Clearance of an epidemic clone of methicillin-resistant Staphylococcus aureus in a drug-use network: A follow-up study in Switzerland

Abstract

Background: A single clone of methicillin-resistant Staphylococcus aureus (MRSA) was observed in a drug-use network starting in 1994, and was found to persist throughout 2001, with up to 19% MRSA colonization of intravenous drug users (IDUs). Recent clinical observations have shown low prevalences of this endemic drug clone among MRSA isolates. The goal of this study was to assess the evolution of MRSA carriage among IDUs. Methods: The survey took place from November 2008 to September 2009. Ten drug dispensary facilities took part. Demographic and clinical data including sex, history of MRSA, past hospitalization, use of antibiotics, and presence of wounds were collected. Screening of the nares, throat, and wounds was done. Results: Five hundred and fourteen swab specimens were obtained; 497 of them were nose/throat samples and 17 were wound swabs. MRSA was identified in 5 samples (1%). Four MRSA were found in nose/throat samples and 1 in a wound swab. Pulsed-field gel electrophoresis typing of the MRSA isolates revealed 2 different common endemic types: 4 were identified as the Zurich IDU clone and 1 as the Grison clone. Conclusions: The study shows a significant decline of MRSA colonization among IDUs. The underlying causes for this decline could not be determined fully, but we hypothesize a bundle of interventions as contributing: enhanced medical care, better wound management, isolation management, teaching IDUs basic hygiene techniques, and the national 'Four Pillars' policy. Hospital epidemiological policies such as pre-emptive isolation, length of isolation time, and screening procedures were adapted accordingly.

Antibiotic-resistant pathogens in different patient settings and identification of surveillance gaps in Switzerland – a systematic review

“…Several studies have looked at MRSA prevalence among IVDU. Whereas prevalence was as high as 10% around the year 2000 [46], the number dropped to 5.4% in 2005 and to 1% in 2008/2009 [47, 48].…”

“…One study which screened asylum seekers presenting at a tertiary care hospital (2014/2015) showed an MRSA-prevalence of 21%, whereas ESBL-and CPE-prevalence was 9% and 0%, respectively [16]. Another cross-sectional study (2015) performed [47,48].…”

Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017

“…Currently we are not aware of any specific guidance in Europe or worldwide for the management of MRSA in PWID. Previous outbreaks have targeted enhanced wound care and basic hand hygiene interventions alongside improved access to healthcare; although the effectiveness of these measures remains untested [39]. Ideally, any intervention should be aimed towards targeting not only MRSA but bacterial infections in general.…”

“…The results of this study have been used to improve the post-infection review process and develop a pilot with planned evaluation for universal supply for of Chlorhexidine wipes to PWID through NSP. The findings from this study provide information to help inform the development of targeted interventions such as community-based screening, health promotion messaging, wound care, skin cleaning advice and suppression therapy with personal and environmental decontamination (washing clothes and bedding) [39,51].…”

The evolution and epidemiology of Listeria monocytogenes in Europe and the United States

“…Such highly adaptive ECs have been described for numerous bacterial pathogens (Arduino et al, 2012;Colombo et al, 2012;Deplano et al, 2005;Diep et al, 2008;Monecke et al, 2011;Morelli et al, 1997). An EC of L. monocytogenes has been defined as groups of isolates that are genetically related and presumably of a common ancestor, but are implicated in different, geographically and temporally unrelated outbreaks (Cheng et al, 2008;Kathariou, 2002).…”