Veterans Affairs Initiative to Prevent Methicillin-Resistant<i>Staphylococcus aureus</i>Infections

Jain, Rajiv; Kralovic, Stephen M.; Evans, Martin E.; Ambrose, Meredith; Simbartl, Loretta A.; Obrosky, D. Scott; Render, Marta L.; Freyberg, Ron; Jernigan, John A.; Muder, Robert R.; Miller, LaToya J.; Roselle, Gary A.

doi:10.1056/nejmoa1007474

Cited by 455 publications

(371 citation statements)

References 32 publications

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“…[1][2][3] The admission prevalence of MRSA carriage in settings with endemic MRSA can vary substantially and is reported to range from 3% to 15%. [4][5][6][7] Patients who acquire MRSA incur significant risks of subsequent infection. [8][9][10] Importantly, MRSA carriage is associated with a fourfold increased infection risk compared with MSSA colonization.…”

Section: Does Colonization With Methicillin-susceptiblementioning

confidence: 99%

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Landelle

Iten

Uçkay

et al. 2014

Infect. Control Hosp. Epidemiol.

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OBJECTIVE: To test the hypothesis that methicillin-susceptible Staphylococcus aureus (MSSA) carriage may protect against nosocomial methicillin-resistant S. aureus (MRSA) acquisition by competing for colonization of the anterior nares. DESIGN: Prospective cohort and nested case-control study. SETTING: Swiss university hospital. PATIENTS: All adult patients admitted to 14 wards of the general medicine division between April 1 and October 31, 2007. METHODS: Patients were screened for MRSA and MSSA carriage at admission to and discharge from the division. Associations between nosocomial MRSA acquisition and MSSA colonization at admission and other confounders were analyzed by univariable and multivariable analysis. RESULTS: Of 898 patients included, 183 (20%) were treated with antibiotics. Nosocomial MRSA acquisition occurred in 70 (8%) of the patients (case patients); 828 (92%) of the patients (control subjects) were free of MRSA colonization at discharge. MSSA carriage at admission was 20% and 21% for case patients and control subjects, respectively. After adjustment by multivariate logistic regression, no association was observed between MSSA colonization at admission and nosocomial MRSA acquisition (adjusted odds ratio [aOR], 1.2 [95% confidence interval (CI), 0.6-2.3]). By contrast, 4 independent predictors of nosocomial MRSA acquisition were identified: older age (aOR per 1-year increment, 1.05 [95% CI, 1.02-1.08]); increased length of stay (aOR per 1-day increment, 1.05 [95% CI, 1.02-1.09]); increased nursing workload index (aOR per 1-point increment, 1.02 [95% CI, 1.01-1.04]); and previous treatment with macrolides (aOR, 5.6 [95% CI, JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

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Section: Does Colonization With Methicillin-susceptiblementioning

confidence: 99%

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Landelle

Iten

Uçkay

et al. 2014

Infect. Control Hosp. Epidemiol.

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“…intensive care unit (ICU) patients and a 45% reduction in non-ICU patients (40). Other hospitals and institutions have taken a more targeted approach and screen certain high-risk ICU patients, employing a slightly different protocol (41).…”

Section: Discussionmentioning

confidence: 99%

Detection of Methicillin-Resistant Staphylococcus aureus by a Duplex Droplet Digital PCR Assay

et al. 2013

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bHealth care-associated infections with methicillin-resistant Staphylococcus aureus (MRSA) contribute to significant hospitalization costs. We report here a droplet digital PCR (ddPCR) assay, which is a next-generation emulsion-based endpoint PCR assay for high-precision MRSA analysis. Reference cultures of MRSA, methicillin-susceptible S. aureus (MSSA), and confounders were included as controls. Copan swabs were used to sample cultures and collect specimens for analysis from patients at a large teaching hospital. Swab extraction and cell lysis were accomplished using magnetic-driven agitation of silica beads. Quantitative PCR (qPCR) (Roche Light Cycler 480) and ddPCR (Bio-Rad QX100 droplet digital PCR system) assays were used to detect genes for the staphylococcal protein SA0140 (SA) and the methicillin resistance (mecA) gene employing standard TaqMan

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“…[77][78][79][80][81][82] ii. Not all studies, however, have come to the same conclusion, 83,84 including the single cluster-randomized trial of targeted MRSA active surveillance where active surveillance and use of barrier precautions in ICU patients was not associated with a reduction in MRSA colonization or infection, although limitations in the study design and suboptimal use of barrier precautions prevent definitive conclusions from being drawn.…”

Section: Section 2: Background-strategies To Detect Mrsamentioning

confidence: 99%

Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update

Calfee

Salgado

Milstone

et al. 2014

Infect. Control Hosp. Epidemiol.

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistant Staphylococcus aureus (MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.

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Veterans Affairs Initiative to Prevent Methicillin-ResistantStaphylococcus aureusInfections

Abstract: A program of universal surveillance, contact precautions, hand hygiene, and institutional culture change was associated with a decrease in health care-associated transmissions of and infections with MRSA in a large health care system.

Cited by 455 publications

References 32 publications

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Detection of Methicillin-Resistant Staphylococcus aureus by a Duplex Droplet Digital PCR Assay

Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update

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