Methicillin-Resistant<i>Staphylococcus aureus</i>Disease in Three Communities

Fridkin, Scott K.; Hageman, Jeffrey; Morrison, Melissa; Sanza, Laurie Thomson; Como‐Sabetti, Kathryn; Jernigan, John A.; Harriman, Kathleen; Harrison, Lee H.; Lynfield, Ruth; Farley, Monica M.

doi:10.1056/nejmoa043252

Cited by 1,367 publications

(933 citation statements)

References 33 publications

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“…Our intervention was in response to steadily increasing nosocomial infection rates over the previous few years and our rates may have increased more dramatically without this intervention. This increase is also consistent with national trends toward greater numbers of MRSA and VRE infections -including the recent emergence of a new strain of community-acquired MRSA [18].…”

Section: Discussionsupporting

confidence: 77%

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Kho¹,

Dexter²,

Warvel³

et al. 2008

International Journal of Medical Informatics

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Purpose-To improve contact isolation rates among patients admitted to the hospital with a known history of infection with Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycinresistant Enterococci (VRE).Methods-A before and after interventional study implementing computerized reminders for contact isolation between February 25th of 2005 and February 28th of 2006. We measured rates of appropriate contact isolation, and time to isolation for the four month pre-intervention period, and the 12 month intervention period. We conducted a survey of ordering physicians at the midpoint of the intervention period.Results-Implementing a computerized reminder increased the rate of patients appropriately isolated from 33% to fully 89% (P < 0.0001). The median time to writing contact isolation orders decreased from 16.6 hours to 0.0 hours (P < 0.0001). Physicians accepted the order 80% of the time on the first or second presentation. 95% of physicians felt the reminder had no impact on workflow, or saved them time.Conclusion-A human reviewed computerized reminder can achieve high rates of compliance with infection control recommendations for contact isolation, and dramatically reduce the time to orders being written upon admission.

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Section: Discussionsupporting

confidence: 77%

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Kho¹,

Dexter²,

Warvel³

et al. 2008

International Journal of Medical Informatics

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“…Antimicrobial-resistant pathogens, especially methicillin-resistant S. aureus (MRSA), are increasingly isolated in nosocomial infections [17][18][19][20]. Several recent reports identified MRSA as the leading pathogen in SSTIs [21][22][23][24]; it also causes 20% to 50% of diabetes-associated foot infections in several countries and is associated with worse outcomes than other pathogens [23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

Tabak²,

et al. 2010

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Aims/hypothesis Skin and soft tissue infections (SSTIs) cause substantial morbidity in persons with diabetes. There are few data on pathogens or risk factors associated with important outcomes in diabetic patients hospitalised with SSTIs. Methods Using a clinical research database from CareFusion, we identified 3,030 hospitalised diabetic patients with positive culture isolates and a diagnosis of SSTI in 97 US hospitals between 2003 and 2007. We classified the culture isolates and analysed their association with the anatomic location of infection, mortality, length of stay and hospital costs. Results The only culture isolate with a significantly increased prevalence was methicillin-resistant Staphylococcus aureus (MRSA); prevalence for infection of the foot was increased from 11.6 to 21.9% (p<0.0001) and for non-foot locations from 14.0% to 24.6% (p=0.006). Patients with non-foot (vs foot) infections were more severely ill at presentation and had higher mortality rates (2.2% vs 1.0%, p<0.05). Significant independent risk factors associated with higher mortality rates included having a polymicrobial culture with Pseudomonas aeruginosa (OR 3

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“…While CA-MRSA can cause severe invasive infections, it predominantly causes SSTAs in young, otherwise healthy individuals. 2,3 Between 1997 and 2005, outpatient visits in the United States for skin and soft tissue infections rose by 50% and more than doubled at emergency departments (EDs). 4 In 2008, CA-MRSA accounted for 59% of all culturable skin and soft tissue infections in the U.S. EDs, 85% of which were abscesses.…”

Section: Introductionmentioning

confidence: 99%

“…2,3,[7][8] Although most RCTs demonstrate no benefit, a few show a trend toward benefit, 7,11 and some authors have argued that these studies were underpowered to show a benefit that likely exists. 9 A 2007 systematic review and 2013 meta-analysis found no benefit from adjunctive antibiotics.…”

Section: Introductionmentioning

confidence: 99%

The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis

Fahimi

Singh

Frazee

2015

CJEM

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Objective: To perform a review and meta-analysis on the effect of antibiotics on treatment of skin and soft tissue abscesses (SSTAs) after incision and drainage. Methods: We searched MEDLINE, EMBASE, Web of Knowledge, and Google Scholar databases to identify randomized controlled trials (RCTs) and observational studies. For RCTs, we included studies comparing any antibiotic (treatment) to placebo (control). For observational studies, treatment was the use of appropriate antibiotics effective against bacterial isolate, and control was the use of inappropriate (ineffective) or no antibiotics. Outcome was treatment success during follow-up. Two investigators reviewed records, assessed quality (according to Cochrane and NewcastleOttawa tools), and extracted treatment success rates. Primary analysis was the effect of treatment among RCTs. Secondary analyses included the effect of treatment in 1) observational studies of confirmed methicillin-resistant Staphylococcus aureus (MRSA) infection (MRSA-only) and 2) all studies after 1998 (MRSA-era). We used random effects modelling, except when no heterogeneity was present when we used fixed effects. Results: We screened 1,968 records. Twelve were included (five RCTs, seven observational studies), representing 1,969 subjects. Seven enrolled from emergency departments, two from surgical clinics, and three from ambulatory clinics. Le résultat recherché était la réussite du traitement pendant le suivi. Deux chercheurs ont passé en revue les documents relevés, évalué la qualité (selon les outils Cochrane et Newcastle-Ottawa) et dégagé les taux de réussite des traitements. L'analyse principale avait pour objet l'effet du traitement dans les ECRA; les analyses secondaires portaient sur l'effet du traitement dans: 1) les études d'observation de cas d'infection avérée à Staphylococcus aureus résistant à la méthicilline (SARM seul); 2) toutes les études menées après 1998 (époque des infections à SARM). Les auteurs ont eu recours au modèle à effets aléatoires, sauf dans les cas où le modèle à effets fixes ne décelait aucune hétérogénéité. Résultats: Ont été relevés 1968 documents; 12 recherches (5 ECRA, 7 études d'observation) totalisant 1969 sujets ont été retenues. Dans 7 recherches, les patients provenaient de services d'urgence; dans 2 recherches, de centres ou de services de chirurgie; et dans 3 recherches, de services de soins ambulatoires. Trois recherches ne portaient que sur les enfants. Le risque relatif (RR) global de la réussite du traitement dans les ECRA était de 1,03 (CI à 95 %: 0,97 − 1,08), et celui dans les analyses secondaires, de 1,05 (CI à 95 %: 0,96 − 1,15) dans les cas de SARM seul, et de 0,99 (CI à 95 %: 0,98 − 1,01) dans les cas traités durant l'époque des infections à SARM. Conclusion: Malgré les faiblesses de la réunion des données existantes, rien n'étaye l'emploi des antibiotiques dans le traitement des APTM sans complications.

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Methicillin-ResistantStaphylococcus aureusDisease in Three Communities

Abstract: Community-associated MRSA infections are now a common and serious problem. These infections usually involve the skin, especially among children, and hospitalization is common.

Cited by 1,367 publications

References 33 publications

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

An effective computerized reminder for contact isolation of patients colonized or infected with resistant organisms

Skin and soft tissue infections in hospitalised patients with diabetes: culture isolates and risk factors associated with mortality, length of stay and cost

The role of adjunctive antibiotics in the treatment of skin and soft tissue abscesses: a systematic review and meta-analysis

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