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Background MRSA colonization is a common neonatal problem and is associated with invasive infection. Good hand-washing and contact precautions reduce transmission. However, long-term contact isolation, sometimes for months, causes dissatisfaction among neonatal intensive care unit (NICU) care providers and parents. We examined the effectiveness of MRSA decolonization among neonates over 3 years. Methods Our NICU patients are routinely screened for MRSA colonization by PCR testing of nasal and rectal swabs upon admission and every 2 weeks. Patients with a history of MRSA infection or colonization became eligible for MRSA eradication upon reaching 2000g. Our protocol included intranasal muporocin 2% ointment applied to both nares twice daily for 5 days and 2% chlorhexidine wipe bath daily for 7 days. Wipes were used for bathing from the neck down for at least 20 sec per wipe. Two wipes were used for patient’s < 10 kg with the first wipe being used on the neck, chest, arms, and back, and the second wipe being used on the legs, buttocks, and perineum. Patients were excluded from chlorhexidine bathing if they had a known allergy, were < 27 weeks gestation, < 1 week chronological age, receiving phototherapy, or had severe skin disease, open wounds, or burns. Contact isolation was discontinued if 2 sets of nares and rectal PCR swabs 5 days apart were negative and the patient had not been on antibiotics during the screening period. Surveillance MRSA PCR testing continued. Contact isolation was to be re-initiated if subsequent MRSA screening was positive. Patients were not decolonized a second time. Results Among infants admitted to the NICU during from 2016 to 2018 MRSA colonization was identified in 102 patients. Fifty-six were noted to have colonization present on admission and 46 were acquired on or after hospital day 3. The decolonization protocol with follow-up screening was completed in 33 infants. Successful decolonization was achieved for only 5 (15%) of infants. There were no adverse reactions noted among neonates and no MRSA decolonized patients reverted to positive by PCR screening while in hospital. Conclusion 85% of neonates with MRSA failed decolonization. Using mupirocin intranasally and chlorhexidine bathing to decolonize neonates with MRSA was welcomed by staff and families, but was poorly effective. Disclosures All authors: No reported disclosures.

Background Methicillin-resistant staphylococcus aureus (MRSA) bloodstream infection (BSI) is associated with significant morbidity and mortality. Healthcare-associated (HCA) MRSA infection (occurring >48 hours after hospitalization or in those with prior healthcare exposure) has traditionally been associated with severe invasive disease, while community-associated (CA) MRSA infection (occurring within 48 hours of hospitalization and without prior healthcare exposure) has been observed in otherwise healthy individuals. We characterized the epidemiology, resistance patterns, and clinical outcomes associated with MRSA BSI over a 5 year period comparing patients with community-onset bacteremia to those with hospital onset bacteremia. Methods We performed a retrospective chart review of 151 MRSA bloodstream infections from 2013–2018 at the University of Alberta Hospital (Edmonton, Canada). We assessed each BSI by: classification (CA vs. HCA), presence of MRSA risk factors, source of infection, MRSA resistance, rate of ICU admission, and 30-day mortality. Results The median age of all patients with MRSA BSI was 53 years (range 23–94). MRSA BSI occurred more commonly in males for both CA and HCA infection (53% and 62%). HCA-MRSA infections had a higher rate of previous MRSA colonization (64.8%) compared with CA-MRSA patients (41.7%). Injection drug use was higher in CA-MRSA infections (47% vs. 11%). The most common source of CA-BSI was bone/joint (30%) while line-associated infections were the most common in HCA-BSI. Clindamycin resistance was common (46–53% susceptible) while resistance to tetracyclines (91–97% susceptible) and trimethoprim/sulfamethoxazole (98–100% susceptible) was uncommon. HCA-MRSA BSI was associated with a higher rate of ICU admission (44% vs. 33%) and 30-day mortality (18.7% vs. 11.7%). Conclusion Invasive MRSA infection continues to be associated with significant morbidity and mortality. We found that healthcare-associated MRSA BSI was associated with a high rate of prior MRSA colonization as well as a higher rate of ICU admission and 30-day mortality. There are significant differences in the demographics of patients with CA BSI compared with HCA BSI. Interventions to prevent these infections need to be targeted to the geographic location of acquisition. Disclosures All authors: No reported disclosures.

This study is aimed at investigating biofilm and enterotoxin producing capacity of methicillin-resistant Staphylococcus aureus isolated from nostrils of healthy students of Delta State University Oleh campus. Three hundred (300) nasal samples were collected using sterile swab stick and the isolates were identified using relevant biochemical tests. Determination of methicillin-resistant Staphylococcus aureus was carried out with the aid of Oxacillin sensitivity disc to test the presence of penicillin binding protein2a (PBP2a). The Methicillin-resistant Staphylococcus aureus (MRSA) isolates were screened to determine their biofilm producing ability using crystal binding assay. Latex agglutination test was carried out to detect the presence of enterotoxins among the MRSA isolates. The incidence of MRSA colonization among healthy individuals in the community of the S. aureus isolated was 47 (48.9%). Enterotoxins B was mostly detected, only three Enterotoxin C were detected. All the MRSA isolates tested for the presence of biofilm showed positive results. It has been observed that MRSAs are capable of producing biofilms and enterotoxins which pose the risk antibiotic resistance and human Staphylococci toxicity. Keywords: Enterotoxins, Biofilm, Staphylococcus aureus

Methicillin-Resistant Staphylococcus Aureus (MRSA) is a serious strain of Staphylococcus Aureas that causes life threatening pneumonia, bloodstream infections and surgical site infections in medical facilities. The transition to colonization or infection of even low risk populations places the Nursing Officers in a vulnerable position as they provide care to the patient with unsuspected MRSA colonization or Infection. The aim of the study is to assess the Knowledge and Behavioral Competence on Methicillin Resistance Staphylococcus aureus (MRSA) among Nursing Officers. So Pre Experimental Time series research design was used for this study. The sample comprised of 50 Nursing Officers. Data was collected by using self administered structured questionnaire before and after Educational Interventional programme. The study result shows that 42 [84%] of Nursing Officers having Inadequate knowledge and 6[12%] of them have Moderate adequate knowledge and 2(4%) of them have adequate knowledge and 50(100%) had Poor Competence and no one had fair and good Competence on MRSA before intervention. Before the Educational Interventional programme, the mean score of Knowledge was 8.32 and mean score of Behavioral Competence was 47.70 and there was a marked gain in Knowledge and Behavioral Competence mean score after the Educational Interventional programme were 19.54 and 98.00. The difference in knowledge and Behavioral competence score were statistically significant at 0.001 level which indicates that Educational Interventional Programme was effective in terms of gaining Knowledge and Behavioral Competence. The findings of this study support the need for conducting CNE on MRSA to increase the Knowledge and Behavioral Competence about MRSA among Nursing Officers and recommended to follow Infection control measures and standard precautions to prevent the spread of MRSA infections.

INTRODUCTION:The frequency of methicillin-resistant Staphylococcus aureus (MRSA) has increased in the community. This study evaluated the prevalence of MRSA and community-acquired (CA)-MRSA in 120 healthy elderly.METHODS:The MRSA were evaluated for the presence of the IS256, mecA, agr, icaA, icaD, fnbB , and pvl genes with PCR. Results: Frequency of S. aureus and MRSA colonization was 17.8% and 19%, respectively. CA-MRSA isolate showed SCC mec IV, fnbB+ , and icaD+ .CONCLUSIONS:CA-MRSA was detected, with genotype determined as SCC mec type IV/IS256/ fnbB+ / icaA / icaD+ / bbp-/agr2 / bap / pvl, characterizing this population as a possible reservoir of this organism in the community.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been recognized as a significant problem among hospitalized patients. Available data about prevalence of MRSA among children with congenital heart disease (CHD) are minimal. The aim of the study was to determine the prevalence of MRSA colonization and to identify risk factors for MRSA colonization among children Methods: Admission and weekly MRSA nasal surveillance testing was performed, and patients were stratified into six risk groups based on the Risk Adjustment for Congenital Heart Surgery-1 Method. The MRSA-colonized children were compared to the MRSA noncolonized children. Results: During the 3-year study period, there were 372 admissions of children with CHD to the PICU. Of the 372, 72 (19.4%) had no surveillance cultures performed or had no prior history of MRSA and were excluded from further analysis. Of the remaining 300 admissions, 29 (9.7%) (263 individual children) were found to be colonized. The mean age of the 263 children when first admitted to the PICU was 3.29 years (range 0.03-18.30, median 0.66). Age distribution was not significantly different between the colonized and noncolonized groups ( P = .236). Gender ( P = .667), race ( P = .837), and CHD complexity ( P = .395) were not significantly associated with colonization. The odds of being colonized if previously hospitalized were 4.42 times greater than if not previously hospitalized (95% confidence interval 1.89, 10.34). Conclusion: Routine MRSA surveillance should be performed in patients with CHD to identify colonized patients.

OBJECTIVE: We studied the prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) nasal carrier in patients who were transferred and admitted to the intensive care unit (ICU). MATERIALS AND METHOD: By using LightCycler® MRSA advanced test for the direct detection of MRSA DNA in nasal colonization by polymerase chain reaction (PCR) and comparing to standard MRSA isolated from plate culture media. RESULTS: From December 2010 to May 2011, 100 patients were enrolled. They were referred to be admitted in ICUs of Bangkok Hospital Medical Center (BMC) (87), Samitivej Hospital Sukhumvit (12) and Bangkok Hospital Pattaya (1). Seventeen patients were excluded from the study. Of 83 patients, the LightCycler® MRSA test detected MRSA from an anterior nasal swab in 12 (14.5%) patients while concomitant plate culture grew MRSA in 10 (12.1%) (Kappa = 0.7913, 95% confi dence interval (CI) = 0.594-0.988). CONCLUSION: The LightCycler® MRSA advanced test is a diagnostic test for rapid MRSA detection. The test aids in the detection of hospital infection and in the control of MRSA infections by rapid detection, therefore identifying the appropiate and isolated patient whom has MRSA colonization particularly in high risk patients.

A longitudinal study was performed to determine the age at which piglets become colonized with livestock-associated MRSA and the effect of the sow MRSA status on the colonization status of their offspring. On four farrow-to-finish farms (A–D), nasal swabs were collected during a 6-month period from 12 sows and their offspring per farm. Piglets and sows were sampled throughout the nursery period. Additionally, the piglets were sampled after weaning, before and after moving to the finishing unit and before slaughterhouse transport. The environment of one pen (wall, floor and air) was sampled every time the pigs were sampled. Two MRSA colonization profiles were observed. On farms A and B, the sows’ colonization prevalence reached 17% and 33%, respectively. The proportion of positive piglets remained low in the nursing unit (farm A: 0–7%, farm B: 0–36%) and increased at the end of their stay in the growing unit (farm A: 91%, farm B: 69%). On farms C and D, the sows’ and piglets’ colonization percentages were high from the beginning of the sampling series and finally reached 100%. On all farms, a decrease in colonization was observed towards slaughter age. The colonization age differed between farms. A statistically significant effect of the sow status at farrowing on the piglets’ status was observed. The present study indicates that the sow's colonization status is important and should be included in control measures. However, the observed differences in colonization percentages among the farms complicate implementation of control measures on the farm.

Preventing the spread of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities is a major infection control target. However, only a few studies have assessed the potential role of healthcare workers (HCWs) for MRSA dissemination. To investigate the MRSA prevalence and the risk factors for MRSA colonization among HCWs, nasopharyngeal swabs were taken between June 2010 and January 2011 from 726 employees from nine acute care hospitals with different care levels within the German part of a Dutch-German border region (EUREGIO). The isolated MRSA strains were investigated using spa typing. The overall MRSA prevalence among HCWs in a non-outbreak situation was 4.6% (33 of 726), and was higher in nurses (5.6%, 29 of 514) than in physicians (1.2%, 1 of 83). Possible risk factors associated with MRSA colonization were a known history of MRSA carriage and the presence of acne. Intensive contact with patients may facilitate MRSA transmission between patients and HCWs. Furthermore, an accumulation of risk factors was accompanied by an increased MRSA prevalence in HCW.

Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been linked to HIV-related sexual and social behaviors. MRSA risk factors may be different for HIV-infected children, adolescents and young adults. We investigated the association of MRSA colonization, persistent colonization and genotypes with potential risk factors among HIV-infected youth.For this case-control study, patients 24 years of age or younger attending 2 HIV reference centers were recruited from February to August 2012 and followed for 1 year. Nasal swabs were collected at enrollment and every 3 months. MRSA clones were characterized by staphylococcal chromosomal cassette mec typing, spa typing and multilocus sequence typing. We compared MRSA colonization and persistent colonization with patient demographic and clinical characteristics.Among 117 participants, MRSA colonization frequency (calculated for each collection based on the number of positive cultures per patient) was 12.8% at the first collection. The average MRSA colonization frequency was 10.4%. Our results showed 11.1% were persistent carriers (subjects with more than 1 positive culture in at least 3). Crowding was the only factor associated with MRSA colonization (P = 0.018). Persistent carriers had significantly higher (4.2 times) odds of living in a crowded household (95% confidence interval-1.1-16.2). We observed high genetic diversity among MRSA isolates, with t002/ST5 and t318/ST30 being the most frequent.MRSA colonization among HIV-infected youth is more closely related to living in a low-income or slum community than to HIV-related clinical factors. High genetic MRSA isolate diversity in our population suggests frequent transmission.

Objectives. We performed a one-year prospective surveillance study on MRSA colonization within the five NICUs of the metropolitan area of Palermo, Italy. The purpose of the study was to assess epidemiology of MRSA in NICU from a network perspective. Methods. Transfer of patients between NICUs during 2014 was traced based on the annual hospital discharge records. In the period February 2014 – January 2015, in the NICU B, at the University teaching hospital, nasal swabs from all infants were collected weekly, whereas in the other four NICUs (A, C, D, E) at four week-intervals of time. MRSA isolates were submitted to antibiotic susceptibility testing, SCCmec typing, PCR to detect lukS-PV and lukF-PV (lukS/F-PV) genes and the gene encoding the toxic shock syndrome toxin (TSST-1), multilocus variable number tandem repeat fingerprinting (MLVF) and multilocus sequence typing (MLST). Results. In the period under study, 587 nasal swabs were obtained from NICU B, whereas 218, 180, 157 and 95 from NICUs A, C, D and E, respectively. Two groups of NICUs at high prevalence and low prevalence of MRSA colonization were recognized. Overall, 113 isolates of MRSA were identified from 102 infants. Six MLVF types (A-F) were detected, with type C being subdivided into five subtypes. Five sequence types (STs) were found with ST22-IVa being the most frequent type in all NICUs. All the MRSA molecular subtypes, except for ST1-IVa, were identified in NICU B. Conclusions. Our findings support the need to approach surveillance and infection control in NICU in a network perspective, prioritizing referral healthcare facilities.

Carbapenem-resistant Acinetobacter baumannii (CRAB) with diverse multilocus sequence typing emerged among our nursing home residents (6.5%) with a high background rate of MRSA (32.2%). Rectal swabs yielded a higher rate of CRAB detection than axillary or nasal swabs. Bed-bound status, use of adult diapers, and nasogastric tube were risk factors for CRAB colonization.Infect Control Hosp Epidemiol 2016;37:983–986

Septorhinoplasty is a commonly performed procedure for facial aesthetics and obstructed nasal breathing. There have been only 4 reported cases of methicillin-resistant Staphylococcus aureus (MRSA)-associated postoperative complications following septorhinoplasty reported in the literature across all specialties. In this article, we report a case of MRSA-associated infection after an uncomplicated septorhinoplasty. Risk stratification and outcome of treatment are described, followed by a review of the current literature. We discuss the epidemiology of MRSA colonization, prophylactic use of antibiotics in septorhinoplasty, previously reported MRSA-associated septorhinoplasty infections, and management of complications. There are no current standards for MRSA decolonization before septorhinoplasty. Finally, we offer recommendations for patients at high risk for MRSA infection undergoing septorhinoplasty and considerations for treatment of MRSA infections should they occur after septorhinoplasty.

John Chipolombwe,1 Mili Estee Török,2 Nontombi Mbelle,3 Peter Nyasulu,4,51Department of Internal Medicine, Mzuzu Central Hospital, Ministry of Health, Mzuzu, Malawi; 2Department of Medicine, University of Cambridge, Cambridge, UK; 3Department of Medical Microbiology, University of Pretoria, Pretoria, South Africa; 4School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, 5Department of Public Health, School of Health Sciences, Monash University, Johannesburg, South Africa Purpose: The objective of this study was to evaluate the optimal number of sampling sites for detection of methicillin-resistant Staphylococcus aureus (MRSA) colonization. Methods: We performed a Medline search from January 1966 to February 2014 for articles that reported the prevalence of MRSA at different body sites. Studies were characterized by study design, country and period of the study, number of patients and/or isolates of MRSA, specimen type, sites of MRSA isolation, study population sampled, diagnostic testing method, and percentage of the MRSA isolates at each site in relation to the total number of sites. Results: We reviewed 3,211 abstracts and 177 manuscripts, of which 17 met the criteria for analysis (n=52,642 patients). MRSA colonization prevalence varied from 8% to 99% at different body sites. The nasal cavity as a single site had MRSA detection sensitivity of 68% (34%–91%).The throat and nares gave the highest detection rates as single sites. A combination of two swabs improved MRSA detection rates with the best combination being groin/throat (89.6%; 62.5%–100%). A combination of three swab sites improved MRSA detection rate to 94.2% (81%–100%) with the best combination being groin/nose/throat. Certain combinations were associated with low detection rates. MRSA detection rates also varied with different culture methods. Conclusion: A combination of three swabs from different body sites resulted in the highest detection rate for MRSA colonization. The use of three swab sites would likely improve the recognition and treatment of MRSA colonization, which may in turn reduce infection and transmission of MRSA to other patients. Keywords: Staphylococcus colonization, swab sites, MRSA detection

Background Recent spread of USA300 methicillin-resistant Staphylococcus aureus (MRSA) to nursing homes has been of particular concern. We sought to predict the ultimate prevalence of USA300 and non-USA300 MRSA and to examine the influence of potential risk factors on MRSA acquisition in community nursing homes. Methods The data were collected during a longitudinal MRSA surveillance study that involved 449 residents in 6 community nursing homes in Wisconsin. The subjects were screened every 3 months for up to 1 year. Markov chain models were employed to predict strain-specific prevalence of MRSA at steady state, and to assess the influence of potential risk factors, including recent hospitalizations, invasive medical devices, and antibiotic exposure on MRSA acquisition rates and average duration of colonization. Results At steady state, 20% (95% confidence interval [CI], 15%-25%) of residents were predicted to remain colonized with non-USA300 and 4% (95% CI, 2%-7%) with USA300 MRSA. Residents who used antibiotics during the previous 3 months were twice more likely to acquire MRSA than those who did not (acquisition rates, 0.052; 95% CI, 0.038-0.075 and 0.025; 95% CI, 0.018-0.037, respectively). Conclusions Non-USA300 was predicted to remain the dominant MRSA strain in community nursing homes. The higher rate of MRSA acquisition among residents with recent antibiotic exposure suggests that antibiotic stewardship may reduce MRSA colonization in this setting.

SUMMARYReadmission of asymptomatic methicillin-resistant Staphylococcus aureus (MRSA) carriers may contribute to the hospital reservoir. Using an electronic alert system, we assessed the weight of readmission of known MRSA carriers on MRSA colonization pressure in a hospital setting. During the 2004–2010 period, 2058 alerts were generated for 1060 inpatients. A total of 486/1060 patients (46%) were readmitted at least once, and 330/486 (64·4%) were readmitted R2 = 0·49). Rapid electronic identification of these patients proved essential in decreasing the global burden of MRSA in our hospital.

Background: The aim of this study was to assess the nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) and the predictive role of colonization pressure (CP) in a low-prevalence healthcare setting. Methods: A retrospective analysis of MRSA infection rates from 2004 to 2009 at the Saudi Aramco Dhahran Health Center, Saudi Arabia, was performed. MRSA patient-days, susceptible patient-days, nosocomial incidence and CP were calculated for each month from January 2008 to December 2009. Results: During the study period, 878 cases of MRSA colonization/infection were identified. Of these cases, 777 (88.4%) and 101 (11.5%) were community-acquired MRSA (CA-MRSA) and healthcare-associated MRSA (HA-MRSA) cases, respectively. A decrease in the number of HA-MRSA cases and an increase in the number of CA-MRSA cases were observed during the study period. The incidence of nosocomial infection per 1000 susceptible patient-days was 1.17 in 2008 and 0.7 in 2009. The monthly colonization pressure ranged from 0.1 to 1.62 throughout the 2-year period. Nosocomial transmission was observed in 13 months of the 24-month study period. No association between the CP of the preceding month and the incidence of nosocomial transmission in the subsequent month was observed. Conclusion: In a setting of low MRSA prevalence, CP does not appear to be a useful predictor of nosocomial transmission or incidence. Keywords: Colonization pressure, MRSA, Hospital-associated infections

Rapid detection of nasal colonization with methicillin-resistant Staphylococcus aureus (MRSA) followed by appropriate infection control procedures reduces MRSA infection and transmission. We compared the performance and workflow of two Food and Drug Administration-approved nucleic acid amplification assays, the LightCycler MRSA Advanced Test and the Xpert MRSA test, with those of directly plated culture (MRSASelect) using 1202 nasal swabs collected at three U.S. sites. The sensitivity of the LightCycler test (95.2%; 95% CI, 89.1% to 98.4%) and Xpert assay (99%; 95% CI, 94.8% to 100%) did not differ compared with that of culture; the specificity of the two assays was identical (95.5%; 95% CI, 94.1% to 96.7%) compared with culture. However, sequencing performed on 71 samples with discordant results among the three methods confirmed the presence of MRSA in 40% of samples that were positive by both molecular methods but negative by culture. Workflow analysis from all sites including batch runs revealed average hands-on sample preparation times of 1.40, 2.35, and 1.44 minutes per sample for the LightCycler, Xpert, and MRSASelect methods, respectively. Discrete event simulation analysis of workflow efficiencies revealed that the LightCycler test used less hands-on time for the assay when greater than eight batched samples were run. The high sensitivity and specificity, low hands-on time, and efficiency gains using batching capabilities make the LightCycler test suitable for rapid batch screening of MRSA colonization.

Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of healthcare-related infection. Surveillance and prevention of MRSA is a priority in infection control programs. The aim of this study was to describe rates and trends of MRSA colonization or infection in 40 hospitals participating in the VINCat Program from 2008 to 2010. The study included all patients treated in acute care areas of participating hospitals. Hospitals were stratified into 3 groups based on size. The following annual indicators were reported: Methicillin-resistance rate, incidence density of new cases of MRSA and incidence density of MRSA bacteremia. Between 2008 and 2010, the yearly mean rate of resistance to methicillin remained stable for the study period (24%–25%), while the mean incidence of new cases of MRSA decreased from 0.65 to 0.54 cases per 1000 patient-days (p=NS) and the mean incidence of MRSA bacteremia decreased from 0.06 to 0.05 cases per 1,000 patient-days (p=NS). The implementation of a MRSA surveillance system in hospitals that participated in the VINCat Program provides information on the situation of each institution and facilitated interhospital comparisons in order to establish appropriate preventive measures.

Summary Background Panton–Valentine leucocidin-positive meticillin-resistant Staphylococcus aureus (PVL-MRSA) has become a globally common cause of community-acquired infections. Aim We report an outbreak of PVL-MRSA in a regional neonatal unit in the UK involving three babies and three staff members. Methods Quinolone susceptibility was helpful in identifying potential PVL-MRSA but toxin gene profiling and sequence-based typing were required to distinguish between two PVL-MRSA strains present in the unit. Findings All three symptomatic babies and two staff carriers, one of whom was symptomatic, were found to be carrying the South West Pacific (SWP) clone of PVL-MRSA (ST30). One of the staff carriers had recently visited the Philippines and was thought to be the source of the outbreak. Control was established using standard infection control procedures but one baby with relapsing MRSA colonization has required more than 100 days in isolation. Conclusion This is the first reported neonatal outbreak associated with the SWP clone in the UK. Our study highlights the potential risk of further introductions of this organism by healthcare staff or patients epidemiologically linked with the Philippines.

Background USA300 MRSA is endemic in certain communities, with congregate settings such as urban jails potentially facilitating spread. The extent of MRSA transmission in jail is unclear, a controversy that impacts prevention strategies. We determined the prevalence of MRSA colonization at jail entrance and defined the acquisition rate during incarceration. Methods Men incarcerated at the Cook County Jail, one of the largest US single-site jails, were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify predictors of colonization. Detainees still in jail at Day30 had cultures repeated to determine MRSA acquisition rate. Univariate and multivariate analysis was performed to identify predictors of MRSA colonization. Results A total o 402 men (447 unique incarcerations) have so far been enrolled (77% AA, 11% Hispanic) with 92% previously in jail (20% in past 6 months). The prevalence of MRSA colonization at intake was 18.6% (83/447), with 39% of those colonized solely in the throat or groin. At 30 days: 10% (9/92) of initially negative men acquired MRSA; 14 admission positives remained colonized while 11 lost colonization. On univariate (Table), predictors of MRSA colonization at entrance to the jail were: methamphetamine use (METH), unstable housing, current skin infection, and care at an outpatient Clinic A that emphasizes comprehensive care to the LGBTQ community. In this cohort, METH use was associated with reporting being a man who has sex with men vs. not (35% vs. 9%, P Conclusion We found that a relatively high proportion of individuals enter the jail colonized with MRSA and the jail may amplify rates. Entrance colonization risk factors point to possible community reservoirs. Enrollment is ongoing but results suggest an intervention in jail could impact MRSA rates in the jail and in the surrounding community. Disclosures M. K. Hayden, Sage, Inc: Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product., Sage is contributing product to healthcare facilities participating in a regional collaborative on which I am a co-investigator. Neither I nor my hospital receive product.; Clorox, Inc.: I have received funding from Clorox for an investigator-initiated clinical trial., Research support; CDC: Grant Investigator, Research grant

Background: The dissemination of methicillin resistant staphylococcus aureus (MRSA) is an increasing challenge in medical care. Apart from hospital acquired MRSA, there has also been an increase in community acquired and livestock associated MRSA. While the risks of MRSA (e. g. wound infections) and consequences (e. g. rejection of patients) are well known, there are little data on the effectiveness of eradication procedures. Patients and methods: 32 patients with proven MRSA colonization were monitored during eradication for the following aspects: (1) localization of MRSA (swabs from hairline, anterior nares, throat, axillae, groins, perineum, and wounds, if present), (2) presence of eradication-impairing factors, (3) length of time needed for eradication, (4) cost of eradication, (5) molecular fingerprint and risk assessment (spa-types). Results: We describe the successful eradication of MRSA in all 32 patients. Most positive nasal swabs were obtained from the anterior nares and the throat and only rarely from the hairline or axillae. The greater the number of positive swabs, the more time was needed for eradication. In most patients (37.5 %), eradication with topical antiseptics was successful. The average time for eradication was 12.97 (+/- 7.6) days. Twelve patients required systemic antibiotic therapy. Treatment costs associated with the use of systemic antibiotics were significantly higher. The most frequent spa types were t032 and t003. Conclusions: We report successful MRSA eradication in outpatients. Systemic antibiotics are unnecessary in the majority of patients. A combined anti-MRSA strategy for inpatients and outpatients is recommended.

INTRODUCTION: Staphylococcus aureus is a known colonizer in humans and has been implicated in community acquired soft tissue infections. However emergence of methicillin resistant S. aureus (MRSA) has aroused great concern worldwide. This study aimed to determine the prevalence of MRSA in the community of Bangalore, southern India. METHODS: Swabs were collected from anterior nares, forearm, dorsum and palm of the hands of 1,000 healthy individuals residing in and around Bangalore, belonging to different socioeconomic strata and age groups. RESULTS: Analysis verified that 22.5% and 16.6% of the individuals presented Staphylococcus aureus and MRSA, respectively, at any of the three sites. Vancomycin resistance was observed in 1.4% of the S. aureus isolates, which was confirmed by detection of the vanA gene. It was interesting to note that 58.8% of the children in the age group 1-5 years-old presented MRSA, the highest percentage compared to other age groups of < 1 (44.4%) year-old, 5-20 (21.7%) years-old, > 40 (11%) years-old and 20-40 (9.9%) years-old. Among the population of various socioeconomic strata, maximum MRSA colonization was observed among doctors (22.2%), followed by upper economic class (18.8%), lower economic class (17.7%), apparently healthy hospital in-patients (16.5%), nurses (16%) and middle economic class (12.5%). Most of the MRSA isolates were capsular polysaccharide antigen type 8 (57.1%). CONCLUSIONS: There is a need for continuous surveillance and monitoring of the presence of MRSA in the community and a clearer understanding of the dynamics of the spread of MRSA will assist in controlling its dissemination. INTRODUÇÃO: O Staphylococcus aureus é conhecido por ser um colonizador em humanos sendo implicado em infecções comunitárias dos tecidos moles. Contudo, a resistência à meticilina e emergência de S. aureus meticilina resistentes (MRSA) têm despertado preocupação em todo o mundo. O presente estudo visa encontrar a prevalência de MRSA na comunidade de Bangalore, sul da Índia. MÉTODOS: Suabes foram coletados de narinas anteriores, antebraço e dorso da palma de 1.000 indivíduos saudáveis, residentes em Bangalore e nas proximidades, pertencentes a diferentes estratos socioeconômicos e faixas etárias. RESULTADOS: Observou-se que 22,5% e 16,6% dos indivíduos foram abrigar Staphylococcus aureus e MRSA, respectivamente, em qualquer um dos três locais. Dos S. aureus isolados, 1,4% também foram resistentes à vancomicina, o que foi confirmado pela detecção do gene vanA. Foi interessante notar que 58,8% das crianças na faixa etária de 1-5 anos foram abrigar MRSA, o mais elevado em comparação com outros grupos etários de < 1 (44,4%) ano, 50-20 (21,7%) anos, > 40 (11%) anos e 20-40 (9,9%) anos. Entre a população de diferentes estratos socioeconômicos, a colonização de MRSA máxima foi observada entre os médicos (22,2%), seguida pela classe econômica superior (18,8%), classe baixa (17,7%), pacientes aparentemente saudáveis (16,5%), enfermeiros (16%) e classe econômica média (12,5%). A maioria dos MRSA isolados eram do tipo polissacarídeo capsular antígeno 8 (57,1%). CONCLUSÕES: Há uma necessidade de vigilância e monitorização contínua da presença de MRSA na comunidade, bem como uma melhor compreensão da dinâmica de propagação de MRSA pode ajudar no controle da disseminação.

Summary A meticillin-resistant Staphylococcus aureus (MRSA) polymerase chain reaction assay (Xpert ® MRSA, Cepheid) was assessed for point-of-care testing (POCT) used by healthcare assistants in an orthopaedic pre-admission clinic and on a vascular ward to reduce turnaround time. POCT results were compared with the routine swabs taken for culture. The POCT assay was easy to use, the turnaround time for negative results was greatly reduced, and sensitivity was 75.0% in the pre-admission clinic and 80.0% in the vascular ward. There were 27 POCT-positive/culture-negative results, but there was no evidence of MRSA infection or colonization in these patients for at least a year post procedure. POCT for MRSA colonization performed beyond the laboratory has important advantages over laboratory-based methods and should be explored further.

Cystic Fibrosis (CF), the most common lethal inherited disorder in Australia, is associated with increased respiratory tract colonization/infection. Given that many adults with CF work as health-care workers (HCW), which has been associated with an increased risk of methicillin-resistant Staphylococcus aureus (MRSA) colonization/infection, we examined these risks in 252 adults with CF at our centre between 2001-2015. Demographic and clinical characteristics, including pathogens, were compared for HCW and non-HCW groups. MRSA colonization/infection was found in 20 subjects, comprising 2/19 HCW, and 18/233 non-HCW (p = 0.66). Sixteen of these 20 subjects undertook eradication therapy, with success in 2/2 HCW and 5/14 non-HCW. This study showed that the rate of MRSA colonization/infection did not differ between adults with CF who work in the health-care setting versus other areas. This suggests that choosing a health-care profession does not necessarily result in an increased risk of MRSA colonization/infection for an adult with CF.

We report our 1-year experience with modified GeneOhm™ MRSA assay (formerly IDI-MRSA) for pooled surveillance specimens in low methicillin-resistant Staphylococcus aureus (MRSA) prevalence clinical setting. We have successfully modified the GeneOhm™ MRSA assay protocol during the specimen preparation step by adding an extra washing step followed by pooling of up to 3 samples per patient (nose, skin, with or without throat) at the lysis step. The sensitivity of the modified assay compared with conventional cultivation was 94.3%, specificity 99.2%, negative predictive value 99.2%, and positive predictive value 94.3%. The modified test is reliable and performed well compared with conventional culture methods in our clinical setting with low-level prevalence of MRSA colonization. Our findings support the use of pooling of the patients samples as a cost-effective way of screening for MRSA colonization.

Carboneum sulfuratum is one of the deep acting and well proved remedies with a broad spectrum of effects. Nevertheless it is used quite rarely. Important indications are the after-maths of intoxications (also by medicaments) and burns, bad wound healing at bacterial colonization and severe pain. Three cases from our clinic confirm the deep going influence of carboneum sulfuratum in severe diseases especially at MRSA colonization.

Objective.Use of active surveillance cultures for methicillin-resistant Staphylococcus aureus (MRSA) for all patients admitted to the intensive care unit has been shown to reduce nosocomial transmission. However, the cost-effectiveness and the utility of implementing use of active surveillance cultures nationwide remain controversial. We sought to develop an artificial neural network (ANN) model that would predict the likelihood of MRSA colonization.Setting.Two acute care hospitals, one in Pittsburgh (hospital A) and one in Kaohsiung, Taiwan (hospital B).Methods.Nasal cultures were performed for all patients admitted to the hospitals. A total of 46 potential risk factors in hospital A and 86 potential risk factors in hospital B associated with MRSA colonization were assessed. Culture results were obtained; 75% of the data were used for training our ANN model, and the remaining 25% were used for validating our ANN model. The culture results were the “gold standard” for determining the accuracy of the model predictions.Results.The ANN model predictions were accurate 95.2% of the time for hospital A (sensitivity, 94.3%; specificity, 96.0%) and 94.2% of the time for hospital B (sensitivity, 96.6%; specificity, 91.8%), integrating all potential risk factors into the model. Only 17 potential risk factors were needed for the hospital A ANN model (accuracy, 90.9%; sensitivity, 98.5%; specificity, 83.4%), and only 20 potential risk factors were needed for the hospital B ANN model (accuracy, 90.5%; sensitivity, 96.6%; specificity, 84.3%), if the minimal risk factor method was used. Cross-validation analysis showed an average accuracy of 85.6% (sensitivity, 91.3%; specificity, 80.0%).Conclusion.Our ANN model can be used to predict with an accuracy of more than 90% which patients carry MRSA. The false-negative rates were significantly lower than the false-positive rates in the ANN predictions, which can serve as a safety buffer in case of patient misclassification.

Methicillin resistant Staphylococcus aureus (MRSA) colonization has recently been identified in pigs and people that work with pigs, raising concerns about the role of pigs as reservoirs of MRSA for human infection. The objectives of this study were to evaluate the prevalence of MRSA colonization in pigs and pig farmers in Ontario, Canada and to characterize MRSA strains. Nasal and rectal swabs were collected from 285 pigs from three different age groups from 20 pig farms. Nasal swabs were collected from farm personnel and a brief questionnaire was also administered. The prevalence of MRSA colonization in farms was 45% (9/20) whereas the prevalence in pigs was 24.9% (71/285). There was no difference in MRSA colonization between age groups. The prevalence of MRSA colonization in pig farmers was 20% (5/25). There was a correlation between the presence of MRSA in pigs and humans on farms (P value = 0.001). The results of spa typing revealed the predominant strain in pigs and humans was eGenomics spa type 539 (Ridom t034, clonal complex 398) which accounted for 59.2% of isolates and has been reported in pigs in Europe. A common human epidemic clone, CMRSA-2 (USA100, clonal complex 5) was also found in both pigs and pig personnel. Indistinguishable strains were found in pigs and pig personnel on all five farms with a colonized human. This study demonstrates that MRSA is common in pigs in Ontario, Canada, and provides further support to concerns about transmission of MRSA between pigs and humans.

Masafumi Seki,1,2,* Hiroki Takahashi,3,* Norihisa Yamamoto,1 Shigeto Hamaguchi,1 Masahiro Ojima,3 Tomoya Hirose,3 Kazuhisa Yoshiya,3 Hiroshi Ogura,3 Takeshi Shimazu,3 Kazunori Tomono11Division of Infection Control and Prevention, Osaka University Hospital, Suita, Osaka, Japan; 2Division of Infection Control and Prevention, Tohoku Pharmaceutical University Hospital, Sendai, Japan; 3Department of Traumatology and Acute Critical Medicine, Osaka University Hospital, Suita, Osaka, Japan*These authors contributed equally to this work Abstract: Conventional culture methods to detect methicillin-resistant Staphylococcus aureus (MRSA) take a few days, and their sensitivity and usefulness also need to be improved. In this study, active screening was performed using the polymerase chain reaction (PCR) for colonization with MRSA on admission and follow-up surveillance after admission to an emergency department between June 2012 and August 2012, and the backgrounds of PCR and/or culture-method-positive patients were compared. Among 95 patients, 15 (15.8%) patients were positive for MRSA on PCR and/or culture; 6.3% (6/95) of patients were positive on admission, and 9.5% (9/95) became positive during the stay after admission. The major primary diagnoses in MRSA-positive patients were trauma and cerebrovascular diseases. Nine (60%) of 15 patients were MRSA-positive on both PCR and culture, compared with three (20%) of 15 who were PCR-positive but culture-negative. The other three (20%) of 15 patients were PCR-negative but culture-positive. Furthermore, there was a tendency for younger age and shorter stay to be associated with PCR-positive but culture-negative results. These findings suggest that active surveillance with PCR may be highly sensitive and useful for the early diagnosis of MRSA colonization to prevent nosocomial transmission from the emergency department to the regular inpatient wards of the hospital. Keywords: active surveillance, length of stay, nosocomial transmission, BD GeneOhm MRSA assay, sensitivity, specificity&nbsp

Background and Objective:At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.Design:All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage ofStaphylococcus aureus, and eradication treatment.Results:A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.Conclusions:Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)

We studied the transmissibility of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) and healthcare-associated methicillin-resistant S. aureus (HA-MRSA) strains and the association of MRSA colonization pressure and MRSA transmission in critically ill children. Importantly, we found that in hospitalized children MRSA colonization pressure above 10% increases the risk of MRSA transmission 3-fold, and CA-MRSA and HA-MRSA strains have similar transmission dynamics.

Methicillin-resistant Staphylococcus aureus (MRSA) represents a serious threat to the health of hospitalized patients. Attempts to reduce the spread of MRSA have largely depended on hospital hygiene and patient isolation. These measures have met with mixed success: although some countries have almost eliminated MRSA or remained largely free of the organism, others have seen substantial increases despite rigorous control policies. We use a mathematical model to show how these increases can be explained by considering both hospital and community reservoirs of MRSA colonization. We show how the timing of the intervention, the level of resource provision, and chance combine to determine whether control measures succeed or fail. We find that even control measures able to repeatedly prevent sustained outbreaks in the short-term can result in long-term control failure resulting from gradual increases in the community reservoir. If resources do not scale with MRSA prevalence, isolation policies can fail “catastrophically.”

A new method for estimating the time to colonization of Methicillin-resistant Staphylococcus Aureus (MRSA) patients is developed in this paper. The time to colonization of MRSA is modelled using a Bayesian smoothing approach for the hazard function. There are two prior models discussed in this paper: the first difference prior and the second difference prior. The second difference prior model gives smoother estimates of the hazard functions and, when applied to data from an intensive care unit (ICU), clearly shows increasing hazard up to day 13, then a decreasing hazard. The results clearly demonstrate that the hazard is not constant and provide a useful quantification of the effect of length of stay on the risk of MRSA colonization which provides useful insight.