Methicillin-resistant Staphylococcus aureus: site of acquisition and strain variation in high-risk nursing home residents with indwelling devices.
Infect Control Hosp Epidemiol
; 35(12): 1458-65, 2014 Dec.
Article
em En
| MEDLINE
| ID: mdl-25419767
ABSTRACT
OBJECTIVE:
Characterize the clinical and molecular epidemiology of new methicillin-resistant Staphylococcus aureus (MRSA) acquisitions at nasal and extranasal sites among high-risk nursing home (NH) residents.DESIGN:
Multicenter prospective observational study.SETTING:
Six NHs in southeast Michigan.PARTICIPANTS:
A total of 120 NH residents with an indwelling device (feeding tube and/or urinary catheter).METHODS:
Active surveillance cultures from the nares, oropharynx, groin, perianal area, wounds (if present), and device insertion site(s) were collected upon enrollment, at day 14, and monthly thereafter. Pulsed-field gel electrophoresis and polymerase chain reaction for SCCmec, agr, and Panton-Valentine leukocidin were performed.RESULTS:
Of 120 participants observed for 16,290 device-days, 50 acquired MRSA (78% transiently, 22% persistently). New MRSA acquisitions were common in extranasal sites, particularly at device insertion, groin, and perianal areas (27%, 23%, and 17.6% of all acquisitions, respectively). Screening extranasal sites greatly increases the detection of MRSA colonization (100% of persistent carriers and 97.4% of transient carriers detected with nares, groin, perianal, and device site sampling vs 54.5% and 25.6%, respectively, for nares samples alone). Colonization at suprapubic urinary catheter sites generally persisted. Healthcare-associated MRSA (USA100 and USA100 variants) were the dominant strains (79.3% of all new acquisition isolates). Strain diversity was more common in transient carriers, including acquisition of USA500 and USA300 strains.CONCLUSION:
Indwelling device insertion sites as well as the groin and perianal area are important sites of new MRSA acquisitions in NH residents and play a role in the persistency of MRSA carriage. Clonal types differ among persistent and transient colonizers.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Infecções Estafilocócicas
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Cateteres de Demora
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Staphylococcus aureus Resistente à Meticilina
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Virilha
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Instituição de Longa Permanência para Idosos
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Cavidade Nasal
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Casas de Saúde
Tipo de estudo:
Clinical_trials
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Diagnostic_studies
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Etiology_studies
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Observational_studies
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Risk_factors_studies
Limite:
Aged
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Female
/
Humans
/
Male
País/Região como assunto:
America do norte
Idioma:
En
Revista:
Infect Control Hosp Epidemiol
Assunto da revista:
DOENCAS TRANSMISSIVEIS
/
ENFERMAGEM
/
EPIDEMIOLOGIA
/
HOSPITAIS
Ano de publicação:
2014
Tipo de documento:
Article