Diversity of Methicillin-Resistant Staphylococcus aureus Strains Isolated from Residents of 26 Nursing Homes in Orange County, California

Hudson, Lyndsey O.; Reynolds, Courtney; Spratt, Brian G.; Enright, Mark C.; Quan, Victor; Kim, Diane; Hannah, Paul; Mikhail, Lydia; Alexander, Richard; Moore, Douglas F.; Godoy, Daniel; Bishop, Cynthia; Huang, Susan S.

doi:10.1128/jcm.01708-13

Cited by 39 publications

(42 citation statements)

References 52 publications

(64 reference statements)

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“…In the aggregate, our data show that a combination of two contiguous amino acid changes (Y446N and E447K) in PBP2a renders S. aureus highly resistant to ceftaroline (MIC Ͼ 32 mg/liter). While previous studies have found ceftaroline-resistant isolates (MICs ϭ 4 to 8 mg/liter) in clonal types ST239 and ST228, which are common to Europe, Asia, and South America, our isolates belong to ST5, a common clonal type in the United States (8,12,34).…”

Section: Discussionmentioning

confidence: 77%

PBP2a Mutations Causing High-Level Ceftaroline Resistance in Clinical Methicillin-Resistant Staphylococcus aureus Isolates

Long

Olsen

Mehta

et al. 2014

Antimicrob Agents Chemother

123

107

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Ceftaroline is the first member of a novel class of cephalosporins approved for use in the United States. Although prior studies have identified eight ceftaroline-resistant methicillin-resistant Staphylococcus aureus (MRSA) isolates in Europe and Asia with MICs ranging from 4 to 8 mg/liter, high-level resistance to ceftaroline (>32 mg/liter) has not been described in MRSA strains isolated in the United States. We isolated a ceftaroline-resistant (MIC > 32 mg/liter) MRSA strain from the blood of a cystic fibrosis patient and five MRSA strains from the respiratory tract of this patient. Whole-genome sequencing identified two amino acid-altering mutations uniquely present in the ceftaroline-binding pocket of the transpeptidase region of penicillin-binding protein 2a (PBP2a) in ceftaroline-resistant isolates. Biochemical analyses and the study of isogenic mutant strains confirmed that these changes caused ceftaroline resistance. Thus, we identified the molecular mechanism of ceftaroline resistance in the first MRSA strain with high-level ceftaroline resistance isolated in the United States.

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Section: Discussionmentioning

confidence: 77%

PBP2a Mutations Causing High-Level Ceftaroline Resistance in Clinical Methicillin-Resistant Staphylococcus aureus Isolates

Long

Olsen

Mehta

et al. 2014

Antimicrob Agents Chemother

123

107

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“…12 Huang and colleagues found a prevalence of 26% from the anterior nares in 26 nursing homes in Orange County. 13 Evans and colleagues reported a mean admission prevalence of 29% from 133 VA long term care facilities. 14 Twenty-two percent of patients in 6 skilled nursing facilities in Wisconsin were colonized with MRSA in nares, skin of the axilla and groin, or perianal skin.…”

Section: Discussionmentioning

confidence: 99%

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Roghmann

Johnson

Sorkin

et al. 2015

Infect. Control Hosp. Epidemiol.

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Objective To estimate the frequency of MRSA transmission to gowns and gloves worn by healthcare personnel (HCP) interacting with nursing home residents in order to inform infection prevention policies in this setting Design Observational study Setting and Participants Residents and HCP from 13 community-based nursing homes in Maryland and Michigan Methods Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. HCP wore gowns and gloves during usual care activities. At the end of each activity, a research coordinator swabbed the HCP’s gown and gloves. Results 403 residents were enrolled; 113 were MRSA colonized. Glove contamination was higher than gown contamination (24% vs. 14% of 954 interactions, p<0.01). Transmission varied greatly by type of care from 0% to 24% for gowns and 8% to 37% for gloves. We identified high risk activities (OR >1.0, p< 0.05) including: dressing, transferring, providing hygiene, changing linens and toileting the resident. We identified low risk activities (OR <1.0, p< 0.05) including: giving medications and performing glucose monitoring. Residents with chronic skin breakdown had significantly higher rates of gown and glove contamination. Conclusions MRSA transmission from MRSA positive residents to HCP gown and gloves is substantial with high contact activities of daily living conferring the highest risk. These activities do not involve overt contact with body fluids, skin breakdown or mucous membranes suggesting the need to modify current standards of care involving the use of gowns and gloves in this setting.

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“…5 Finally, we identified MRSA colonization using surveillance cultures at enrollment, and our prevalence rate was similar to those of other studies. 17–20 …”

Section: Discussionmentioning

confidence: 99%

“…21 Approximately 30% of nursing home residents are colonized with MRSA, which can be spread from patient-to-patient by HCWs. 17–20 The Centers for Medicare and Medicaid Services has recently proposed substantial changes to the regulations requiring nursing homes to have more robust infection control programs which will substantially increase costs for nursing homes. Our prior study and this cost analysis demonstrate the possibility and the advantages of stratifying infection prevention strategies based on resident characteristics.…”

Section: Discussionmentioning

confidence: 99%

Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis

Roghmann

Lydecker

Mody

et al. 2016

Infect. Control Hosp. Epidemiol.

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OBJECTIVE. To estimate the costs of 3 MRSA transmission prevention scenarios compared with standard precautions in community-based nursing homes. DESIGN. Cost analysis of data collected from a prospective, observational study. SETTING AND PARTICIPANTS. Care activity data from 401 residents from 13 nursing homes in 2 states. METHODS. Cost components included the quantities of gowns and gloves, time to don and doff gown and gloves, and unit costs. Unit costs were combined with information regarding the type and frequency of care provided over a 28-day observation period. For each scenario, the estimated costs associated with each type of care were summed across all residents to calculate an average cost and standard deviation for the full sample and for subgroups. RESULTS. The average cost for standard precautions was $100 (standard deviation [SD], $77) per resident over a 28-day period. If gown and glove use for high-risk care was restricted to those with MRSA colonization or chronic skin breakdown, average costs increased to $137 (SD, $120) and $125 (SD, $109), respectively. If gowns and gloves were used for high-risk care for all residents in addition to standard precautions, the average cost per resident increased substantially to $223 (SD, $127). CONCLUSIONS. The use of gowns and gloves for high-risk activities with all residents increased the estimated cost by 123% compared with standard precautions. This increase was ameliorated if specific subsets (eg, those with MRSA colonization or chronic skin breakdown) were targeted for gown and glove use for high-risk activities.

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Diversity of Methicillin-Resistant Staphylococcus aureus Strains Isolated from Residents of 26 Nursing Homes in Orange County, California

Cited by 39 publications

References 52 publications

PBP2a Mutations Causing High-Level Ceftaroline Resistance in Clinical Methicillin-Resistant Staphylococcus aureus Isolates

PBP2a Mutations Causing High-Level Ceftaroline Resistance in Clinical Methicillin-Resistant Staphylococcus aureus Isolates

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Strategies to Prevent MRSA Transmission in Community-Based Nursing Homes: A Cost Analysis

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