MRSA (Mersa, Staph) Questions

Care home residents - simple strategies to avoid MRSA infection

Link: HighWire Press -- Medline Abstract.

Infections caused by methicillin-resistant Staphylococcus aureus (MRSA) are a growing concern in long-term care facilities (LTCF). Epidemiologic studies performed in our area have shown high rates of MRSA colonization in elderly residents, and very high rates in some centres. However, the clinical impact of nasal MRSA colonization is often slight. Prevention of MRSA transmission in LTCF includes the application of simple preventive measures with proven effectiveness, such as hand washing, adequately covering of infected wounds, and proper use of antibiotics, without limiting the activities of colonized residents or carrying out active surveillance.

Poor care raises MRSA risk at nursing home

Link: Nurse cites issues at mental health facility- al.com.

The former head nurse of a group home for mentally ill residents who have medical problems said her complaints about management there culminated Wednesday when she was fired in a clash over a resident with an apparently severe staph infection. Registered nurse Teresa West said she was hired two months ago as nursing coordinator to help organize and improve medical care at Azalea Manor on U.S. 31 south. The facility operated by the Baldwin County Board of Mental Health opened in February to bring together residents from other group homes who have health conditions that need monitoring and treatment, she said. On Wednesday, West contacted the Press-Register because she said she was concerned about the safety of residents. She said she believes the facility needs to be evacuated, inspected and cleaned up.

Care home residents with low mobility more MRSA infection prone

Link: HighWire Press -- Medline Abstract.

Objective. @nbsp; To identify risk factors for surgical site infection (SSI) due to methicillin-resistant Staphylococcus aureus (MRSA). Design. @nbsp; Prospective case-control study. Setting. @nbsp; One tertiary and 6 community-based institutions in the southeastern United States. Methods. @nbsp; We compared patients with SSI due to MRSA with 2 control groups: matched uninfected surgical patients and patients with SSI due to methicillin-susceptible S. aureus (MSSA). Multivariable logistic regression was used to determine variables independently associated with SSI due to MRSA, compared with each control group. Results. @nbsp; During the 5-year study period, 150 case patients with SSI due to MRSA were identified and compared with 231 matched uninfected control patients and 128 control patients with SSI due to MSSA. Two variables were independently associated with SSI due to MRSA in both multivariable regression models: need for assistance with 3 or more activities of daily living (odds ratio [OR] compared with uninfected patients, 3.97 [95% confidence interval {CI}, 2.18-7.25]; OR compared with patients with SSI due to MSSA, 3.88 [95% CI, 1.91-7.87]) and prolonged duration of surgery (OR compared with uninfected patients, 1.98 [95% CI, 1.11-3.55]; OR compared with patients with SSI due to MSSA, 2.33 [95% CI, 1.17-4.62]). Lack of independence (ie, poor functional status) remained associated with an increased risk of SSI due to MRSA after stratifying by age. Conclusions. @nbsp; Poor functional status was highly associated with SSI due to MRSA in adult surgical patients, regardless of age. A patient's level of independence can be easily determined, and this information can be used preoperatively to target preventive interventions.

Influenza-like illness complicated by MRSA in Care Home Patients

Link: Influenza-like illness in residential care homes: a study of the incidence, aetiological agents, natural history and health resource utilisation -- Hui et al. 63 (8): 690 -- Thorax.

Results: 259 episodes of ILI occurred in 194 subjects, with mild peaks in winter and summer, over a sustained level throughout the year. The infectious agent was identified in 61.4% of all episodes, comprising bacterial infection in 53.3% and viral in 46.7%. Multiple infections occurred in 16.2% of subjects. The most frequent organism was Streptococcus pneumoniae, followed by respiratory syncytial virus, Pseudomonas aeruginosa, metapneumovirus and parainfluenza virus types 1 and 3. Clinical features did not vary according to the underlying aetiology, the common presenting features being a decrease in general condition, cognitive and functional deterioration, and withholding of food in addition to fever and respiratory symptoms. Overall, mortality at 1 month/discharge was 9.7%. Infection with methicillin-resistant Staphylococcus aureus, low body mass index and poor function predisposed to mortality. No association was observed between influenza vaccination status and underlying aetiology, clinical features or outcome. Conclusions: The clinical presentation of ILI is non-specific and is mainly due to bacterial and viral infections other than influenza in the RCHE population.

Superbug inquest - coroner demands changes

Link: Superbug inquest - coroner demands change - News - Stockport Express.

STOCKPORT’S coroner has demanded more rigorous checks from doctors responsible for nursing home residents, after an 87-year-old woman contracted MRSA and died. John Pollard’s call came at the inquest of Eva Duckworth where he heard evidence that the Edgeley grandmother had a 16cm bedsore on her lower back when she was admitted to hospital from a Stockport care home. The sore became infected with MRSA which ultimately led to her death. However her back had not been examined by the home’s doctor, as he said he had not been alerted to any skin problems. Mr Pollard, who concluded Mrs Duckworth died of natural causes, is now writing to the home and to GP Dr John Swarbrick, demanding full body checks should become routine, normal practice for all nursing home residents.

MRSA is Epidemic in Care Homes

Link: HighWire Press -- Medline Abstract.

OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug-resistant gram-negative bacteria (MDRGN) in the long-term care (LTC) setting. DESIGN: Cross-sectional. SETTING: Four nursing units in a 648-bed LTC facility in Boston, Massachusetts. PARTICIPANTS: Eighty-four long-term care residents. MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization. RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2-7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1-28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person-to-person transmission. CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.

X Ray facility an MRSA issue?

Link: Methicillin-resistant Staphylococcus aureus carriage in a long-term care facility: hypothesis about selection and transmission -- Eveillard et al. 37 (3): 294 -- Age and Ageing.

Background: many studies have identified long-term care facilities (LTCFs) as reservoirs of patients carrying methicillin-resistant Staphylococcus aureus (MRSA). However, few data about the mechanisms of MRSA diffusion in these settings are available. Objectives: the purpose of our study was to suggest hypothesis on the possible ways of MRSA transmission to residents in or outside a LTCF. Methods: data concerning patients on the day of the survey and within the preceding year were collected. Multivariate analysis was performed by logistic regression to identify characteristics associated with MRSA carriage. MRSA strains were analysed by pulsed-field gel electrophoresis (PFGE) and the relatedness between DNA patterns was studied with Gel Compar software. Results: the prevalence of MRSA carriage was 37.6%. Treatment with fluoroquinolones or third-generation cephalosporins [odds ratio (OR) = 12.07; 95% confidence interval (CI) = 5.90–24.7], treatment with other antimicrobial agents (OR = 4.40; 95% CI = 2.43–7.97), at least one medical imaging session (OR = 5.08; 95% CI = 2.66–9.69) within the 12 preceding months, and the presence of a subcutaneous catheter on the day of the survey (OR = 3.09; 95% CI = 1.87–5.10) were independently associated with MRSA carriage. Twenty-eight of the 38 strains tested were clustered in two major groups. In each of these groups, strains had at least a 90% relatedness. These strains were isolated in patients hospitalised in different areas of the LTCF. Conclusion: we identified that both molecular and epidemiological arguments support the hypothesis of the possibility of MRSA cross-transmission inside the LTCF. Further studies are needed to confirm and explain the association identified between MRSA carriage and medical imaging.

Nursing Homes are MRSA 'Supersites'

Link: Chicago Journals - Clinical Infectious Diseases.

Background.  We sought to characterize the clinical and molecular epidemiologic characteristics of Staphylococcus aureus colonization (especially extranasal colonization) and to determine the extent to which community-associated methicillin-resistant S. aureus (MRSA) has emerged in community nursing homes. Methods.  The study enrolled a total of 213 residents, with or without an indwelling device, from 14 nursing homes in southeastern Michigan. Samples were obtained from the nares, oropharynx, groin, perianal area, wounds, and enteral feeding tube site. Standard microbiologic methods were used to identify methicillin-susceptible S. aureus and MRSA. Molecular epidemiologic methods included pulsed-field gel electrophoresis, PCR detection of Panton-Valentine leukocidin, and SCCmec and agr typing. Results.  One hundred thirty-one residents (62%) were colonized with S. aureus (MRSA colonization in 86). S. aureus colonization occurred in 80 (76%) of 105 residents with indwelling devices and in 51 (47%) of 108 residents without indwelling devices ( ). Of the 86 residents who were colonized with MRSA, nares culture results were positive for only 56 (65%). Residents with devices in place were more likely to be colonized at multiple sites. Eleven different strains of MRSA were identified by pulsed-field gel electrophoresis. Seventy-three residents (85%) were colonized with hospital-associated SCCmec II strains, and 8 (9%) were colonized with community-associated SCCmec IV strains, 2 of which carried Panton-Valentine leukocidin. Conclusions.  Extranasal colonization with MRSA is common among nursing home residents—particularly among residents with an indwelling device. We documented the emergence of community-associated SCCmec IV MRSA strains in the community nursing home setting in southeastern Michigan.

1 in 3 in Nursing Homes MRSA Carriers

Link: Methicillin-resistant Staphylococcus aureus carriage in a long-term care facility: hypothesis about selection and transmission -- Eveillard et al., 10.1093/ageing/afn021 -- Age and Ageing.

Background: many studies have identified long-term care facilities (LTCFs) as reservoirs of patients carrying methicillin-resistant Staphylococcus aureus (MRSA). However, few data about the mechanisms of MRSA diffusion in these settings are available. Objectives: the purpose of our study was to suggest hypothesis on the possible ways of MRSA transmission to residents in or outside a LTCF. Methods: data concerning patients on the day of the survey and within the preceding year were collected. Multivariate analysis was performed by logistic regression to identify characteristics associated with MRSA carriage. MRSA strains were analysed by pulsed-field gel electrophoresis (PFGE) and the relatedness between DNA patterns was studied with Gel Compar software. Results: the prevalence of MRSA carriage was 37.6%. Treatment with fluoroquinolones or third-generation cephalosporins [odds ratio (OR) = 12.07; 95% confidence interval (CI) = 5.90–24.7], treatment with other antimicrobial agents (OR = 4.40; 95% CI = 2.43–7.97), at least one medical imaging session (OR = 5.08; 95% CI = 2.66–9.69) within the 12 preceding months, and the presence of a subcutaneous catheter on the day of the survey (OR = 3.09; 95% CI = 1.87–5.10) were independently associated with MRSA carriage. Twenty-eight of the 38 strains tested were clustered in two major groups. In each of these groups, strains had at least a 90% relatedness. These strains were isolated in patients hospitalised in different areas of the LTCF. Conclusion: we identified that both molecular and epidemiological arguments support the hypothesis of the possibility of MRSA cross-transmission inside the LTCF. Further studies are needed to confirm and explain the association identified between MRSA carriage and medical imaging.

MRSA a quiet killer in care homes

Link: Influenza-like illness in residential care homes: A study of the incidence, aetiological agents, natural history, and health resource utilization -- Hui et al., 10.1136/thx.2007.090951 -- Thorax.

Background: Influenza-like illness (ILI) among elderly living in residential care homes (RCHE) is a common cause for hospitalization. We examined the incidence, underlying aetiology, natural history and associated healthcare resource utilization related to ILI in the RCHE population. Methods: A prospective study of ILI in 4 RCHEs in Shatin, HK, from Apr 2006 to Mar 2007 was conducted. Each RCHE was monitored daily for ILI occurrence, and followed up until resolution of illness or death. Clinical features were recorded whereas sputum, nasopharyngeal aspirate, blood, and urine specimens were examined for underlying aetiology. Results: 259 episodes of ILI occurred in 194 subjects, with mild peaks in winter and summer, over a sustained level throughout the year. Infection agent was identified in 61.4% of all episodes, comprising bacterial infection in 53.3% and viral in 46.7%. Multiple infections occurred in 16.2% of subjects. The most frequent organisms were Streptococcus pneumoniae, followed by respiratory syncytial virus, Pseudomonas aeruginosa, Metapneumovirus and parainfluenza viruses type 1 & 3. Clinical features did not vary according to underlying aetiology, the common presenting features being "decrease in general condition", cognitive and functional deterioration, and withholding of food in addition to fever and respiratory symptoms. Overall, mortality at 1 month/discharge was 9.7%. MRSA infection, low BMI, and poor function predisposed to mortality. No association between influenza vaccination status and underlying aetiology, clinical features or outcome, was observed. Conclusions: Clinical presentation of ILI is non-specific and is mainly due to bacterial and other viral infections than influenza in the RCHE population.