MRSA Bacteraemia (mrsa + bacteraemia)

Distribution by Scientific Domains

Selected Abstracts

Impact of rapid molecular screening for meticillin-resistant Staphylococcus aureus in surgical wards,

M. R. S. Keshtgar
Background: This study aimed to establish the feasibility and cost-effectiveness of rapid molecular screening for hospital-acquired meticillin-resistant Staphylococcus aureus (MRSA) in surgical patients within a teaching hospital. Methods: In 2006, nasal swabs were obtained before surgery from all patients undergoing elective and emergency procedures, and screened for MRSA using a rapid molecular technique. MRSA-positive patients were started on suppression therapy of mupirocin nasal ointment (2 per cent) and undiluted chlorhexidine gluconate bodywash. Results: A total of 18 810 samples were processed, of which 850 (45 per cent) were MRSA positive. In comparison to the annual mean for the preceding 6 years, MRSA bacteraemia fell by 385 per cent (P < 0001), and MRSA wound isolates fell by 127 per cent (P = 0031). The reduction in MRSA bacteraemia and wound infection was equivalent to a saving of 378 beds per year (276 220), compared with the annual mean for the preceding 6 years. The cost of screening was 302 500, making a net loss of 26 280. Compared with 2005, however, there was a net saving of 545 486. Conclusion: Rapid MRSA screening of all surgical admissions resulted in a significant reduction in staphylococcal bacteraemia during the screening period, although a causal link cannot be established. Copyright 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source]

Case,control study to identify factors associated with mortality among patients with methicillin-resistant Staphylococcus aureus bacteraemia

D. Marchaim
Clin Microbiol Infect 2010; 16: 747,752 Abstract Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is associated with increased mortality. Delay in appropriate antimicrobial therapy (DAAT) is an important risk factor for death, although confounding between carriage of MRSA and DAAT has not been resolved. We studied the association of risk factors with mortality and searched for specific populations vulnerable to DAAT. We conducted a case,control study comparing patients with MRSA bacteraemia who died during hospitalization (cases) with patients with MRSA bacteraemia who survived (controls) in three medical centres in two states. Patients were identified using computerized hospital databases for the years 2001,2005. Medical records were retrieved and various epidemiological data extracted. Bivariate and multivariate logistic regression analyses were performed. Overall, 388 patients with MRSA bacteraemia were included, 164 cases and 224 controls. According to bivariate analyses, cases were significantly more likely than controls to (i) be older (>65 years), (ii) have transferred from an institution, (iii) have stayed in an ICU, (iv) have had more invasive devices, (v) have a poorer prognosis on admission, (vi) have higher disease severity at the time of bacteraemia, and (vii) have a DAAT of ,2 days. Upon multivariate analysis, among patients >65 years, DAAT was significantly associated with increased mortality (p 0.04). Furthermore, patients >65 years with severe sepsis were much more likely to experience DAAT (p 0.02). In elderly patients with MRSA bacteraemia, DAAT is associated with increased mortality. Moreover, advanced age is a predictor for DAAT. These significant epidemiological associations mandate early coverage of MRSA in septic elderly patients. [source]

Strain relatedness of meticillin-resistant Staphylococcus aureus isolates recovered from patients with repeated bacteraemia

C-H. Liao
Clin Microbiol Infect 2010; 16: 463,469 Abstract Information on the relatedness of isolates causing repeated meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia is limited. An observational study of 177 patients with MRSA bacteraemia, admitted to the emergency department of National Taiwan University Hospital, was conducted from January 2001 to June 2006. Among these patients, 28 had a previous episode of MRSA bacteraemia and 59 died during the index episode of bacteraemia. Until December 2007, among the 118 patients who survived the index episode (101 without previous bacteraemia and 17 with previous bacteraemia), 24 (20.3%) had repeated MRSA bacteraemia. The duration from discontinuation of antimicrobial therapy to repeat episodes was in the range 35,854 days (median 86 days). Eight patients (33.3%) died as a result of the second bacteraemic episode. Clinical characteristics associated with repeated bacteraemia included the diagnosis of infective endocarditis and active malignancy. Pulsed-field gel electrophoresis and multilocus sequence typing analysis were performed for 32 pairs of available isolates recovered from patients with repeated bacteraemia and revealed that 29 of them (90.6%) were genetically closely-related strains. The majority of patients with repeated MRSA bacteraemia had recurrent infections and a high mortality rate. [source]

Methicillin-resistant Staphylococcus aureus bacteraemia in neonatal intensive care units: an analysis of 90 episodes

Y-Y Chuang
Aim: To delineate the clinical features of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in infants hospitalized at the neonatal intensive care unit. Methods: Episodes of MRSA bacteraemia in Chang Gung Children's Hospital neonatal intensive care unit from 1997 to 1999 were reviewed for incidence, predisposing factors, clinical presentations, treatment and outcome. Results: Ninety episodes of MRSA bacteraemia were identified. The overall rate of MRSA bacteraemia was 1.05 per 1000 patient days during the 3-y period. Most of the patients were premature infants (76%), with prior operation or invasive procedures (39%), had an indwelling intravascular catheter (79%) and exposure to antibiotic therapy (96%). A localized cutaneous infection was found in 53.3% of the episodes. The most common clinical diagnoses were catheter-related infections (54.4%), skin and soft tissue infections (21.1%), bacteraemia without a focus (20%) and pneumonia (16.7%). Metastatic infection occurred in 18% of these infants. Among the patients treated with vancomycin for 14d, 88.7% did not develop any complications, and 11.3% developed a recurrence. Conclusions: MRSA is an established pathogen in our NICU. MRSA bacteraemia in the neonates predominantly presented as catheter-related infections, and metastatic infections were not infrequently seen. In uncomplicated MRSA bacteraemia, treatment with vancomycin for 14 d seems to be adequate. [source]