MRSA, Staph, Staff, Mersa, Methicillin Resistant Staphylococcus Aureus Symptoms & Treatment

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.

Few Strategies Exist to Prevent MRSA Spread in Nursing Homes

Link: Few Strategies Exist to Prevent MRSA Spread in Nursing Homes.

Close living proximity, multiple medications, pressure sores and catheters all make nursing homes ideal for breeding and spreading MRSA. However, nursing homes appear to have been short-changed in the medical literature on prevention, despite studies repeatedly reporting that residents are at higher risk. “Many different ways of preventing the spread of MRSA have been studied, particularly in hospitals; however, we found no studies that looked at ways of preventing the spread of MRSA in nursing homes for older people,” the reviewers say. The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

Hospital screening nursing home patients for MRSA

Link: Danger bugs hit hospital : Express & Star.

Around a third of superbug cases at a Black Country hospital come from the region’s nursing homes, it is claimed. Bosses at Russells Hall Hospital, Dudley, say this is hampering attempts to fight the potentially fatal bugs. They are desperate to reduce the number of outbreaks, a condition which needs to be fulfiled before Dudley Group of Hospitals (DGoH) can be granted “go-it alone” foundation status. Stringent infection control standards now in place at hospitals have yet to be adopted at many nursing homes and medical staff at Russells Hall have begun swabbing new patients to identify cases. Adrian Hamlyn, consultant gastroenterologist at Russells Hall Hospital, said: “A good proportion of MRSA has been imported from nursing homes,” he said. “A practice we have now adopted has been to begin swabbing patients who come in from nursing homes.”

MRSA epidemic in Eindhoven

Link: MRSA epidemic in Eindhoven, Dutch News, The Netherlands, Holland, Expatica.

An MRSA epidemic has been declared in the De Weerde nursing home in Eindhoven. 11 residents and nine employees have been infected with the bacteria, a spokesperson for the nursing home said on Wednesday. After a resident was found to be infected with the bacteria on 12 August, the institution tested other residents and carers working in the same ward. 19 of them appear to be infected. The residents infected with MRSA have been kept isolated from the other residents since the infection was found. The infected workers have been treated but have now resumed their duties wearing protective clothing. The infection seems to have been limited to a single ward.

Care Homes - MRSA a growing cause of death

Link: Care Homes: Infectious Diseases: 9 Jul 2007: Written answers (TheyWorkForYou.com).

The Office for National Statistics (ONS) publish figures on deaths with MRSA (meticillin resistant Staphylococcus aureus or Clostridium difficile) mentioned on the death certificate each year. These include figures on the type of place in which the deaths occurred. Information about where the infection was acquired is not collected at death registration and may be different from the place of death. The following tables provide figures for the past three years by type of care home in which the deaths happened.

Click the link above for the figures

MRSA hits nursing home residents with cognitive problems hard

Link: HighWire Press -- Medline Abstract.

After adjustment for age, sex, and Charlson comorbidity index, the risk for 36-month mortality remained significantly higher in MRSA carriers (hazard ratio (HR)= 1.4, 95% confidence interval (CI) = 1.1-1.8) than in noncarriers. The effect of MRSA on mortality was dependent on the degree of cognitive impairment, with the highest effect in patients with severe cognitive impairment (adjusted HR =1.8, 95% CI =1.1-2.8) and absence of effect in residents with good mental status (adjusted HR =0.8, 95% CI =0.43-1.62). Deaths were more frequently reported to be infection-related in MRSA carriers. No association was found between MRSA colonization and hospitalization for any reason, but during follow-up, MRSA carriers were twice as frequently hospitalized for respiratory tract infections. CONCLUSION: Colonization of MRSA in Belgian nursing home residents was associated with higher mortality. This excess mortality was restricted to residents with impaired cognitive function, probably reflecting differences in therapeutic approaches, in delay of diagnosis of pneumonia and other acute disorders in these patients, or in both.

Care Home fined $25000 over neglect of MRSA wound

Link: PJStar.com - Journal Star News.

    According to Journal Star files and the department's report, Catherine G. Martin, 95, of Peoria, formerly of Princeville, died on April 9 from infection and multiple organ failure, because of or as a consequence of an infected leg wound. Martin had been a school teacher, a farm wife, an election judge and served as supervisor of Princeville Township. She was admitted to the nursing home in March 2006 after she fractured an ankle while living at Independence Village in Peoria. She also had other health problems, including a "soft spot" on her heel, which the department alleges was not properly cared for in the nursing home. She was taken to Methodist Medical Center on April 4 with gangrene to the right heel, and found to have MRSA, an antibiotic-resistant infection in the heel.