Nasal colonization with methicillin-resistant Staphylococcus aureus among elderly living in nursing homes in Brazil: risk factors and molecular epidemiology.

BACKGROUND: Methicillin-resistant Staphylococcus aureus poses a threat to elderly living in nursing homes. Studies focusing on the epidemiology of colonization may help in the design of infection control strategies. OBJECTIVE: To identify factors associated with MRSA colonization and the dissemination of clones among nursing home residents. METHODS: Nasal swabs were collected from 300 persons from nine nursing homes in the city of Bauru, Brazil. Resistance to methicillin was identified through amplification of the mecA gene. Strain typing (Pulsed-Field Gel Electrophoresis) and characterization of the Staphylococcal Chromosome Cassette (SCC) mec was performed. Univariate and multivariable models were used to identify predictors of overall S. aureus and MRSA carriage. RESULTS: Rates of S. aureus and MRSA colonization were 17.7 and 3.7%, respectively. Age and recent admission to a hospital were independently associated with colonization with S. aureus. MRSA colonization was associated with living in small (< 15 residents) and medium-sized (15-49 residents) facilities, as well as with recent hospitalization. Most MRSA strains carried SCCmec types II or IV, and there was evidence of clonal spread within and among different facilities. CONCLUSIONS: MRSA may be introduced in nursing homes form hospitals or arise from the community setting. Screening for asymptomatic colonization may identify persons with greater risk for infection, and is advised for residents discharged from acute care hospitals.

Neuron-specific enolase at admission as a predictor for stroke volume, severity and outcome in ischemic stroke patients: a prognostic biomarker review.

An ideal blood biomarker for stroke should provide reliable results, enable fast diagnosis, and be readily accessible for practical use. Neuron-specific enolase (NSE), an enzyme released after neuronal damage, has been studied as a marker for brain injury, including cerebral infarction. However, different methodologies and limited sample sizes have restricted the applicability of any potential findings. This work aims to determine whether NSE levels at Emergency Department (ED) admission correlate with stroke severity, infarcted brain volume, functional outcome, and/or death rates. A systematic literature review was performed using PubMed, Embase, and Scopus databases. Each reviewer independently assessed all published studies identified as potentially relevant. All relevant original observational studies (cohort, case-control, and cross-sectional studies) were included. Eleven studies (1398 patients) met the inclusion criteria. Among these, six studies reported a significant correlation between NSE levels and stroke severity, while only one found no association. Four studies indicated a positive relationship between infarcted brain volume assessed by imaging and NSE levels, in contrast to the findings of only one study. Four studies identified an association related to functional outcome and death rates, while three others did not reach statistical significance in their findings. These data highlight that NSE levels at ED admissions proved to be a promising tool for predicting the outcome of ischemic stroke patients in most studies. However, they presented high discrepancies and low robustness. Therefore, further research is necessary to establish and define the role of NSE in clinical practice.

Incidence and predictors of health care-associated infections among patients colonized with carbapenem-resistant Enterobacteriaceae.

Colonization with carbapenem-resistant Enterobacteriaceae (CRE) precedes invasive infections. Neither the actual risk for the latter nor the route between the 2 stages is completely clear. We studied a retrospective cohort of patients hospitalized between 2013-2016 and colonized with CRE. The incidence of CRE health care-associated infections was 13.2%, and predictors were the presence of a urinary catheter and the use of carbapenems. Infection prevention strategies in CRE-colonized patients should focus on invasive devices and antimicrobial stewardship.

Estudo da prevalência de Staphylococcus Coagulase Negativa em amostras de hemoculturas em um hospital público de Bauru-SP / Study of the prevalence of Coagulase Negative Staphylococcus in blood culture samples in a public hospital in Bauru-SP

Objetivo ­ Realizar um levantamento da positividade em hemoculturas para isolados de Staphylococcus Coagulase Negativa, contemplando as espécies mais prevalentes e o perfil de resistência a antimicrobianos, analisando a ocorrência de contaminação durante a fase pré-analítica ou uma bacteremia, em um Hospital Público do município de Bauru-SP. Métodos ­ Trata-se de um estudo retrospectivo por meio da coleta de dados do prontuário eletrônico do hospital que foram analisados estatisticamente. Resultados ­ Foi encontrada uma prevalência de bactérias Staphylococcus epidermidis dentre as hemoculturas positivas observadas de 285 pacientes, sendo 55% de pessoas do sexo masculino, com uma taxa de 80% de resistência desses microrganismos aos antimicrobianos oxacilina e cefoxitina, contudo verificou-se 100% de sensibilidade a vancomicina. Conclusão ­ Apesar de serem necessárias duas amostras de hemoculturas positivas para diagnóstico de bacteremia, nesse estudo constatou-se que os pacientes em estado crítico e com sintomatologia de infecção de corrente sanguínea com apenas uma amostra de hemocultura positiva, recebeu tratamento antimicrobiano para não agravar a condição do paciente

Objective ­ To carry out a survey of positivity in blood cultures for Staphylococcus Coagulase Negative isolates, contemplating the most prevalent species and the antimicrobial resistance profile, analyzing the occurrence of contamination during the pre-analytical phase or a bacteremia, in a Public Hospital in the city from Bauru-SP. Methods ­ This is a retrospective study through the collection of data from the hospital's electronic medical record, which were statistically analyzed. Results ­ A prevalence of Staphylococcus epidermidis bacteria was found among the positive blood cultures observed in 285 patients, 55% of whom were male, with a rate of 80% of resistance of these microorganisms to the antimicrobials oxacillin and cefoxitin, however it was found 100% of sensitivity to vancomycin. Conclusion ­ Although two samples of positive blood cultures are needed for the diagnosis of bacteremia, in this study it was found that patients in critical condition and with symptoms of bloodstream infection with only one positive blood culture sample received antimicrobial treatment so as not to worsen the condition of the patient

Small hospitals matter: insights from the emergence and spread of vancomycin-resistant enterococci in 2 public hospitals in inner Brazil.

Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants of VRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals.