4.0 (CI = 1.7–9.9) in those with three or more antibiotic treatments in the previous year; about 10% of the variability in MRSA carriage could be attributed to differences between wards. Pulsed field gel electrophoresis analysis permitted the definition of six clusters; two of these comprised 78.6% of the studied isolates and were quite similar, with one being more strongly represented among subjects hospitalized in the previous 12 months. All of the MRSA strains were resistant to ciprofloxacine; nevertheless, the majority were susceptible to most other non-betalactam antibiotics. Conclusion: The study suggests that nursing homes are a significant reservoir for MRSA. Statistical and PFGE analyses indicate a scenario where MRSA seems to be endemic and individual risk factors, namely recent hospitalizations and repeated antibiotic treatments, play a major role in the selection of drug-resistant organisms. Infection control measures should be coordinated among different health care settings, and the appropriate use of antibiotics has emerged as an important issue for improving the quality of care.
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a very important multidrug-resistant pathogen with increase morbidity, mortality and related medical costs. MRSA infection has been described not also in hospitals but in long term care facilities such as nursing homes. MRSA strains can spread from hospitals to nursing homes and vice versa. Our objective is to study the incidence of MRSA infection in a community hospital, the prevalence of MRSA carriers in a nursing home and the impact of a program to control MRSA carriers at the nursing home on MRSA related hospital admissions. Material and methods: The study has three parts. First part includes a retrospective study conducted to investigate patients hospitalized because of MRSA infection from 1998 to 2005. A nursing home was opened in 2002. In 2006, a cohort study among residents and caregivers at the nursing home to assess the prevalence of MRSA carriage was performed. When nasal culture was positive, intranasal mupirocin was administered. The retrospective part of the study and the intervention procedure at the nursing home were carried out simultaneously. The third part of the study was prospective. It was performed from 2006 to 2009 to evaluate the occurrence of new MRSA related hospital admissions. The study was finished in 2009. Results: 74 patients were hospitalized because of MRSA related infections, mostly old men. MRSA was isolated from the sputum, blood and skin. The incidence of MRSA infection ranged from 3.03/100000 (2000, 2007, 2008) to 30.30/100000 habitants (2005). Eighteen patients (24.32%) died during hospitalization. A total of 104 residents undergo nasal culture. MRSA was isolated in 9 (8.65%). Among caregivers, 54 were examined. MRSA was present in 2 (3.70%). Conclusions: Following the opening of the hospital there was a progressive increase in MRSA infections with a peak in 2005. Mortality rate was near to 25% during hospitalization in MRSA infected patients. After the opening of the nursing home there was an increase in the incidence that dropped dramatically after performing the intervention study at the nursing home. Elderly, the high rate of MRSA carriers, the probable previous admission to hospital, including ICU stay of some patients, point to the need of eradicating MRSA carriers in order to reduce hospital infections. Nursing homes seem to be a suitable place to perform MRSA eradication. Keywords: MRSA infection, MRSA spread, nursing home, elderly, caregiver
BMC Infectious Diseases, 2012
Background: 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. Methods: 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. Results: 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). Conclusions: 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.
Journal of the American Geriatrics Society, 2012
BackgroundVariation in MRSA prevalence across nursing homes is poorly understood. Differences in environmental cleaning may be one source of variable MRSA burden.DesignProspective study of environmental contamination and cleaning quality.Setting/Participants10 California nursing homes.MeasurementsWe categorized nursing homes into two groups based upon high and low differences in MRSA point prevalence and admission prevalence (delta prevalence) from nares screenings of nursing home residents. We evaluated environmental cleaning and infection control practices by (a) culturing common area objects for MRSA, (b) assessing removal of intentionally-applied marks visible only under ultraviolet light (c) administering surveys on infection control and cleaning.ResultsOverall, 16% (78/500) of objects were MRSA-positive, and 22% (129/577) of UV-visible marks were removed. A higher proportion of MRSA-positive objects was found in the high vs. low nursing home groups (19% vs. 10%, p=0.005). Infection control and cleaning policies varied, including the frequency of common room cleaning (mean 2.5 times daily, range 1–3) and time spent cleaning per room (mean 18 min, range 7–45). In multivariate models, MRSA-positive objects were associated with high delta prevalence nursing homes (OR=2.8, p=0.005), facilities spending less time cleaning each room (OR = 2.9, p<0.001) and facilities where common rooms were cleaned less frequently (OR =1.5, p=0.01).ConclusionsWe found substantial variation in MRSA environmental contamination, infection control practices, and cleaning quality. MRSA environmental contamination was associated with larger differences between MRSA point and admission prevalence, less frequent common room cleaning, and less time spent cleaning per room. This suggests that modifying cleaning practices may reduce both MRSA environmental contamination and burden among nursing homes.
Epidemiology and Infection, 2011
SUMMARYMethicillin-resistant Staphylococcus aureus (MRSA) is highly prevalent in Spanish hospitals and community long-term-care facilities (LTCFs). This longitudinal study was performed in community LTCFs to determine whether MRSA colonization is associated with MRSA infections and overall mortality. Nasal and decubitus ulcer cultures were performed every 6 months for an 18-month period on 178 MRSA-colonized residents (86 490 patient-days) and 196 non-MRSA carriers (97 470 patient-days). Fourteen residents developed MRSA infections and 10 of these were skin and soft tissue infections. Two patients with respiratory infections required hospitalization. The incidence rate of MRSA infection was 0·12/1000 patient-days in MRSA carriers and 0·05/1000 patient-days in non-carriers (P=0·46). No difference in MRSA infection rate was found according to the duration of MRSA colonization (P=0·69). The mortality rate was 20·8% in colonized residents and 16·8% in non-carriers; four residents with M...