Quantitative Analysis and Molecular Fingerprinting of Methicillin-Resistant<i>Staphylococcus aureus</i>Nasal Colonization in Different Patient Populations: A Prospective, Multicenter Study

Mermel, Leonard A.; Eells, Samantha J.; Acharya, Muralidhar; Cartony, Jennifer M.; Dacus, D.; Fadem, Stephen Z.; Gay, Émilie; Gordon, Steven M.; Lonks, John R.; Perl, Trish M.; McDougal, Linda K.; McGowan, John E.; Maxey, Gail E.; Morse, Dan J.; Tenover, Fred C.

doi:10.1086/652778

Cited by 38 publications

(28 citation statements)

References 21 publications

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“…At 11.5% prevalence, the USA500/Iberian type was the most frequently isolated strain in our population, representing 48.0% of the MRSA isolates recovered from the groin and 57.4% from the nares. This is higher than the reported prevalence of USA500 among HIV-infected patients in Dallas, TX, and New York City (range, 4.8 to 5.6%) (8,49) but lower than the reported prevalence (19%) among general patients screened at admission to another Atlanta-area hospital (21), and both USA300 and USA500 colonization has been associated with HIV infection (36).…”

Section: Discussioncontrasting

confidence: 61%

Evaluation of the Impact of Direct Plating, Broth Enrichment, and Specimen Source on Recovery and Diversity of Methicillin-Resistant Staphylococcus aureus Isolates among HIV-Infected Outpatients

et al. 2011

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We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swab specimens of 600 HIV-infected outpatients by selective and nonselective direct plating and broth enrichment. Swabs were collected at baseline, 6-month, and 12-month visits and cultured by direct plating to mannitol salt agar (MSA) and CHROMagar MRSA (CM) and overnight broth enrichment with subculture to MSA (broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), staphylococcal cassette chromosome mec (SCCmec) typing, and PCR for the Panton-Valentine leukocidin. At each visit, 13 to 15% of patients were colonized with MRSA and 30 to 33% were colonized with methicillin-susceptible S. aureus (MSSA). Broth, CM, and MSA detected 95%, 82%, and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from broth than CM (P < 0.001) or MSA (P < 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly when using broth than when using MSA (P < 0.001). Among specimens collected from the groin, broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (P < 0.001) and MSA (P < 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal swab specimen culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (P ‫؍‬ 0.05).

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Section: Discussioncontrasting

confidence: 61%

Evaluation of the Impact of Direct Plating, Broth Enrichment, and Specimen Source on Recovery and Diversity of Methicillin-Resistant Staphylococcus aureus Isolates among HIV-Infected Outpatients

et al. 2011

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“…Persistent S. aureus carriers have been found to carry a greater quantity of S. aureus in their noses (measured in log 10 CFU per nares culture) than intermittent carriers (46). Average S. aureus bacterial loads among nasal carriers tend to range between 1.8 and 2.9 log 10 CFU per nares culture (47,48). One study found that this load increased among MRSA carriers when patients received antibiotics that did not have activity against MRSA (e.g., beta-lactams or fluoroquinolones) (48).…”

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confidence: 99%

Decolonization in Prevention of Health Care-Associated Infections

2016

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SUMMARYColonization with health care-associated pathogens such asStaphylococcus aureus, enterococci, Gram-negative organisms, andClostridium difficileis associated with increased risk of infection. Decolonization is an evidence-based intervention that can be used to prevent health care-associated infections (HAIs). This review evaluates agents used for nasal topical decolonization, topical (e.g., skin) decolonization, oral decolonization, and selective digestive or oropharyngeal decontamination. Although the majority of studies performed to date have focused onS. aureusdecolonization, there is increasing interest in how to apply decolonization strategies to reduce infections due to Gram-negative organisms, especially those that are multidrug resistant. Nasal topical decolonization agents reviewed include mupirocin, bacitracin, retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, photodynamic therapy, omiganan pentahydrochloride, and lysostaphin. Mupirocin is still the gold standard agent forS. aureusnasal decolonization, but there is concern about mupirocin resistance, and alternative agents are needed. Of the other nasal decolonization agents, large clinical trials are still needed to evaluate the effectiveness of retapamulin, povidone-iodine, alcohol-based nasal antiseptic, tea tree oil, omiganan pentahydrochloride, and lysostaphin. Given inferior outcomes and increased risk of allergic dermatitis, the use of bacitracin-containing compounds cannot be recommended as a decolonization strategy. Topical decolonization agents reviewed included chlorhexidine gluconate (CHG), hexachlorophane, povidone-iodine, triclosan, and sodium hypochlorite. Of these, CHG is the skin decolonization agent that has the strongest evidence base, and sodium hypochlorite can also be recommended. CHG is associated with prevention of infections due to Gram-positive and Gram-negative organisms as well asCandida. Conversely, triclosan use is discouraged, and topical decolonization with hexachlorophane and povidone-iodine cannot be recommended at this time. There is also evidence to support use of selective digestive decontamination and selective oropharyngeal decontamination, but additional studies are needed to assess resistance to these agents, especially selection for resistance among Gram-negative organisms. The strongest evidence for decolonization is for use among surgical patients as a strategy to prevent surgical site infections.

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“…The prevalence of USA300 in varied patient populations in the USA has been reported to range from 10 to almost 70 % among S. aureus isolates (Mermel et al, 2010). Using the sensitivity and specificity as determined above for the USA300 family isolates, this resulted in post-test probabilities of 47 % (positive test) and 2 % (negative test) for 10 % prevalence, and 95 % (positive test) and 26 % (negative test) for 70 % prevalence.…”

Section: Resultsmentioning

confidence: 99%

Characterization of a Staphylococcus aureus USA300 protein signature using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

Boggs

Cazares

Drake

2012

Journal of Medical Microbiology

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Staphylococcus aureus strain type USA300 is an important human pathogen. Matrix-assisted laser desorption/ionization time of flight (MALDI-TOF) mass spectrometry has been used successfully for rapid identification of S. aureus at the genus and species levels. Here, it was hypothesized that MALDI-TOF could be used to identify USA300 organisms at the strain level. A genetic algorithm model using ClinProTools software (Bruker Daltonics) was built using 47 isolates of USA300 S. aureus and 77 non-USA300 S. aureus isolates. Three mass/charge peaks (5932, 6423 and 6592) were found to be discriminators between the groups of isolates. The model was validated using 224 test isolates: 197 of 224 test isolates were correctly classified as 'USA300 family' or 'non-USA300'. The sensitivity of the model was 0.87, with a specificity of 0.89, positive likelihood ratio of 8.19 and negative likelihood ratio of 0.15. The three-peak intensity MALDI-TOF model designed and tested in the current study can be used to rapidly identify USA300 family S. aureus isolates with reasonable sensitivity and specificity.

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Quantitative Analysis and Molecular Fingerprinting of Methicillin-ResistantStaphylococcus aureusNasal Colonization in Different Patient Populations: A Prospective, Multicenter Study

Cited by 38 publications

References 21 publications

Evaluation of the Impact of Direct Plating, Broth Enrichment, and Specimen Source on Recovery and Diversity of Methicillin-Resistant Staphylococcus aureus Isolates among HIV-Infected Outpatients

Evaluation of the Impact of Direct Plating, Broth Enrichment, and Specimen Source on Recovery and Diversity of Methicillin-Resistant Staphylococcus aureus Isolates among HIV-Infected Outpatients

Decolonization in Prevention of Health Care-Associated Infections

Characterization of a Staphylococcus aureus USA300 protein signature using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry

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