Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus

Cox, R.A.; Conquest, C.

doi:10.1016/s0195-6701(97)90100-6

Cited by 60 publications

(33 citation statements)

References 25 publications

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“…In many instances hospital outbreaks have proved both expensive (in associated costs) and di¤cult to eradicate, requiring careful surveillance and e¡ective infection control measures (Cookson 1995;Boyce et al 1995;Cox & Conquest 1997). Each case of MRSA in England and Wales was estimated to carry an additional cost of »2500 in increased patient stay and additional antimicrobial treatment (Mehtar 1995).…”

Section: Epidemic Spread Of Hospital Outbreaks Of Mrsa and Vre (A) Trmentioning

confidence: 99%

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Austin

Anderson

1999

Phil. Trans. R. Soc. Lond. B

172

127

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The emergence of antibiotic resistance in a wide variety of important pathogens of humans presents a worldwide threat to public health. This paper describes recent work on the use of mathematical models of the emergence and spread of resistance bacteria, on scales ranging from within the patient, in hospitals and within communities of people. Model development starts within the treated patient, and pharmacokinetic and pharmacodynamic principles are melded within a framework that mirrors the interaction between bacterial population growth, drug treatment and the immunological responses targeted at the pathogen. The model helps identify areas in which more precise information is needed, particularly in the context of how drugs in£uence pathogen birth and death rates (pharmacodynamics). The next area addressed is the spread of multiply drug-resistant bacteria in hospital settings. Models of the transmission dynamics of the pathogen provide a framework for assessing the relative merits of di¡erent forms of intervention, and provide criteria for control or eradication. The model is applied to the spread of vancomycin-resistant enterococci in an intensive care setting. This model framework is generalized to consider the spread of resistant organisms between hospitals. The model framework allows for heterogeneity in hospital size and highlights the importance of large hospitals in the maintenance of resistant organisms within a de¢ned country. The spread of methicillin resistant Staphylococcus aureus (MRSA) in England and Wales provides a template for model construction and analysis. The ¢nal section addresses the emergence and spread of resistant organisms in communities of people and the dependence on the intensity of selection as measured by the volume or rate of drug use. Model output is ¢tted to data for Finland and Iceland and conclusions drawn concerning the key factors determining the rate of spread and decay once drug pressure is relaxed.

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Section: Epidemic Spread Of Hospital Outbreaks Of Mrsa and Vre (A) Trmentioning

confidence: 99%

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Austin

Anderson

1999

Phil. Trans. R. Soc. Lond. B

172

127

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“…Also, given the poor yield of the endemic strain from repeated nose\hand staff sampling exercises, it is unlikely that extended screening would have yielded many further positive individuals. Elsewhere, the yield of clinically significant MRSA isolates from staff specimens is often extremely low [34,35].…”

Section: Discussionmentioning

confidence: 99%

“…Isolates had very similar antimicrobial resistance profiles and 95 % (38\40, with indistinguishable PFGE profile) were resistant to 4 compounds. Only resistance to penicillin (36 strains), ethidium bromide (34), and acriflavine (34) was common. Three strains (with the common PFGE profile) were resistant to triclosan ; these were isolated before and after institution of triclosan hand washing.…”

Section: Pfge Plasmid Analysis Antibiotic Resistance Profilesmentioning

confidence: 99%

A five year outbreak of methicillin-susceptible Staphylococcus aureus phage type 53,85 in a regional neonatal unit

et al. 2000

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Article ReuseUnless indicated otherwise, fulltext items are protected by copyright with all rights reserved. The copyright exception in section 29 of the Copyright, Designs and Patents Act 1988 allows the making of a single copy solely for the purpose of non-commercial research or private study within the limits of fair dealing. The publisher or other rights-holder may allow further reproduction and re-use of this version -refer to the White Rose Research Online record for this item. Where records identify the publisher as the copyright holder, users can verify any specific terms of use on the publisher's website. TakedownIf you consider content in White Rose Research Online to be in breach of UK law, please notify us by emailing eprints@whiterose.ac.uk including the URL of the record and the reason for the withdrawal request. SUMMARYWe identified a 5-year outbreak of a methicillin-susceptible Staphylococcus aureus (MSSA) strain, affecting 202 babies on a neonatal unit, by routine weekly phage typing all S. aureus isolates. Multiple staged control measures including strict emphasis on hand hygiene, environmental and staff surveillance sampling, and application of topical hexachlorophane powder failed to end the outbreak. S. aureus PT 53,85 (SA5385) was found on opened packs of Stomahesive2, used as a neonatal skin protectant. Only following the implementation of aseptic handling of Stomahesive, and the use of topical mupirocin for staff nasal carriers of SA5385, and for babies colonized or infected with S. aureus, did the isolation rate of SA5385 decline. DNA fingerprinting indicated that 95 % of SA5385 isolates were clonal. In itro death rates of SA5385 on Stomahesive with human serum were significantly lower than on Stomahesive alone (P l 0n04), and on cotton sheet with serum (P l 0n04), highlighting the potential of this material as a survival niche. Phage typing remains a valuable, inexpensive and simple method for monitoring nosocomial MSSA infection.

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“…The prevalence of MRSA colonization among HCWs varies between less than 1% to 8% in different outbreaks [37][38][39][40]. Although infected and colonized patients represent the most important reservoir of MRSA in hospitals, colonized HCWs may also be a significant contributor [37].…”

Section: Methicillin-resistant Staphylococcus Aureus Carriage Among Hmentioning

confidence: 99%

“…Although infected and colonized patients represent the most important reservoir of MRSA in hospitals, colonized HCWs may also be a significant contributor [37]. Transmission of the organism between patients is thought to result from the transient hand carriage of HCWs, and several studies have implicated colonized HCWs in the transmission of MRSA among patients [37][38][39][40].…”

Section: Methicillin-resistant Staphylococcus Aureus Carriage Among Hmentioning

confidence: 99%

Staphylococcus aureus carriage and health care-acquired infection

Chiang

Climo

2002

Curr Infect Dis Rep

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Staphylococcus aureus is one of the most common nosocomial pathogens. Its propensity to establish prolonged carriage among hospitalized patients and increasing resistance to antibiotics makes control of this organism within the hospital difficult. High-level vancomycin resistance has now been reported in a single clinical isolate of S. aureus, emphasizing the need to increase efforts to control nosocomial spread. Knowledge of the epidemiology of S. aureus colonization among patients has shed new light on the potential difficulties in interrupting nosocomial transmission. Effective control of S. aureus within the hospital and community will require more aggressive measures that include earlier diagnosis of colonized patients, better handwashing and barrier precaution measures, and renewed efforts to eradicate the carriage state.

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Strategies for the management of healthcare staff colonized with epidemic methicillin-resistant Staphylococcus aureus

Cited by 60 publications

References 25 publications

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

Studies of antibiotic resistance within the patient, hospitals and the community using simple mathematical models

A five year outbreak of methicillin-susceptible Staphylococcus aureus phage type 53,85 in a regional neonatal unit

Staphylococcus aureus carriage and health care-acquired infection

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