Control of healthcare- and community-associated MRSA: recent progress and persisting challenges

Henderson, Andrew; Nimmo, Graeme R.

doi:10.1093/bmb/ldx046

Cited by 38 publications

(32 citation statements)

References 121 publications

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“…All isolates had SCC mec IVa and no isolates had Panton–Valentine leukocidin (PVL) or the arginine catabolic mobile element (ACME). The 14 non-outbreak related isolates of t267/ST97 had SCC mec IVc/e ( Gonzalez et al, 2006 ), SCC mec IVa ( Henderson and Nimmo, 2017 ), and SCC mec V ( Gonçalves da Silva et al, 2017 ). The outbreak isolates were resistant to methicillin and susceptible to erythromycin, clindamycin, gentamicin, fusidic acid, linezolid, mupirocin, trimethoprim/sulfamethoxazole, and rifampicin.…”

Section: Resultsmentioning

confidence: 99%

“…In human medicine, the focus has traditionally been on the hospital-acquired clones (HA-MRSA), but new clones have emerged both in livestock and in community settings ( DeLeo et al, 2010 ; Gonçalves da Silva et al, 2017 ). Outbreaks in hospitals and nursing homes are today caused by both HA-MRSA and community-associated MRSA (CA-MRSA) clones ( DeLeo et al, 2010 ; Di Ruscio et al, 2017 ; Henderson and Nimmo, 2017 ) and it has been suggested no longer to regard HA-MRSA and CA-MRSA as separate entities ( Zarfel et al, 2013 ). Hospital admission of unknown MRSA carriers, lack of MRSA admittance screening and spread of MRSA among nursing home residents could all be part of the explanation of this mélange of HA-MRSA and CA-MRSA in hospitals ( Gonzalez et al, 2006 ).…”

Section: Introductionmentioning

confidence: 99%

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A Sporadic Four-Year Hospital Outbreak of a ST97-IVa MRSA With Half of the Patients First Identified in the Community

et al. 2018

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This study describes a sporadically occurring 4-year outbreak of methicillin-resistant Staphylococcus aureus (MRSA) originating from a surgical ward. Whole-genome sequencing (WGS) identified the outbreak clone as spa type t267, sequence type ST97, and SCCmec IVa. Prompted by the finding of four patients within 6 months in the same ward with this unusual MRSA type, an outbreak was suspected. Subsequent MRSA screening in the ward in February 2017 identified three-additional patients and two health care workers (HCWs) with t267/ST97-IVa. WGS linked these 9 isolates to 16 previous isolates in our WGS database and the outbreak thus included 23 patients and two HCWs. Twenty-one patients had a connection to the surgery ward during the period 2013–2017, but half of them had MRSA diagnosed in the community long after discharge. The community debut of several patients MRSA infections weeks to months after hospital discharge made the identification of a hospital source difficult and it was the SNP relatedness of the isolates that led us to identify the common denominator of hospitalization. An index patient was not identified, but our hypothesis is that HCWs with unrecognized long-term MRSA colonization could have caused sporadic nosocomial transmission due to intermittent breaches in infection prevention and control practice.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Sporadic Four-Year Hospital Outbreak of a ST97-IVa MRSA With Half of the Patients First Identified in the Community

et al. 2018

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“…Nosocomial infections with MRSA, also called hospital-associated MRSA (HA-MRSA), have been known for a long time, and thus, effective measures have been taken to limit their spread [ 14 , 15 , 16 ]. Since HA-MRSA rarely cause disease in healthy individuals without predisposing conditions, it has been suggested that they display a reduced virulence and could therefore only thrive in low-competition environments [ 17 ].…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

“…The first described CA-MRSA cases date back to the 1980s, and since then, regionally dominant strains have evolved, with USA300 being the prime culprit in Northern America. In contrast to HA-MRSA strains, most CA-MRSA strains possess other staphylococcal cassette chromosome mec (SCCmec) variants, as well as fewer and varying resistance determinants, and are more likely to carry the Panton-Valentine leukocidin, a two-component toxin directed against human neutrophils [ 14 , 15 , 16 , 18 ]. LA-MRSA were first described in 2005 by Voss et al, who demonstrated their transmission between pigs and pig farmers [ 19 ].…”

Section: Staphylococcus Aureusmentioning

confidence: 99%

Staphylococcus aureus Host Tropism and Its Implications for Murine Infection Models

Mrochen

Oliveira

Raafat

et al. 2020

IJMS

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Staphylococcus aureus (S. aureus) is a pathobiont of humans as well as a multitude of animal species. The high prevalence of multi-resistant and more virulent strains of S. aureus necessitates the development of new prevention and treatment strategies for S. aureus infection. Major advances towards understanding the pathogenesis of S. aureus diseases have been made using conventional mouse models, i.e., by infecting naïve laboratory mice with human-adapted S.aureus strains. However, the failure to transfer certain results obtained in these murine systems to humans highlights the limitations of such models. Indeed, numerous S. aureus vaccine candidates showed promising results in conventional mouse models but failed to offer protection in human clinical trials. These limitations arise not only from the widely discussed physiological differences between mice and humans, but also from the lack of attention that is paid to the specific interactions of S. aureus with its respective host. For instance, animal-derived S. aureus lineages show a high degree of host tropism and carry a repertoire of host-specific virulence and immune evasion factors. Mouse-adapted S.aureus strains, humanized mice, and microbiome-optimized mice are promising approaches to overcome these limitations and could improve transferability of animal experiments to human trials in the future.

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“…Both strategies in LTCFs are predominately adopted from acute-care settings or based on consensus opinions from experts. Recent narrative reviews have described the types of interventions without summarizing the data [20][21][22]. Studies quantifying intervention effects on MDROs are mostly conducted in acute-care hospitals, which have different contact patterns from LTCFs [23,24].…”

Section: Introductionmentioning

confidence: 99%

Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

Wong

Huang

Wei

et al. 2021

Preprint

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Background: Current guidelines recommend infection prevention and control (IPC) interventions to limit the spread of multidrug-resistant organisms (MDROs) in long-term care facilities (LTCFs). Despite clear evidence of benefits in acute-care hospital settings, the effectiveness of IPC programmes in LTCFs has not been quantified.Objective: To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. Data sources: Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. Eligibility criteria: Original and peer-reviewed articles examining the post-intervention effects of IPC interventions on MDRO colonization and infections in LTCFs for older adults. Interventions: i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and ii) vertical intervention: decolonization. Study appraisal and synthesis: We employed random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for Methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention durations; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. Results: Of 3877 studies initially identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs) and 11 non-RCTs). Studies reported outcomes associated with MRSA (15 studies), Vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies included in the meta-analysis. The pRRs were closed to unity regardless of intervention durations (long: RR 0.81 [95%CI 0.60-1.10]; medium: RR 0.81 [95%CI 0.25-2.68]; short: RR 0.95 [95%CI 0.53-1.69]). All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies.Conclusions: Our meta-analysis did not show beneficial effects from IPC interventions on MRSA reductions in LTCFs. Administrative engagement was crucial in all programmes with reductions. Before more evidence is available, LTCFs should elucidate their goals and weigh cautiously for the benefits and risks before implementing IPC interventions, which may have potential negative impacts on residents. An alternative approach would be to reinforce strict compliance to standard precautions through administrative engagement. We call for high-quality trials with detailed execution and exit plans to refine the existing IPC strategies in LTCFs.

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Control of healthcare- and community-associated MRSA: recent progress and persisting challenges

Cited by 38 publications

References 121 publications

A Sporadic Four-Year Hospital Outbreak of a ST97-IVa MRSA With Half of the Patients First Identified in the Community

A Sporadic Four-Year Hospital Outbreak of a ST97-IVa MRSA With Half of the Patients First Identified in the Community

Staphylococcus aureus Host Tropism and Its Implications for Murine Infection Models

Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

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