Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients

Issler‐Fisher, Andrea C.; McKew, Genevieve; Fisher, Oliver M.; Harish, Varun; Gottlieb, Thomas; Maitz, Peter

doi:10.1016/j.burns.2015.03.003

Cited by 32 publications

(17 citation statements)

References 43 publications

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“…Similar to previous studies, we found that compared to patients with HA-MSSA infections, a higher proportion of patients with HA-MRSA had longer hospital stays and higher mortality rates [ 14 , 15 ]. These results suggest that MRSA could be pre-disposing patient to poor outcomes, although this is difficult to ascertain due to other co-morbidities and differences in treatment practices.…”

Section: Discussionsupporting

confidence: 89%

Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals

et al. 2017

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IntroductionHospital-associated methicillin-resistant S. aureus (HA-MRSA) remains a significant cause of morbidity and mortality worldwide. We conducted a study to determine risk factors for HA-MRSA in order to inform control strategies in South Africa.MethodsWe used surveillance data collected from five tertiary hospitals in Gauteng and Western Cape provinces during 2014 for analysis. A case of HA-MRSA was defined as isolation of MRSA from a blood culture 48 hours after admission and/or if the patient was hospitalised in the six months prior to the current culture. Multivariable logistic regression modelling was used to determine risk factors for HA-MRSA.ResultsOf the 9971 patients with positive blood cultures, 7.7% (772) had S. aureus bacteraemia (SAB). The overall prevalence of MRSA among those with SAB was 30.9% (231/747; 95% confidence interval [CI] 27.6%– 34.3%). HA-MRSA infections accounted for 28.3% of patients with SAB (207/731; 95% CI 25.1%– 31.7%). Burns (adjusted odds ratio [aOR] 12.7; 95% CI 4.7–34.4), age ≤1 month (aOR 8.7; 95% CI 3.0–24.6), residency at a long-term care facility (aOR 5.2; 95% CI, 1.5–17.4), antibiotic use within two months of the current SAB episode (aOR 5.1; 95% CI 2.8–9.1), hospital stay of 13 days or more (aOR 2.8; 95% CI 1.3–5.6) and mechanical ventilation (aOR 2.2; 95% CI 1.07–4.6), were independent risk factors for HA-MRSA infection.ConclusionThe prevalence of MRSA remains high in South African tertiary public hospitals. Several identified risk factors of HA-MRSA infections should be considered when instituting infection and prevention strategies in public-sector hospitals, including intensifying the implementation of antimicrobial stewardship programmes. There is an urgent need to strengthen infection prevention and control in burn wards, neonatal wards, and intensive care units which house mechanically ventilated patients.

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Section: Discussionsupporting

confidence: 89%

Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals

et al. 2017

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“…Susceptibilities to chlorhexidine were similar in 2015 (MIC = 4, 82.9%; MIC = 2, 16.5%; MIC = 1, 0.6%) and 2016 (MIC = 4, 86.4%; MIC = 2, 13.1%; MIC = 1, 0.6%), whilst susceptibilities to octenidine differed slightly between 2015 (MIC = 2, 7.7%; MIC = 1, 92.3%) and 2016 (MIC = 2, 13.1%; MIC = 1, 86.4%; MIC = 0.5, 0.6%). Our observations that gender, prior antibiotics exposure and duration of hospitalisation stay increased the risk of MRSA colonisation were consistent with the findings reported in other studies [12][13][14][15][16].…”

Section: Discussionsupporting

confidence: 93%

Intranasal octenidine and universal antiseptic bathing reduce methicillin-resistant Staphylococcus aureus (MRSA) prevalence in extended care facilities

et al. 2018

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Intranasal octenidine, an antiseptic alternative to mupirocin, can be used for methicillin-resistant Staphylococcus aureus (MRSA) decolonisation in the prevention of nosocomial transmission. A controlled before-after study was conducted in three extended-care hospitals in Singapore. All inpatients with >48 h stay were screened for MRSA colonisation in mid-2015(pre-intervention) and mid-2016(post-intervention). Hospital A: universal daily chlorhexidine bathing throughout 2015 and 2016, with intranasal octenidine for MRSA-colonisers in 2016. Hospital B: universal daily octenidine bathing and intranasal octenidine for MRSA-colonisers in 2016. Hospital C: no intervention. In 2015, MRSA prevalence was similar among the hospitals (Hospital A: 38.5%, Hospital B: 48.1%, Hospital C: 43.4%, P = 0.288). From 2015 to 2016, MRSA prevalence reduced by 58% in Hospital A (Adj OR 0.42, 95% CI 0.20-0.89) and 43% in Hospital B (Adj OR 0.57, 95% CI 0.39-0.84), but remained similar in Hospital C (Adj OR 1.19, 95% CI 0.60-2.33), after adjusting for age, gender, comorbidities, prior MRSA carriage, prior antibiotics exposure and length of hospital stay. Compared with the change in MRSA prevalence from 2015 to 2016 in Hospital C, MRSA prevalence declined substantially in Hospital A (Adj OR 0.35, 95% CI 0.13-0.97) and Hospital B (Adj OR 0.48, 95% CI 0.22-1.03). Topical intranasal octenidine, coupled with universal daily antiseptic bathing, can reduce MRSA colonisation in extended-care facilities.

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“…Other studies have also found that burn size, inhalational injury, and cardiac disease were associated with increased risk of infection. 3,15–17 However, these previous analyses have been in specific populations (eg, older adults) or only looked at specific infection sites and pathogens. To our knowledge, this is the first study to conduct a comprehensive analysis of risk factors for HAIs, irrespective of site and pathogen, among all adults.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

Strassle

Williams

Weber

et al. 2017

Infect. Control Hosp. Epidemiol.

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Objective Burn patients are particularly vulnerable to infection, and an estimated half of all burn deaths are due to infections. This study explored risk factors for healthcare-associated infections (HAIs) in adult burn patients. Design Retrospective cohort study. Setting Tertiary-care burn center. Patients Adults (≥18 years old) admitted with burn injury for at least 2 days between 2004 and 2013. Methods HAIs were determined in real-time by infection preventionists using Centers for Disease Control and Prevention criteria. Multivariable Cox proportional hazards regression was used to estimate the direct effect of each risk factor on time to HAI, with inverse probability of censor weights to address potentially informative censoring. Effect measure modification by burn size was also assessed. Results Overall, 4,426 patients met inclusion criteria, and 349 (7.9%) patients had at least 1 HAI within 60 days of admission. Compared to <5% total body surface area (TBSA), patients with 5%–10% TBSA were almost 3 times as likely to acquire an HAI (hazard ratio [HR], 2.92; 95% CI, 1.63–5.23); patients with 10%–20% TBSA were >6 times as likely to acquire an HAI (HR, 6.38; 95% CI, 3.64–11.17); and patients with >20% TBSA were >10 times as likely to acquire an HAI (HR, 10.33; 95% CI, 5.74–18.60). Patients with inhalational injury were 1.5 times as likely to acquire an HAI (HR, 1.61; 95% CI, 1.17–2.22). The effect of inhalational injury (P = .09) appeared to be larger among patients with ≤20% TBSA. Conclusions Larger burns and inhalational injury were associated with increased incidence of HAIs. Future research should use these risk factors to identify potential interventions.

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Risk factors for, and the effect of MRSA colonization on the clinical outcomes of severely burnt patients

Cited by 32 publications

References 43 publications

Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals

Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals

Intranasal octenidine and universal antiseptic bathing reduce methicillin-resistant Staphylococcus aureus (MRSA) prevalence in extended care facilities

Risk Factors for Healthcare-Associated Infections in Adult Burn Patients

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