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BACKGROUND We conducted a longitudinal survey for methicillin-resistant Staphylococcus aureus (MRSA) carriage in nursing homes and long-term care facilities (LTCFs) in northern Taiwan. METHODS From July 2016 to February 2017, healthcare workers and residents in four institutions were enrolled. One swab sample from nares and another swab sample from umbilicus were obtained from each participant for detection of MRSA at enrolment and then follow-up samples were collected every two months for additional three times if feasible. RESULTS We enrolled a total of 194 participants, including 127 residents and 67 healthcare workers. MRSA colonization rates were 23.2%, 22.8%, 20.7% and 18.6% at enrolment, the 2-, 4-, and 6-month follow-up survey, respectively, and the cumulative colonization rate was 40.2%. The MRSA detection rate was significantly higher at Institution 2 (70.7%) than that at other three institutions (25.7% ∼ 35%) (p

Hanzada T Nour El-Din,1 Aymen S Yassin,1 Yasser M Ragab,1 Abdelgawad M Hashem1,2 1Department of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Cairo, 11562, Egypt; 2Department of Microbiology and Immunology, Faculty of Pharmacy, British University in Egypt, El-Sherouk City, Cairo, 11837, EgyptCorrespondence: Aymen S YassinDepartment of Microbiology and Immunology, Faculty of Pharmacy, Cairo University, Kasr Eleini Street, Cairo, 11562, EgyptTel +2-02-23620122Fax +2-02-23620122Email aymen.yassin@pharma.cu.edu.egIntroduction: Methicillin-resistant Staphylococcus aureus (MRSA) presents a profound hazard to public health. MRSA colonizing skin, mucous membranes, and the anterior nares without clinical symptoms is termed “colonizing MRSA”. Upon manifestation of clinical symptoms, it is termed “infectious MRSA”. Here, we characterize and differentiate colonizing and infectious MRSA, and analyze the phenotypic-genotypic and antibiotic susceptibility correlations.Methodology: Clinical MRSA isolates were recovered from intensive care units (ICUs) of two major Egyptian hospitals and their biofilm formation ability was tested. Antibiograms against 16 antibiotics were determined, in addition to the minimum inhibitory concentrations (MICs) of vancomycin and linezolid. The entire collection was typed by enterobacterial repetitive intergenic consensus (ERIC)-PCR, as well as multi-locus sequence typing (MLST). Representative resistance and virulence genes were detected by PCR amplification.Results: Forty-nine isolates were confirmed as MRSA, of which 30 isolates were infectious and 19 were colonizing. Versatile resistance patterns were observed in both groups of isolates. We report a higher tendency for biofilm-formation and borderline minimum inhibitory concentrations among infectious isolates. A Positive antibiotic correlation was observed between susceptibility to protein synthesis inhibitors and cell wall inhibitors. Positive correlations were observed between isolation site and rifampicin resistance: nasal samples were enriched in rifampicin-resistant isolates, while urine and blood samples were enriched in susceptible ones. Furthermore, biofilm formation ability was slightly associated with amikacin resistance, and an association between teicoplanin resistance and the presence of the Panton-Valentine leukocidin gene was the only significant phenotype-genotype correlation observed. Finally, ERIC typing and MLST had congruent results.Conclusion: Linezolid and vancomycin are still the most convenient choice for MRSA treatment. ERIC PCR and MLST show promising typing combination that could be easily used periodically for tracking the genotypic changes of MRSA, especially within the healthcare facilities. Several correlations were established between groups of antibiotics and the genotypes/phenotypes of the selected isolates.Keywords: methicillin-resistant Staphylococcus aureus, MRSA carriage, MRSA colonization, multi-drug-resistant bacteria, virulence, phenotype correlations

Introduction Medical students who engage in clinical learning in healthcare settings can be potential methicillin-resistant Staphylococcus aureus (MRSA) carriers. Methods This is a descriptive cross-sectional study having a follow-up approach. Three batches of medical students who were studying at the Faculty of Medicine and Allied Sciences, Rajarata University of Sri Lanka (1st, 3rd and 5th study years of MBBS course) were screened for nasal and axillary MRSA colonization. The first-year students were screened before and 6 months after clinical learning. The knowledge of the students about infection control was scored (percentage) using a questionnaire in the one week before and later one year after the hospital exposure. Data was compared using two-sample t test. Results The percentage of MRSA colonization was 6.36% (7/110) and 49.57% (59/119) before clinical exposure and after 2.5 years of exposure, respectively (p

Objective:Little is known about the short-term dynamics of methicillin-resistant Staphylococcus aureus (MRSA) transmission between patients and their immediate environment. We conducted a real-life microbiological evaluation of environmental MRSA contamination in hospital rooms in relation to recent patient activity.Design:Observational pilot study.Setting:Two hospitals, hospital 1 in Zurich, Switzerland, and hospital 2 in Ann Arbor, Michigan, United States.Patients:Inpatients with MRSA colonization or infection.Methods:At baseline, the groin, axilla, nares, dominant hands of 10 patients and 6 environmental high-touch surfaces in their rooms were sampled. Cultures were then taken of the patient hand and high-touch surfaces 3 more times at 90-minute intervals. After each swabbing, patients’ hands and surfaces were disinfected. Patient activity was assessed by interviews at hospital 1 and analysis of video footage at hospital 2. A contamination pressure score was created by multiplying the number of colonized body sites with the activity level of the patient.Results:In total, 10 patients colonized and/or infected with MRSA were enrolled; 40 hand samples and 240 environmental samples were collected. At baseline, 30% of hands and 20% of high-touch surfaces yielded MRSA. At follow-up intervals, 8 (27%) of 30 patient hands, and 10 (6%) of 180 of environmental sites were positive. Activity of the patient explained 7 of 10 environmental contaminations. Patients with higher contamination pressure score showed a trend toward higher environmental contamination.Conclusion:Environmental MRSA contamination in patient rooms was highly dynamic and was likely driven by the patient’s MRSA body colonization pattern and the patient activity.

MRSA colonization is a critical public health concern. Decolonization protocols have been designed for the clearance of MRSA. Successful decolonization protocols reduce disease incidence; however, multiple protocols exist, comprising diverse therapies targeting multiple body sites, and the optimal protocol is unclear. Here, we formulate a machine learning model using data from a randomized controlled trial (RCT) of MRSA decolonization, which estimates interactions between body sites, quantifies the contribution of each therapy to successful decolonization, and enables predictions of the efficacy of therapy combinations. This work shows how a machine learning model can help design and improve complex clinical protocols., Comment: Extended Abstract presented at Machine Learning for Health (ML4H) symposium 2022, November 28th, 2022, New Orleans, United States & Virtual, http://www.ml4h.cc, 12 pages

Staphylococcus aureus (SA) and especially methicillin-resistant staphylococcus aureus (MRSA) remains a major cause of healthcare-associated infections worldwide. Health care workers (HCWs) may act as reservoirs for transmission of MRSA to patients and other HCWs. The aim of this systematic review was to investigate the prevalence of SA and MRSA colonization among HCWs in Iran. The used keywords for searching were: “Iran”, “S. aureus” and “MRSA” conducted in PubMed, and Google Scholar, and two national scientific databases and proceedings of recent national conferences. The studies related to SA or MRSA prevalence in Iran published from 1993 to 2018 were included for review. Meta-analysis was performed using the Open Meta (Analyst) software. Results showed that the prevalence of SA among HCWs was 26% (95% CI=19.4-32.6%). The ratios of MRSA/total isolated SA and MRSA/total HCWs were obtained 35.4% (95% CI=29.6-41.1%) and 7.6% (95% CI= 6.4-8.8%), respectively. Older studies showed a higher prevalence compared to recent studies. The prevalence of nasal MRSA carriage among Iranian HCWs was in a range between the rates reported in the U.S/European and African countries.

Several decolonization regimens have been studied to prevent recurrent methicillin-resistantMRSA-colonized patients were randomized to receive either standard or systemic decolonization. Follow-up with MRSA screening was obtained at approximately 3, 6, and 12 months after completion of therapy. Kaplan-Meier survival curves were calculated and assessed for significant differences using log-rank tests.Of 98 enrolled patients (25 standard decolonization, 73 systemic decolonization), 24 patients (7 standard decolonization, 17 systemic decolonization) did not complete the study. Univariate analysis showed a marginally significant difference in the probability of remaining MRSA-negative post-treatment (Initial MRSA clearance is more readily achieved with systemic decolonization than with standard decolonization. There is no significant difference in the probability of sustained MRSA clearance.Plusieurs schémas de décolonisation ont été étudiés pour prévenir la récurrence d’infections àDes patients colonisés par le SARM ont été choisis au hasard pour recevoir une décolonisation standard ou systémique. Les chercheurs ont obtenu les données de suivi par un dépistage du SARM environ trois, six et 12 mois après la fin du traitement. Ils ont calculé la courbe de survie de Kaplan-Meier et l’ont évaluée pour déterminer les différences importantes au moyen des tests logarithmiques par rang.Des 98 patients inscrits (25 par décolonisation standard, 73 par décolonisation systémique), 24 n’ont pas terminé l’étude (sept par décolonisation standard, 17 par décolonisation systémique). L’analyse univariée a révélé une différence légèrement significative quant à la probabilité de demeurer négatif au SARM après le traitement (La clairance initiale du SARM est plus facile à obtenir par une décolonisation systémique que standard. La clairance initiale du SARM était obtenue plus rapidement par la décolonisation systémique que standard. Il n’y a pas de différence significative dans la probabilité de clairance soutenue du SARM.

Staphylococcus aureus and MRSA are important clinical pathogens representing a serious public health problem. This study aimed to determine the prevalence of S. aureus and methicillin-resistant S. aureus (MRSA) nasal carriage among dental students, identify the factors that influence this carriage, and characterize MRSA. A prevalence of S. aureus and MRSA carriage of 25.2% and 0.86% was estimated, respectively, and SCCmec Type VI, was identified in all isolated MRSA. The low MRSA colonization rate can reflect good infection control practices followed by students.

MRSA infections cause significant morbidity and mortality in neonates. Clinical testing and routine surveillance screening identified an increase in neonates with MRSA colonization and infection which triggered prospective genomic surveillance. Here we show the complex transmission dynamics of MRSA in a NICU setting. Analyses revealed concurrent transmission chains affecting 16 of 22 MRSA-colonized patients (68%), and 3.1% of all NICU patients (n=517). Prematurity and longer lengths of stay increased risks for colonization. Intervals of up to 7 months occurred among some cluster-related isolates. 3 of 22 MRSA-colonized patients developed invasive infections with the colonizing strain. Comparisons with 21,521 isolates in the NCBI Pathogen Detection Resource revealed NICU strains to be distinct from MRSA seen locally and internationally. Integration of international strain datasets in analyses increased the resolution of strain clusters and helped rule-out suspected transmission events. Analyses also identified sequence type 1535 isolates, emergent in the Middle East, carrying a unique SCCmec with fusC and aac(6’)-Ie/aph(2’’)-1a that provided a multi-drug resistant phenotype. NICU genomic surveillance identified cryptic MRSA colonization events, including NICU-endemic strains not linked with local hospital or international clusters, and has rich potential to guide improvements in infection prevention for this vulnerable patient population.

Summary Background The role of meticillin-resistant Staphylococcus aureus (MRSA) colonization of healthcare workers (HCWs), patients and the hospital environment in MRSA transmission in non-outbreak settings is poorly understood. Aims To investigate transmission events (TEs) involving HCWs, patients and the environment under non-outbreak conditions in a hospital with a history of endemic MRSA using whole-genome sequencing (WGS). Methods HCW (N = 326) and patient (N = 388) volunteers on nine wards were tested for nasal and oral MRSA colonization over two years. Near-patient environment (N = 1164), high-frequency touch sites (N = 810) and air (N = 445) samples were screened for MRSA. Representative MRSA and clinical isolates were analysed by WGS and core-genome multi-locus sequence typing (cgMLST). Closely related isolates (≤24 allelic differences) were segregated into related isolated groups (RIGs). Findings In total, 155 MRSA were recovered: clinical isolates (N = 41), HCWs (N = 22), patients (N = 37), environmental isolates (N = 55). Nine clonal complexes (CCs) were identified among 110/155 MRSA sequenced with 77/110 assigned to CC22. Seventy-nine MRSA segregated into 17 RIGs. Numerous potential TEs were associated with CC22-MRSA (RIGs 1–15), CC45-MRSA (RIG-16) and CC8-MRSA (RIG-17). RIG-1, (the largest RIG) contained 24 ST22-MRSA-IVh from six HCWs, six patients, four clinical and eight environmental samples recovered over 17 months involving 7/9 wards. TEs involving HCW-to-patient, HCW-to-HCW, patient-to-patient and environmental contamination by HCW/patient isolates were evident. HCW, patient, clinical and environmental isolates were identified in four, nine, seven and 13 RIGs, respectively, with 12/13 of these containing isolates closely related to HCW and/or patient isolates. Conclusions WGS detected numerous potential hospital MRSA TEs involving HCWs, patients and the environment under non-outbreak conditions.

Background: Periprosthetic infection is commonly caused by Staphylococcus aureus and, if resistant to methicillin (MRSA), is associated with increase in severity and costs to patient and healthcare systems. MRSA colonizes 1–5% of the population, therefore using a screening and decolonisation protocol the risk of periprosthetic infection could be reduced. The objective of our study is to report the results of a preoperative MRSA screening and management protocol utilised at our hospital. Methods: All patients undergoing a total joint arthroplasty at our hospital were preoperatively screened for MRSA colonization with swab samples of five different locations. Exposure to risk factors were investigated in colonised patients and they were treated for 5 days prior surgery with nasal mupirocin, chlorhexidine sponges and oral tablets. Results: During the 48 months of the study, MRSA colonisation was identified in 22 (1.01%) of 2188 patients operated. The culture was positive only in the nasal swab in 55 patients. In five patients the nasal culture was negative, but they had another positive swab culture (three in the groin and two perianal). None of the patients reported a history of recent antibiotic treatment or hospitalization. Conclusion: At our institution, the prevalence of MRSA colonisation is 1.01% in patients undergoing hip and knee arthroplasty. Interestingly, our screening protocol included samples from five different anatomic locations, and it is important to highlight that we found patients with negative nares culture and positive cultures in other locations. Therefore, the number of carriers may be underdiagnosed if only nasal samples are obtained. Level of evidence: IV

Methicillin-resistant Staphylococcus aureus (MRSA) has long been known as a major cause of hospital-acquired (HA-MRSA) infections worldwide. For the past twenty years, an increasing number of studies have described its emergence in the community as well. In Portugal, a country with a high-prevalence of HA-MRSA, there are only limited data available on the epidemiology of MRSA in the community. We studied the prevalence of S. aureus and MRSA colonization among healthy adults in Portugal. Between February 2015 and December 2016, a longitudinal study was conducted in which 87 adults aged 25–50 years old were followed for six months. For each participant nasopharyngeal, oropharyngeal and saliva samples were obtained monthly and, in some cases, weekly. A total of 1,578 samples (n = 526 for each sampling site) were examined for the presence of S. aureus and MRSA by classical culture-based methods. Fifty-seven adults (65.5%) carried S. aureus at least once during the six months period of the study: 19.5% were persistent S. aureus carriers and 46.0% were intermittent carriers. Carriage rates per sampling site were 20.5% in nasopharynx, 18.3% in oropharynx, and 13.5% in saliva. Simultaneous screening of the three sampling sites increased detection of S. aureus, which overall occurred in 34.4% of the 526 sampling time-points. No MRSA were isolated. In conclusion, this study adds novel information about the MRSA scenario in the Portuguese community. Our results indicate that, in Portugal, MRSA does not seem to circulate among healthy adults without risk factors and therefore this age group does not constitute, at the current time, a reservoir of MRSA in the community.

Background:Methicillin-resistant Staphylococcus aureus (MRSA) nasal polymerase chain reaction (PCR) testing can rapidly detect MRSA colonization via nasopharyngeal swab. With a high negative predictive value for MRSA pneumonia, this test may help minimize the duration of anti-MRSA therapy and associated adverse drug events. Objective: This study aimed to evaluate the impact of a pharmacist-initiated MRSA nasal PCR protocol on pneumonia therapy. Methods: This retrospective, quasi-experimental study evaluated adult patients with pneumonia before and after the implementation of a pharmacist-initiated MRSA nasal PCR protocol. The primary outcome of this study was to compare duration of anti-MRSA therapy between the Pre-PCR group and PCR group. Secondary comparisons included duration of antipseudomonal therapy, time from intravenous (IV) to oral interchange, and clinical outcomes. Results: In total, 210 patients (Pre-PCR: n = 138, PCR: n = 72) were included. The MRSA nasal PCR result was negative for 63 patients (87.5%), and 56 (88.9%) vancomycin orders were discontinued within 24 hours of the negative result. The mean duration of vancomycin therapy was significantly shorter in the PCR group (2.5 vs 1.4 days, P < .001) as well as duration of IV therapy (5 vs 3.9 days, P = .003). There was no difference between groups in duration of antipseudomonal therapy ( P = .425), acute kidney injury (AKI; P = .332), 30-day readmission ( P = .137), or 30-day mortality ( P = .179). Conclusion and Relevance: A pharmacist-driven MRSA nasal PCR protocol significantly decreased the duration of anti-MRSA therapy and IV antibiotics in patients with pneumonia. These findings add to the relatively small body of literature supporting pharmacist-initiated rapid diagnostic testing and follow-up.

We assessed the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) strains on surfaces of hospital dental clinics. Specimens were obtained from 5 clinically symptoms-free patients of five different specialties clinics (Implantology, Pediatric Dentistry, Prosthetics, Restorative Dentistry, and Oral Medicine) of the Dental Clinic Hospital of King Saud University before and after each patient. A Q-tip swabs were used from 10 surfaces in each clinic (Arm rest of dental chair, floor beneath dental chair, sink/faucet, towel dispenser, instrument table handle, light handle, X-ray viewer, paper dental records, head rest, and bench). Specimens were cultured in CHROMagar MRSA medium. Prevalence of MRSA colonization was compared between periods before and after patients visited each clinic for treatment. The results showed that the prevalence of MRSA was remarkably increased after patients visited the area. The results indicate that dental clinics should be considered as possible reservoirs of MRSA in the hospital setting. Keywords: Staphylococcus aureus, Methicillin resistance, MRSA carrier, Epidemiology, Dental clinic, MRSA

We investigated the prevalence of Hepatitis E Virus (HEV), Leptospira and Ascaris suum (A. suum) seropositivity, and of nasal methicillin‐resistant Staphylococcus aureus (MRSA) colonization among Austrian practising veterinarians, and assessed the association with occupational swine livestock exposure. The 261 participants completed a questionnaire on demographics, intensity of occupational swine livestock contact and glove use during handling animals and their secretions. Participants' blood samples were tested for HEV, Leptospira and A. suum seropositivity and nasal swabs cultured for MRSA. We compared swine veterinarians (defined as >3 swine livestock visits/week) to non‐swine veterinarians (≤3 swine livestock visits/week) with regard to the outcomes through calculating prevalence ratio (PR) and 95% confidence interval (CI). Furthermore, the relationship between occupational swine livestock contact and the study outcomes was examined by age (3 occupational swine livestock visits per week is associated with HEV and A. suum seropositivity and nasal MRSA colonization and that glove use may play a putative preventive role in acquiring HEV and A. suum. Further analytical epidemiological studies have to prove the causality of these associations.

Objective:Medical procedures and patient care activities may facilitate environmental dissemination of healthcare-associated pathogens such as methicillin-resistant Staphylococcus aureus (MRSA).Design:Observational cohort study of MRSA-colonized patients to determine the frequency of and risk factors for environmental shedding of MRSA during procedures and care activities in carriers with positive nares and/or wound cultures. Bivariate analyses were performed to identify factors associated with environmental shedding.Setting:A Veterans Affairs hospital.Participants:This study included 75 patients in contact precautions for MRSA colonization or infection.Results:Of 75 patients in contact precautions for MRSA, 55 (73%) had MRSA in nares and/or wounds and 25 (33%) had positive skin cultures. For the 52 patients with MRSA in nares and/or wounds and at least 1 observed procedure, environmental shedding of MRSA occurred more frequently during procedures and care activities than in the absence of a procedure (59 of 138, 43% vs 8 of 83, 10%; P < .001). During procedures, increased shedding occurred ≤0.9 m versus >0.9 m from the patient (52 of 138, 38% vs 25 of 138, 18%; P = .0004). Contamination occurred frequently on surfaces touched by personnel (12 of 38, 32%) and on portable equipment used for procedures (25 of 101, 25%). By bivariate analysis, the presence of a wound with MRSA was associated with shedding (17 of 29, 59% versus 6 of 23, 26%; P = .04).Conclusions:Environmental shedding of MRSA occurs frequently during medical procedures and patient care activities. There is a need for effective strategies to disinfect surfaces and equipment after procedures.

Available data suggests a high burden of methicillin-resistant staphylococcus aureus (MRSA) in Arab countries of the Middle East and North Africa (MENA). To review the MRSA prevalence and molecular epidemiology in this region, we used PubMed search engine to identify relative articles published from January 2005 to December 2019. Great heterogeneity in reported rates was expectedly seen. Nasal MRSA colonization ranged from 0-32% in healthy volunteers but 4-73% in healthcare workers. Infective MRSA rates ranged between 6%-66% in Saudi Arabia, 12%-29% in United Arab of Emirates, 13%-21% in Qatar, 14%-37% in Oman, 20%-72% in Lebanon, 56% in Gaza, 32%-68% in Jordan, 34%-88% in Iraq and Iraqi Kurdistan, 47%-77% in Egypt, 19-86% in Algeria, and 18-40% in Tunisia. In the GCC, [PVL-] ST239-III, [PVL+] ST80-IV, [PVL+] ST30-IV, [PVL-] ST22-IV and its [PVL+] and [tst1+] variants, [PVL-] CC6-IV, [PVL-] CC5-IV, and [PVL-] ST5-II had a significant presence. In the Levant region, [PVL+] ST80-IV, [PVL+] ST30-IV, [PVL-] ST239-III, [PVL-] ST22-IV were prevalent in Lebanon, Jordan, and Gaza; [PVL-] ST22-IVa-t223 (“Gaza strain”) was prevalent in Gaza and Jordan; USA300, and USA800 were prevalent in Iraq. In North Africa, [PVL+] ST80-IV and [PVL-] ST239-III was commonly reported in Egypt, Algeria, and Tunisia. Finally, significant antimicrobial resistance was seen in the region with variation in patterns depending on location and clonal type. For a more accurate assessment of MRSA epidemiology and burden, the Arab countries need to implement national surveillance systems.

International travel has been identified as a major contributing factor to the global spread of MRSA. We examined the incidence of MRSA-colonization in a cohort of 196 travellers. We observed a low rate of only one case of MRSA, indicating a low risk of acquisition of MRSA-colonization in travel.

To determine risk factors for MRSA colonization in a Level IV Neonatal Intensive Care Unit (NICU) independent of length of stay and gestational age in the context of a persistently circulating MRSA clone.Retrospective matched case-control study.Level IV NICU PATIENTS: Infants admitted between April 4,2017- March 31,2018.Based on weekly surveillance cultures, infants who acquired MRSA were matched 1:1 with MRSA-negative control infants by duration of exposure (length of stay) and gestational age to determine risk factors for acquisition.Fifty case infants were matched with controls. Isolates from 45 of the 50 cases were mupirocin-resistant and related by pulse-field gel electrophoresis. On matched univariable analysis, the following were significantly associated with a risk for MRSA acquisition: 1.Bed location in the acute area(P = 0.03), 2.Requirement of any level of respiratory support during the week prior to MRSA detection(P = 0.04), 3.Higher ATP pass rate (a measure of effectiveness of cleaning) during the week of and week prior(P = 0.01), 4.Higher MRSA colonization pressure during the week of and week prior(P0.0001), 5.Not having a hearing test during the time between the previous negative culture and MRSA acquisition(P = 0.01). A multivariable conditional logistic regression model (that excluded ATP pass rate) found that only colonization pressure was associated with acquisition of MRSA colonization.In an outbreak setting, MRSA colonization pressure is significantly associated with MRSA acquisition in the NICU independent of length of stay and gestational age.

Background A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs. Methods We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n = 204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n = 79). Results Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p = 0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing. Conclusions The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs might be associated with resident transfer rather than spread via cross-transmission inside LTCFs.

Methicillin-resistant Staphylococcus aureus or MRSA infection is virulent and presents with a broad spectrum of severity. Limited regional reports that specifically outlined the potential risk of medical students being part of the dissemination of MRSA in healthcare settings were noted. This study aims to assess the prevalence and contributory factors of colonization of MRSA on neckties, headscarves, and ID badges among medical students in a local medical university in Malaysia. A cross-sectional study was conducted involving 256 medical students. A validated questionnaire was used to collect the data, and sample swabs were collected between July and August 2013 by swabbing neckties, headscarves, or identification badges. The swabs were then streaked onto mannitol salt agar (MSA) and incubated at 37 &deg, C overnight. Out of 433 samples taken, 40 swabs (9.24%) were positive for Staphylococcus aureus. Out of the 40 swabs, five (12.5%) isolates were MRSA (one culture was isolated from the headscarf of a preclinical student, one culture was isolated from the necktie of clinical students, while the remaining three were isolated from identification badges of clinical students. There was no significant association between age, gender, ethnicity, and phase of medical students with the colonization of MRSA (p &gt, 0.05). There was a significant association between knowledge score on hand hygiene practice and phase of medical students. MRSA colonies were present on neckties, headscarves, and identification badges of medical students of all phases. The findings from this study suggest the need for improvement of hand hygiene knowledge and discontinuity of mandatory use of physical ID badges and neckties among medical students.

Background Cases of colonization or infection caused by Methicillin-resistant Staphylococcus aureus (MRSA) are frequently reported in people who work with animals, including veterinary personnel. The aim of this study was to determine the prevalence of MRSA colonization among veterinary professionals. A total of 134 nasal swabs from healthy attendees of a veterinary conference held in the Czech Republic were tested for presence of MRSA. The stains were further genotypically and phenotypically characterized. Results Nine isolated MRSA strains were characterized with sequence type (ST), spa type (t) and Staphylococcal Cassette Chromosome mec type. Five different genotypes were described, including ST398-t011-IV (n = 5), ST398-t2330-IV (n = 1), ST398-t034-V (n = 1), ST225-t003-II (n = 1) and ST4894-t011-IV (n = 1). The carriage of the animal MRSA strain was confirmed in 8 cases, characteristics of one strain corresponded to the possible nosocomial origin. Among animal strains were described three spa types (t011, t034, t2330) belonging into one dominating clonal complex spa-CC11. Conclusion According to our results, the prevalence of nasal carriage of MRSA in veterinary personnel is 6.72%. Although we described an increase compared to the results of previous study (year 2008), the prevalence in the Czech Republic is still remaining lower than reported from neighboring countries. Our results also indicate that healthcare - associated MRSA strains are still not spread among animals.

A retrospective cohort study was conducted to investigate the duration and risk factors for persistence of meticillin-resistant Staphylococcus aureus (MRSA) colonization among known carriers who were re-admitted to hospital. MRSA carriage persisted in a high proportion of known carriers up to two years after their last date of discharge, and re-admission screening should be performed for at least this duration. A targeted screening approach should focus on older patients with a history of long inpatient stays, who are at higher risk of persistent carriage. Timely discharge planning is important in reducing the risk of persistent MRSA colonization among known carriers.

Summary Background The prevalence of nosocomial meticillin-resistant Staphylococcus aureus (MRSA) was previously estimated as 23% in a paediatric hospital in Luanda, Angola and 18% in a general hospital in Sao Tome and Principe. Aim To evaluate the prevalence of S. aureus/MRSA colonization among hospitalized children and their parents at two hospitals in Angola and Sao Tome and Principe. Methods In 2017, 127 hospitalized children and 129 of their parents had nasal swabs for S. aureus/MRSA carriage in the two countries. The isolates were tested for the presence of the mecA and Panton-Valentine leukocidin (PVL) genes, and characterized by pulsed-field gel electrophoresis (PFGE), spa typing, multi-locus sequence typing and SCCmec typing. Findings Twenty of 127 children (15.7%) and 13 of 129 parents (10.1%) were MRSA nasal carriers. Three lineages comprised 88% of the MRSA isolates: (i) PFGE A-ST5-SCCmec IVa (N=15; 45%), associated with spa type t105, recovered in Angola alone; (ii) PFGE N-ST8-IV/V (N=7; 21%), associated with spa types t008/t121, recovered in Sao Tome and Principe alone; and (iii) PFGE B-ST88-IVa (N=7; 21%), associated with spa types t325/t786, present in both countries. Fifteen child/guardian pairs were colonized with identical MRSA (N=8) or meticillin-susceptible S. aureus (N=7) strains. PVL was detected in 25% of isolates, including two MRSA (ST30-V and ST8-IVa). Conclusion Hospitalized children and their parents are important reservoirs of MRSA. Infection control measures should focus on parents in order to minimize the spread of MRSA to the community.

MRSA is an organism that is a possible risk factor for postoperative SSI. The purpose of the study was to examine relationships among surgical site infection (SSI) after spinal surgery, nasal methicillin-resistant staphylococcus aureus (MRSA) colonization, and wound drain culture results. The subjects were 132 patients who underwent spinal instrumentation surgery. A preoperative nasal swab was used to check for the presence of MRSA colonization, and a wound drain tip culture was performed for detection of SSI. Data from culture studies using nasal samples and those from the distal tip of the wound drain were used for analysis. Five patients (3.8%) had nasal MRSA, 17 (13%) had positive drain tip cultures, 15 (11%) had SSIs, and 10 (8%) had SSIs with MRSA. Patients with nasal MRSA had a higher rate of detection of bacteria in the drain tip culture (40 vs. 19%, p = 0.065), and the SSI rate was significantly higher in patients with a positive drain tip culture (33 vs. 10%, p = 0.012). The total SSI rate differed significantly between patients with and without nasal MRSA (40 vs. 10%, p = 0.039); however, the SSI with MRSA rate did not differ significantly between these groups. MRSA carriers were not necessarily associated with MRSA infection, but were related to a positive drain tip culture and SSI, which might be due to endogenous skin bacteria. Therefore, possible SSI should be considered in patients with nasal MRSA colonization or bacteria detected in a drain tip culture.

For patients with possible Staphylococcus aureus infection, providers must decide whether to treat empirically for methicillin-resistant S. aureus (MRSA). Nares MRSA colonization screening tests could inform decisions regarding empiric MRSA-active antibiotic use.1,2

Purpose The purpose of this study was to test whether the placement of a standardized cleaning protocol in oral and maxillofacial surgery operatories could effectively reduce MRSA (methicillin-resistant Staphylococcus aureus) colonization rates on operatory surfaces. Methods Eight operatories were each swabbed at 6 different sites using a moist sterile swab (Amies gel with charcoal). The sites were right light handle, right armrest, headlight band, headlight bulb cover, handpiece buttons, pen from pen pad. Swabs were immediately transported to the microbiology lab and inoculated onto agar media, 3 plates/swab. MRSA colonizations were counted. Rooms were initially swabbed twice approximately 2 months apart, without prior notice being given (experiment 1 and experiment 2, respectively). Following the posting of room cleaning protocols, the rooms were reswabbed following a further 2-month period (post-Standard Operating Procedure). Results For those sites resulting in the isolation of MRSA, the total count for all 6 sites was 5 for experiments 1 and 2; hence, the RR (relative risk) for the comparison of experiments 1 and 2 was 1.00 (P = 1.000, 95% confidence interval, 0.27-3.72). In the post-SOP period, the total count was 0 for all 6 sites (Figure 1c); thus, the RR for the comparisons of experiment 1 and experiment 2 vs post-SOP was 0.0 (P = .031, 95% confidence interval, 0.00-0.82). Conclusion Posting a standardized cleaning protocol in oral and maxillofacial surgery operatories is a simple and effective way to reduce MRSA colonization on operatory surfaces. In our study, multiple colonies of MRSA were isolated from operatory surfaces in 2 independent samplings before the posting of a cleaning protocol, but no colonies were isolated after its posting. There are essentially no costs associated with placement of this protocol, and there are potentially tremendous savings to the patient and health care system if infections can be prevented by this method.