Environmental Contamination Due to Methicillin-Resistant <i>Staphylococcus aureus:</i> Possible Infection Control Implications

Boyce, John M.; Potter-Bynoe, Gail; Chenevert, Claire; King, Thomas

doi:10.1086/502213

Cited by 1,327 publications

(756 citation statements)

References 361 publications

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“…We believe that the swab technique is likely to detect patients who are densely colonized and most likely to be vectors for the colonization of others. Additionally, both the CDC and the Society for Healthcare Epidemiology of America recommend this method for screening hospitalized patients for VRE colonization [18, 19]. …”

Section: Discussionmentioning

confidence: 99%

The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients

et al. 2007

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Backgound: Hospitalized dialysis patients are at increased risk for colonization and infection with resistant bacterial strains. Methods: We performed a cross-sectional analysis of the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) colonization in 198 hemodialysis outpatients, 75 of whom had longitudinal screening data from prior hospitalization. Nasal specimens for MRSA, perirectal specimens for VRE, and permanent catheter exit site specimens were collected. Results: MRSA colonization was present in 5.6% and VRE colonization in 3.14%. Univariate analyses revealed that prior exposure (defined as infection/colonization) with MRSA, hospitalization, and low serum albumin were associated with MRSA colonization. VRE colonization was associated with hospitalization, prior VRE or MRSA exposure, low serum albumin, and low ferritin. Multivariate analyses revealed MRSA colonization was predicted by prior MRSA exposure and VRE colonization was predicted by prior VRE exposure and number of hospitalizations. Among the 75 participants with longitudinal screening data, MRSA colonization was associated with prior MRSA history, and VRE colonization was associated with prior MRSA or VRE. Conclusions: Generally low rates of MRSA and VRE colonization were observed in hemodialysis outpatients. Prior hospital screening was predictive of future outpatient colonization and may be useful in risk assessment.

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Section: Discussionmentioning

confidence: 99%

The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients

et al. 2007

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“…Die Screeningempfehlungen der amerikanischen Society for Healthcare Epidemiology (SHEA) [15] sehen nicht nur ein Aufnahmescreening vor, sondern empfehlen auch ein wöchentliches Wiederholungsscreening. Vor allem Screeninguntersuchungen an einem festen Wochentag füh-ren in der Regel zu einer hohen Compliance, sodass evtl.…”

Section: Wiederholungsscreeningunclassified

Prävention von Methicillin-resistentem S. aureus durch Screeninguntersuchungen

et al. 2006

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In Germany, methicillin-resistant S. aureus (MRSA) is increasing continuously. To control the spread of MRSA, active surveillance and admission screening are recommended. In most cases, screening cultures of patients at risk for MRSA will be sufficient. Screening of all patients admitted to an ICU is cost-effective when the incidence of MRSA and nosocomial MRSA infections is high (>2 cases/100 patients and 0.3 MRSA infections/100 patients, respectively): Under these circumstances, a decrease in the incidence of nosocomial MRSA infections of 50% leads to cost-effectiveness at costs of 16 Euro/sample (including subsequent costs). If the incidence of nosocomial MRSA infections decreases by 75%, costs of 24 Euro/sample (including subsequent costs) are cost-effective. If the incidence of MRSA is high, screening by PCR may be cost-effective for patients at high risk for MRSA, especially if they are isolated prophylactically. Recently, PCR methods have been developed which allow the specific identification of MRSA even from nasal swabs.

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“…Methicillin-resistant S. aureus (MRSA) is an important cause of community-acquired and hospital-acquired infections (3,4). MRSA can colonize the nares, skin, and other body sites, serving as a reservoir for infection and transmission in health care environments (5)(6)(7). Screening for MRSA colonization in order to help identify patients at greater risk for MRSA infection and to allow for the initiation of isolation precautions has become standard practice in many institutions (5,6,(8)(9)(10).…”

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Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

et al. 2015

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The BD Max MRSAXT and the BD Max StaphSR assays were validated for the detection of methicillin-resistant Staphylococcus aureus (MRSA) in ESwab samples. In addition, the BD Max StaphSR assay was evaluated for its ability to detect and differentiate S. aureus and MRSA in the same sample. A total of 255 ESwab samples collected from the anterior nares of patients were tested by each of three BD Max assays, including the BD Max MRSA first-generation assay. The results were compared to those of direct and enrichment culture. Additionally, a challenge panel comprising 14 control strains was evaluated to determine the ability of these assays to correctly identify MRSA and also appropriately differentiate S. Staphylococcus aureus is a leading cause of health care-associated infections. Infection due to S. aureus imposes a high and increasing burden on health care resources and increases morbidity and mortality. Nasal carriage of S. aureus has been identified as a risk factor for the development of infections in various settings. This has been studied extensively in surgical patients (general, orthopedic, and thoracic surgery), patients on hemodialysis, patients on continuous ambulatory peritoneal dialysis (CAPD), HIV-infected patients, and patients in intensive care units (1, 2). Methicillin-resistant S. aureus (MRSA) is an important cause of community-acquired and hospital-acquired infections (3, 4). MRSA can colonize the nares, skin, and other body sites, serving as a reservoir for infection and transmission in health care environments (5-7). Screening for MRSA colonization in order to help identify patients at greater risk for MRSA infection and to allow for the initiation of isolation precautions has become standard practice in many institutions (5,6,(8)(9)(10).MRSA screening using molecular amplification methods provides faster results than culture and has been demonstrated to be more sensitive (11-15). However, most of the molecular commercially available rapid tests are based on the detection of a sequence indicating the integration of the staphylococcal cassette chromosome mec element (SCCmec) within the chromosome and do not specifically target the methicillin resistance gene mecA (16). S. aureus isolates with an SCCmec lacking the mecA gene have been described and can be incorrectly identified as MRSA by assays that do not specifically target the mecA gene (17). False-positive results can lead to unnecessary and expensive isolation and treatment of patients. In addition, MRSA strains with the newly discovered methicillin resistance gene mecC account for 3 to 4% of all new MRSA cases in Denmark (18) and cannot be detected by assays that do not detect the mecC gene (19). These false-negative results can lead to uncontrolled transmission of undetected MRSA strains.The BD Max StaphSR and the BD Max MRSAXT assays (BD Diagnostics, Québec, Canada) performed on the BD Max system (BD Diagnostics, Sparks, MD) are next-generation automated qualitative in vitro diagnostic tests able to detect MRSA strains harboring the m...

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Environmental Contamination Due to Methicillin-Resistant Staphylococcus aureus: Possible Infection Control Implications

Abstract: Active surveillance cultures are essential to identify the reservoir for spread of MRSA and VRE infections and make control possible using the CDC's long-recommended contact precautions.

Cited by 1,327 publications

References 361 publications

The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients

The Prevalence of Resistant Bacterial Colonization in Chronic Hemodialysis Patients

Prävention von Methicillin-resistentem S. aureus durch Screeninguntersuchungen

Evaluation of BD Max StaphSR and BD Max MRSA XT Assays Using ESwab-Collected Specimens

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