[Scientific article] The dissemination of staph infections in hospitals

From the ScienceDaily summary

Date:March 19, 2015
Source:PLOS
Summary:Wireless sensors recording human interactions explain the transmission of germs, such as MRSA, in hospitals, according to new research.

…

The results indicate that the study of individuals contact may help identify increased risk of transmission situations and ultimately reduce the burden of nosocomial S. aureus transmission.

The researchers say: “Contact networks have been increasingly used in modeling the spread of infectious diseases. Yet, the contacts collected were often incomplete or used proxies that were thought to capture situation at risk. In this unique experiment, the joint analysis of contact and carriage validates the use of close-proximity interactions recorded by electronic devices, and opens a new field for prevention measures in hospitals.”

…

[News release] MRSA can linger in homes, spreading among its inhabitants

View image | gettyimages.com

From the 10 March 2015 EurkAlert!

Households can serve as a reservoir for transmitting methicillin-resistant Staphylococcus aureus (MRSA), according to a study published this week inmBio®, the online open-access journal of the American Society for Microbiology. Once the bacteria enters a home, it can linger for years, spreading from person to person and evolving genetically to become unique to that household.

…

The researchers found that isolates within households clustered into closely related groups, suggesting a single common USA300 ancestral strain was introduced to and transmitted within each household. Researchers also determined from a technique called Bayesian evolutionary reconstruction that USA300 MRSA persisted within households from 2.3 to 8.3 years before their samples were collected, and that in the course of a year, USA300 strains had a 1 in a million chance of having a random genetic change, estimating the speed of evolution in these strains. Researchers also found evidence that USA300 clones, when persisting in households, continued to acquire extraneous DNA.

“We found that USA300 MRSA strains within households were more similar to each other than those from different households,”

…

We’re also getting hints at how it evolves inside households. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States.”

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Highly effective regimen for decolonization of methicillin-resistant Staphylococcus aureus carriers.“Standardized decolonization treatment consisted of mupirocin nasal ointment, chlorhexidine mouth rinse, and full-body wash with chlorhexidine soap for 5 days. Intestinal and urinary-tract colonization were treated with oral vancomycin and cotrimoxazole, respectively. Vaginal colonization was treated with povidone-iodine or, alternatively, with chlorhexidine ovula or octenidine solution. Other antibiotics were added to the regimen if treatment failed.”

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[News article] Vaccination leads to decline in pneumococcal disease and antibiotic resistance | Daily Science News

Vaccination leads to decline in pneumococcal disease and antibiotic resistance | Daily Science News.

Wits University and the National Institute for Communicable Diseases (NICD) released a new study, led by Wits academics, showing rates of invasive pneumococcal disease (IPD) – including cases caused by antibiotic resistant bacteria – have fallen substantially in South Africa following the introduction of a pneumococcal conjugate vaccine (PCV) in 2009.

The release of the results of the study coincides with World Pneumonia Day, commemorated annually on 12 November.

The study, titled: Effects of Vaccination on Invasive Pneumococcal Disease in South Africa, published in the latest edition of the New England Journal of Medicine (NEJM), compares IPD incidence after the introduction of PCV (post-introduction: 2011 and 2012) to incidence prior to its introduction (2005-2008), focusing on high-risk groups.

Although the majority of childhood pneumococcal deaths occur in Africa, evidence of the potential impact of pneumococcal vaccines in routine use has largely been drawn from high-income countries. However, two recent publications from South Africa have demonstrated PCVs to be effective in preventing pneumococcal disease among South African children, in conditions of routine vaccine use.

“The results show that the vaccine works as rolled out in our immunization program and this supports the hard work of our national and provincial Departments of Health. However, much still remains to be done in South Africa, other countries in Africa and elsewhere to prevent children from developing and dying from pneumonia,”said Dr Anne von Gottberg, lead author of the paper, Clinical Microbiologist, Head of the Centre for Respiratory Diseases and Meningitis at the NICD and Associate Professor in the School of Pathology at Wits.

This study demonstrates significant declines in pneumococcal disease cases caused by bacteria resistant to one or more antibiotics, a phenomenon of growing concern among health professionals. In fact, the rate of infections resistant to two different antibiotics declined nearly twice as much as infections that could be treated with antibiotics. This proportionately greater effect of vaccination on antibiotic-resistant strains points to a very valuable added benefit of immunization.

“These are very compelling results,” said Dr Seth Berkley, CEO of Gavi, the Vaccine Alliance, a Geneva-based global health organization that part-funded the research. “Not only does it add significant weight to the growing body of evidence that PCV prevents disease, but it suggests that vaccines may have a role to play in the fight against antibiotic resistance.”

“Vaccination is one of the most effective and underappreciated tools available to reduce antibiotic resistance. The majority of resistant strains of pneumococcus are of types which are included in the vaccine, for this reason, vaccine introduction in South Africa, has led to a substantial decline in antibiotic resistant invasive pneumococcal disease,” said Dr Cheryl Cohen, co-author of the paper, Clinical Epidemiologist at the NICD and senior lecturer in the School of Public Health at Wits.

In 2009, South Africa became the first African country – and the first nation in the world with a high HIV prevalence – to introduce PCV7 into its routine immunization program. The current study shows a significant decline in IPD in children and in unvaccinated adults, which demonstrates the indirect protection conferred by herd immunity. Among children under two years of age, overall incidence of IPD declined nearly 70% after PCV introduction, and rates of IPD caused by bacteria specifically targeted by the vaccine plummeted nearly 90%.

A recent study published by the researchers in the Pediatric Infectious Disease Journal found that the risk of IPD in South African children increased with HIV exposure, as well as with underlying medical conditions, malnutrition, tuberculosis, upper-respiratory tract infections and exposure to other children.

“We have shown that HIV-infected and HIV-exposed children experience a disproportionate burden of pneumococcal disease. The vaccine has also been shown to be highly effective in HIV-exposed children and disease reductions have been observed in both HIV-infected and uninfected children,” said Dr Claire von Mollendorf, a medical epidemiologist from the NICD. “This study reinforces what the scientific community has known – that the pneumococcal vaccine saves lives.”

Although incidence of HIV among infants is decreasing in South Africa due to improved prevention of the mother-to-child HIV transmission and the use of anti-retrovirals, a large number of HIV-exposed yet uninfected children remain, for whom vaccination against pneumococcal disease may be of particular importance to ensuring reduced risk of life-threatening infections in childhood.

Source: University of the Witwatersrand

by Taboola

Infection Report 5: What you really should be worried about | The Pediatric Insider

Infection Report 5: What you really should be worried about | The Pediatric Insider.

From the 10 October 2014 posting by Roy Benaroch, MD

This week’s posts have all been about infections, new and old—infections newly found, and infections sneaking back. On the one hand, the media is agog with news of Ebola and the mysterious paralysis virus; on the other hand, threats that are far more likely to kill us are being largely ignored.

One infection is on the verge of sneaking back, which is a shame. We had it beaten, and now we’re allowing it to gain a foothold. We’ve got a great way to eradicate measles, but fear and misinformation have led to pro-disease, anti-vaccine sentiment, especially among those white, elite, and wealthy. As we’ve seen, we’re all in this together—so those anti-vaccine enclaves are going to affect all of us.

Measles, itself, is just about the most contagious disease out there.

…..

English: This is the skin of a patient after 3 days of measles infection; treated at the New York – Presbyterian Hospital. Prior to widespread immunization, measles was common in childhood, with more than 90% of infants and children infected by age 12. Recently, fewer than 1,000 measles cases have been reported annually since 1993. 日本語: 麻疹患者の発疹. 中文: 感染了痲疹的皮膚. Українська: Як кір поражає шкіру. עברית: פריחה על עורו של חולה חצבת. (Photo credit: Wikipedia)

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Fighting Bacteria’s Strength in Numbers

Example of signaling between bacteria. Salmonella enteritidis uses acyl-homoserine lactone for Quorum sensing (Photo credit: Wikipedia)

From the 18 May 2012 article at Science Daily

Scientists at The University of Nottingham have opened the way for more accurate research into new ways to fight dangerous bacterial infections by proving a long-held theory about how bacteria communicate with each other.

Researchers in the University’s School of Molecular Medical Sciences have shown for the first time that the effectiveness of the bacteria’s communication method, a process called ‘quorum sensing’, directly depends on the density of the bacterial population. This work will help inform wider research into how to stop bacteria talking to each other with the aim of switching off their toxin production.

As some pathogenic organisms are increasingly resistant to traditional antibiotics, medical researchers around the world, including scientists at The University of Nottingham, are trying to find other ways of fighting infection. This new work involves using ‘quorum quenching’ compounds which interfere with bacterial signalling and disrupt their social lives.

Quorum sensing (QS) is the process by which bacteria communicate and co-operate using signal molecules which control, among other things, the production of toxins. QS is therefore an important factor in a number of bacterial species that cause serious infection in humans includingPseudomonas aeruginosa, a leading cause of death among cystic fibrosis sufferers, and MRSA which is a huge clinical problem in hospitals….

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For Rapid Response To Health-Care-Associated Infections, Collaboration Needed, Survey Reveals

From the 10 March 2012 Medical News Today article

he U.S. Department of Health and Human Services (HHS) estimates that about one in every 20 patients develops an infection each year related to their hospital care. The key to preventing an outbreak of potentially deadly healthcare-associated infections (HAIs) – such as methicillin-resistant Staphylococcus aureus (MRSA) or C. difficile – is identifying them before affected individuals can pose a transmission risk.

But, according to a survey released by the Association for Professionals in Infection Control and Epidemiology (APIC) and the American Society for Microbiology (ASM), the typical turnaround time for laboratory test results may not be meeting expectations. Greater collaboration between labs and infection preventionists may hold the key to addressing the gap – and to more effective management of some HAIs.

Most (51 percent) of the infection preventionists (IPs) surveyed indicated that they need results for MRSA screening tests within 12 hours to initiate the necessary precautions; however, MRSA cultures – a traditional method for screening – typically take 24 to 48 hours to complete.

The survey identified two factors that could be addressed to help resolve the discrepancy and reduce HAIs: the need for increased communication between IPs and lab professionals, and the lack of tools and resources for training and educating all healthcare personnel. …

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Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Proportion of MRSA human blood isolates from participating countries in 2008***

From the 14 December edition of Full Text Reports

Antibacterial Drugs and the Risk of Community-Associated Methicillin-Resistant Staphylococcus aureus in Children

Source:  Archives of Pediatrics & Adolescent Medicine

Objective
To investigate in children the association between antibacterial drugs and subsequent diagnosis of methicillin-resistant Staphylococcus aureus (MRSA) in the community.

Design
Population-based case-control study in children 1 to 19 years of age.

Setting
Primary care, General Practice Research Database, United Kingdom, 1994-2007.

Participants
Cases were children who had MRSA diagnosed as outpatients, and controls were individually matched on age and practice, with the matched case’s diagnosis date as the index date for both.

Main Exposures
Antibacterial agents prescribed 180 to 30 days prior to the index date, excluding prescriptions 30 days before the index date to prevent protopathic bias.

Outcome Measures
Rate ratios (RRs) estimated from the odds ratios of exposure in cases compared with controls using conditional logistic regression, adjusted for comorbid conditions, other prescription drug use, and hospitalization.

Results
The rate of MRSA was 4.5 per 100 000 per year. Of 297 cases and 9357 controls, 52.5% and 13.6%, respectively, received antibacterial drug prescriptions during the 150-day exposure window. The adjusted RR with any antibacterial drug was 3.5 (95% confidence interval [CI], 2.6-4.8). The RRs increased with the number of prescriptions (2.2 [95% CI, 1.5-3.2], 3.3 [95% CI, 1.9-5.6], 11.0 [95% CI, 5.6-21.6], and 18.2 [95% CI, 9.4-35.4] for 1, 2, 3, and 4 prescriptions, respectively). The RR was particularly elevated for quinolones at 14.8 (95% CI, 3.9-55.8), with wide variation among antibacterial classes.

Conclusion
While close to half of children were diagnosed as having MRSA in the community without prior antibacterial drugs, such agents are associated with a dose-dependent increased risk, concordant with findings in adults.

***Image from http://commons.wikimedia.org/wiki/File:EARSS_MRSA_2008.sv, Institute for Public Health and the Environment (RIVM), Epidemiology and Surveillance, 3720 BA Bilthoven,The Netherlands

 

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• MRSA (MedlinePlus) A general guide with links to overviews, diagnosis/symptoms, specific conditions, news items, and more
• MRSA Infection (eMedicine Health)  A patient/consumer guide with links to diagnosis/symptoms, risk factors, images, and slideshows
• Methicillin-resistant Staphylococcus Aureus (MRSA) Infections (CDC) Comprehensive guide with links to definition, symptoms, prevention, people at risk, environmental cleaning, statistics, and educational resources

   

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Disclaimer: Links below are for informational/awareness only

                            The inclusion of any article here does not necessarily mean agreement with this author’s beliefs 

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HHS Releases New Online Patient Safety Training Resources for Clinicians and Patient Advocates

Partnering to Heal is a computer-based, interactive learning tool for clinicians, health professional students, and patient advocates.

The training highlights effective communication about infection control practices and what it means to help create a “culture of safety” in healthcare institutions.

From the press release

The HHS Office of the Assistant Secretary for Health released Partnering to Heal: Teaming Up Against Healthcare-Associated Infections, an interactive learning tool for clinicians, health professional students, and family caregivers.  The training videos include information on basic protocols for universal precautions and isolation precautions to protect patient, visitors, and practitioners from the most common disease transmissions.  The training promotes six key behaviors: teamwork, communication, hand washing, vaccination against the flu, appropriate use of antibiotics, and proper insertion, use, and removal of catheters and ventilators.  Learn how five characters can contribute to—or prevent—risk of several healthcare-associated infections, including surgical site infections, central line-associated bloodstream infections, ventilator-associated pneumonia, catheter-associated urinary tract infections,clostridium difficile and methicillin-resistant Staphylococcus aureus.  These resources support the new Partnership for Patients, a new national public-private partnership with hospitals, medical groups, consumer groups, and employers that will help save lives by preventing millions of injuries and complications in patient care over the next 3 years.  Select to read the HHS press release.

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Antimicrobial Resistance Posing Growing Health Threat

CDC and Partners Celebrate World Health Day 2011 to Draw Attention to the Issue

Methicillin-resistant Staphylococcus aureus (MRSA) bacteria
Source: Public Health Image Library (PHIL)

Excerpts from the US Centers for Disease Control and Prevention (CDC) press release

Millions of Americans take antimicrobial drugs each year to fight illness, trusting they will work. However, the bacteria, viruses and other pathogens are fighting back. Within the past couple of years alone, new drug-resistant patterns have emerged and resistance has increased – a trend that demands urgent action to preserve the last lines of defense against many of these germs. Today, CDC joins theWorld Health Organization and other health partners in recognizing World Health Day, which this year spotlights antimicrobial resistance.

“People assume that antibiotics will always be there to fight the worst infections, but antimicrobial resistance is robbing us of that certainty and new drug-resistant pathogens are emerging,” said CDC Director Thomas R. Frieden, M.D., M.P.H. “It’s not enough to hope that we’ll have effective drugs to combat these infections. We must all act now to safeguard this important resource.”

Antimicrobial resistance—when germs change in a way that reduces or eliminates the effectiveness of drugs to treat them—is a growing global problem. Plasmodium falciparum, the most dangerous of the malaria parasites, has developed resistance to nearly all of the currently available antimalarial drugs in parts of Southeast Asia. Sporadic cases of pandemic H1N1 flu have shown resistance to oseltamivir, one of only two antivirals that work against it. In the United States, methicillin-resistant Staphylococcus aureus, known as MRSA, remains a problem in many health care settings. Drug-resistant Klebsiella pneumoniae, previously seen in a limited number of hospitals, has now been reported in at least 36 states. Gonorrhea is now showing potential for resistance to cephalosporins, the only recommended antibiotic left to treat this common sexually transmitted infection.

Antibiotic resistance increases the economic burden on the entire health care system. Resistant infections are often more severe, leading to longer hospital stays and increased costs for treatment. According to the latest available data, antibiotic resistance in the United States costs an estimated $20 billion a year in excess health care costs, $35 million in other societal costs and more than 8 million additional days that people spend in the hospital.

As part of this effort, CDC—in collaboration with the Food and Drug Administration, the National Institutes of Health and other partners—recently released a public health action plan laying out 11 key goals to combat antimicrobial resistance in the areas of surveillance, prevention and control, research and product development. The plan is designed to facilitate communication and coordination as well to provide guidance on the most pressing resistance issues and how to address them….

…Appropriate use of existing antibiotics can limit the spread of antibiotic resistance, preserving antibiotics for the future. CDC advocates for the appropriate use of antibiotics through its Get Smart programs focused on community and health care settings. CDC is engaged in working to address antimicrobial resistance across a growing number of disease-causing organisms and settings.

The public can also play a role in reducing the threat of antimicrobial resistance by not pressuring their health care providers for antibiotics, not sharing or saving antibiotics, and taking antibiotics exactly as prescribed, including taking the entire amount prescribed. Health care providers can prevent antimicrobial resistance by ensuring prompt diagnosis and treatment of infections, prescribing antibiotics appropriately, and following infection prevention techniques to prevent the spread of drug-resistant infections in health care facilities.

To learn more about antimicrobial resistance by disease and setting, please visithttp://www.cdc.gov/media/releases/2011/f0407_antimicrobialresistance.html. For more information on CDC’s antimicrobial resistance efforts, please visit http://www.cdc.gov/drugresistance/index.html.

The action plan is posted on the Federal Register and comments on the plan will be accepted through April 15, 2011. To view the action plan, please visit:http://wwwn.cdc.gov/publiccomments/comments/a-public-health-action-plan-to-combat-antimicrobial-resistance-draft.aspx.

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