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Summary: Background: The optimal screening strategy in hospitals to identify secondary cases after contact with a meticillin-resistant Staphylococcus aureus (MRSA) index patient in a low prevalence setting is not well defined. We aimed at identifying factors associated with documented MRSA transmissions. Method: Single center, retrospective, nested case-control study. We evaluated the screening strategy in our 950 bed tertiary care hospital from 2008 – 2014. Room and ward contacts of MRSA index patients present at time of MRSA identification were screened. We compared characteristics of Staphylococcus aureus Protein A (spa)-type matched contact patients (cases) to negative or spa-type mismatched contact patients (controls). Results: Among 270,000 inpatients from 2008 – 2014, 215 MRSA screenings yielded 3013 contact patients, and 6 (0.2%) spa-type matched pairs. We included 225 controls for the nested case-control study. The contact type for the cases was more frequently “same room” and less frequently “same ward” compared with the controls (P = 0.001). Also, exposure time was longer for cases (median of 6 days [IQR 3–9]) than for controls (1 day [0–3], P=0.016). Conclusion: The extensive MRSA screening strategy revealed only few index/contact matches based on spa-typing. Prolonged exposure time and a shared room were significantly associated with MRSA transmission. A targeted screening strategy may be more useful in a low prevalence setting than screening entire wards.

Summary: Background: Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks. Methods: Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings. Results: We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2390 case patients) were reported but only 28 (1.2% of the 2390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up. Conclusion: Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.