Molecular epidemiology of MRSA in 13 ICUs from eight European countries.

OBJECTIVES: The European epidemiology of MRSA is changing with the emergence of community-associated MRSA (CA-MRSA) and livestock-associated MRSA (LA-MRSA). In this study, we investigated the molecular epidemiology of MRSA during 2 years in 13 ICUs in France, Greece, Italy, Latvia, Luxemburg, Portugal, Slovenia and Spain. METHODS: Surveillance cultures for MRSA from nose and wounds were obtained on admission and twice weekly from all patients admitted to an ICU for ≥3 days. The first MRSA isolate per patient was genotyped in a central laboratory by MLST, spa typing, agr typing and SCCmec (sub)typing. Risk factors for patients with an unknown history of MRSA colonization were identified. RESULTS: Overall, 14 390 ICU patients were screened, of whom 8519 stayed in an ICU for ≥3 days. Overall MRSA admission prevalence was 3.9% and ranged from 1.0% to 7.0% for individual ICUs. Overall MRSA acquisition rate was 2.5/1000 patient days at risk and ranged from 0.2 to 8/1000 patient days at risk per ICU. In total, 557 putative MRSA isolates were submitted to the central laboratory for typing, of which 511 (92%) were confirmed as MRSA. Each country had a distinct epidemiology, with ST8-IVc (UK-EMRSA-2/-6, USA500) being most prevalent, especially in France and Spain, and detected in ICUs in five of eight countries. Seventeen (3%) and three (<1%) isolates were categorized as CA-MRSA and LA-MRSA, respectively. Risk factors for MRSA carriage on ICU admission were age >70 years and hospitalization within 1 year prior to ICU admission. CONCLUSIONS: The molecular epidemiology of MRSA in 13 European ICUs in eight countries was homogeneous within, but heterogeneous between, countries. CA-MRSA and LA-MRSA genotypes and Panton-Valentine leucocidin-producing isolates were detected sporadically.

Patient engagement to counter catheter-associated urinary tract infections with an app (PECCA): a multicentre, prospective, interrupted time-series and before-and-after study.

BACKGROUND: The risk of urinary tract infections (UTIs) is increased by unnecessary placement and prolonged use of urinary catheters. AIM: To assess whether inappropriate use of catheters and catheter-associated UTI were reduced through patient participation. METHODS: In this multicentre, interrupted time-series and before-and-after study, we implemented a patient-centred app which provides catheter advice for patients, together with clinical lessons, feedback via e-mails and support rounds for staff members. Data on catheter use and infections were collected during a six-month baseline and a six-month intervention period on 13 wards in four hospitals in the Netherlands. Dutch Trial Register: NL7178. FINDINGS: Between June 25th, 2018 and August 1st, 2019, 6556 patients were included in 24 point-prevalence surveys, 3285 (50%) at baseline and 3271 (50%) during the intervention. During the intervention 249 app users and a median of seven new app users per week were registered (interquartile range: 5.5-13.0). At baseline, inappropriate catheter use was registered for 175 (21.9%) out of 798 catheters, compared to 55 (7.0%) out of 786 during the intervention. Time-series analysis showed a non-significant decrease of inappropriate use of 5.8% (95% confidence interval: -3.76 to 15.45; P = 0.219), with an odds ratio of 0.27 (0.19-0.37; P < 0.001). Catheter-associated UTI decreased by 3.0% (1.3-4.6; P = 0.001), with odds ratio 0.541 (0.408-0.716; P < 0.001). CONCLUSION: Although UTI significantly decreased after the implementation, patient participation did not significantly reduce the prevalence of inappropriate urinary catheter use. However, the inappropriate catheter reduction of 5.8% and an odds ratio of 0.27 suggest a positive trend. Patient participation appears to reduce CAUTI and could reduce other healthcare-associated infections.

Hepatitis C virus transmission in a Dutch haemodialysis unit: detailed outbreak investigation using NS5A gene sequencing.

BACKGROUND: Haemodialysis is a risk factor for hepatitis C virus (HCV) transmission. Two patients receiving haemodialysis in a Dutch dialysis unit in The Hague were found to seroconvert to HCV in December 2016 after the yearly routine control for blood-borne viruses. Following the presumed time of infection, three chronically infected HCV patients were identified as possible index cases. AIM: To confirm inter-patient transmission and to identify the source. METHODS: Molecular investigation and review of medical records were performed. FINDINGS: Both of the incident cases and one of the three possible index cases were demonstrated to be infected with HCV genotype 2b based on 5'UTR sequencing. Epidemiological relatedness between these viruses was further investigated by sequencing of the NS5A region. Phylogenetic analysis clearly identified the incident cases and the index case to represent a cluster distinct from unrelated controls with HCV genotype 2b. Detailed review of the medical records identified two possible incidents that might have resulted in the HCV transmission cases: contamination of the venous pressure-sensing port due to high venous pressures or incomplete compliance with infection control precautions of the unit staff during handling of two incidents, that occurred at the same time in a single haemodialysis session with the index patient as well as both incident cases present. CONCLUSION: This study demonstrates that detailed incident recording in combination with state-of-the-art molecular investigations such as sequencing of the NS5A region resulted in unravelling a set of two HCV transmissions that occurred at a haemodialysis unit.

Clinical relevance of mupirocin resistance in Staphylococcus aureus.

Mupirocin is a topical antibiotic used for decolonization of meticillin-susceptible S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA), both in patients and in healthcare personnel, and for treatment of local skin and soft tissue infections caused by S. aureus and streptococcal species. Mupirocin prevents bacterial protein synthesis by inhibiting the bacterial isoleucyl-tRNA synthetase (IleRS). Low-level resistance against mupirocin, defined as minimum inhibitory concentration (MIC) of 8-256mg/L, results from a point mutation in the native IleRS, and high-level resistance (MIC ≥512mg/L) is mediated by the mupA (ileS-2) gene, located on mobile genetic elements decoding for an alternate IleRS. EUCAST and BSAC clinical thresholds for S. aureus are ≤1mg/L for susceptible and >256mg/L for resistant, placing the susceptible threshold at the epidemiological cut-off value (ECOFF). Isolates with MICs above the wild type (ECOFF 1mg/L) but without a recognized resistance mechanism (MIC ≤4mg/L) will thus be reported intermediate. Resistance to mupirocin, both high- and low-level, reduces the effectiveness of decolonizing strategies for S. aureus or MRSA. Low-level resistant isolates may initially be eradicated as effectively as susceptible isolates, but recolonization appears to be more usual. Increased use of mupirocin has been associated with emergence of resistance through enhanced selective pressure and cross-transmission. Unrestricted over-the-counter use and treatment of wounds and pressure sores with mupirocin are especially strongly associated with resistance. Yet emergence of mupirocin resistance following increased use has not been reported consistently, and an integrated understanding of all factors underlying the dynamics of mupirocin resistance in hospitals and communities is lacking.

Probable transmission of Yersinia enterocolitica from a pet dog with diarrhoea to a 1-year-old infant.

We report a highly probable case of transmission of a Yersinia enterocolitica from a pet puppy dog, adopted from a Spanish asylum, to a 1-year-old girl. After several weeks of diarrhoea, a PCR detecting enteropathogenic bacteria was performed on the faeces, revealing Y enterocolitica. Following cultures yielded a Y enterocolitica biotype 4, serotype O:3 in the faeces of the girl as well as puppy dog. Despite antibiotic treatment, symptoms and shedding of the organism in the faeces endured during a 2 month period.