BACKGROUND: Despite large reductions from 2005-2012, hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections (HO MRSA BSIs) continue be a major source of morbidity and mortality. AIM: To describe risk factors for and underlying sources of HO MRSA BSIs. METHODS: We investigated HO MRSA BSIs at eight high-burden short-stay acute care hospitals. A case was defined as first isolation of MRSA from a blood specimen collected in 2016 on hospital day ≥4 from a patient without an MRSA-positive blood culture in the 14 days prior. We reviewed case-patient demographics and risk factors by medical record abstraction. The potential clinical source(s) of infection were determined by consensus by a clinician panel. FINDINGS: Of the 195 eligible cases, 186 were investigated. Case-patients were predominantly male (63%); median age was 57 years (range 0-92). In the two weeks prior to the BSI, 88% of case-patients had indwelling devices, 31% underwent a surgical procedure, and 18% underwent dialysis. The most common locations of attribution were intensive care units (ICUs) (46%) and step-down units (19%). The most commonly identified non-mutually exclusive clinical sources were CVCs (46%), non-surgical wounds (17%), surgical site infections (16%), non-ventilator healthcare-associated pneumonia (13%), and ventilator-associated pneumonia (11%). CONCLUSIONS: Device-and procedure-related infections were common sources of HO MRSA BSIs. Prevention strategies focused on improving adherence to existing prevention bundles for device-and procedure-associated infections and on source control for ICU patients, patients with certain indwelling devices, and patients undergoing certain high-risk surgeries are being pursued to decrease HO MRSA BSI burden at these facilities.
BACKGROUND: Despite large reductions from 2005-2012, hospital-onset methicillin-resistant Staphylococcus aureus bloodstream infections (HO MRSA BSIs) continue be a major source of morbidity and mortality. AIM: To describe risk factors for and underlying sources of HO MRSA BSIs. METHODS: We investigated HO MRSA BSIs at eight high-burden short-stay acute care hospitals. A case was defined as first isolation of MRSA from a blood specimen collected in 2016 on hospital day ≥4 from a patient without an MRSA-positive blood culture in the 14 days prior. We reviewed case-patient demographics and risk factors by medical record abstraction. The potential clinical source(s) of infection were determined by consensus by a clinician panel. FINDINGS: Of the 195 eligible cases, 186 were investigated. Case-patients were predominantly male (63%); median age was 57 years (range 0-92). In the two weeks prior to the BSI, 88% of case-patients had indwelling devices, 31% underwent a surgical procedure, and 18% underwent dialysis. The most common locations of attribution were intensive care units (ICUs) (46%) and step-down units (19%). The most commonly identified non-mutually exclusive clinical sources were CVCs (46%), non-surgical wounds (17%), surgical site infections (16%), non-ventilator healthcare-associated pneumonia (13%), and ventilator-associated pneumonia (11%). CONCLUSIONS: Device-and procedure-related infections were common sources of HO MRSA BSIs. Prevention strategies focused on improving adherence to existing prevention bundles for device-and procedure-associated infections and on source control for ICU patients, patients with certain indwelling devices, and patients undergoing certain high-risk surgeries are being pursued to decrease HO MRSA BSI burden at these facilities.
Authors: Marin L Schweizer; Hsiu-Yin Chiang; Edward Septimus; Julia Moody; Barbara Braun; Joanne Hafner; Melissa A Ward; Jason Hickok; Eli N Perencevich; Daniel J Diekema; Cheryl L Richards; Joseph E Cavanaugh; Jonathan B Perlin; Loreen A Herwaldt Journal: JAMA Date: 2015-06-02 Impact factor: 56.272
Authors: Susan S Huang; Edward Septimus; Ken Kleinman; Julia Moody; Jason Hickok; Lauren Heim; Adrijana Gombosev; Taliser R Avery; Katherine Haffenreffer; Lauren Shimelman; Mary K Hayden; Robert A Weinstein; Caren Spencer-Smith; Rebecca E Kaganov; Michael V Murphy; Tyler Forehand; Julie Lankiewicz; Micaela H Coady; Lena Portillo; Jalpa Sarup-Patel; John A Jernigan; Jonathan B Perlin; Richard Platt Journal: Lancet Date: 2019-03-05 Impact factor: 79.321
Authors: Lonneke G M Bode; Jan A J W Kluytmans; Heiman F L Wertheim; Diana Bogaers; Christina M J E Vandenbroucke-Grauls; Robert Roosendaal; Annet Troelstra; Adrienne T A Box; Andreas Voss; Ingeborg van der Tweel; Alex van Belkum; Henri A Verbrugh; Margreet C Vos Journal: N Engl J Med Date: 2010-01-07 Impact factor: 91.245
Authors: Makoto Jones; John A Jernigan; Martin E Evans; Gary A Roselle; Kelly M Hatfield; Matthew H Samore Journal: MMWR Morb Mortal Wkly Rep Date: 2019-03-08 Impact factor: 17.586
Authors: Athena P Kourtis; Kelly Hatfield; James Baggs; Yi Mu; Isaac See; Erin Epson; Joelle Nadle; Marion A Kainer; Ghinwa Dumyati; Susan Petit; Susan M Ray; David Ham; Catherine Capers; Heather Ewing; Nicole Coffin; L Clifford McDonald; John Jernigan; Denise Cardo Journal: MMWR Morb Mortal Wkly Rep Date: 2019-03-08 Impact factor: 17.586
Authors: Susan S Huang; Edward Septimus; Ken Kleinman; Julia Moody; Jason Hickok; Taliser R Avery; Julie Lankiewicz; Adrijana Gombosev; Leah Terpstra; Fallon Hartford; Mary K Hayden; John A Jernigan; Robert A Weinstein; Victoria J Fraser; Katherine Haffenreffer; Eric Cui; Rebecca E Kaganov; Karen Lolans; Jonathan B Perlin; Richard Platt Journal: N Engl J Med Date: 2013-05-29 Impact factor: 91.245