Browsing by Subject "Staphylococcal Infections"
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Item Changes in Rate of Methicillin-Resistant Staphylococcus Infection in a Community Neonatal Intensive Care Unit Before and During the COVID-19 Pandemic(2024-01-30) Blumenfeld, Abby; Hagans, Michelle; Chan, ChristinaBACKGROUND: Methicillin-Resistant Staphylococcus aureus (MRSA) infections represent a significant healthcare challenge, particularly in neonatal intensive care units (NICUs) where patients experience increased morbidity and mortality. MRSA transmission has not been well studied in the setting of enhanced infection precautions (EIP) taken during the COVID-19 pandemic - such as universal masking and enhanced hand hygiene. OBJECTIVE: This retrospective cohort study compared rates of MRSA infection in a community NICU during two distinct time periods: January 2016 to March 2020 (Pre-EIP: before EIP was instituted) and April 2020 to December 2022 (With-EIP: after EIP was instituted). METHODS: During the study period, 74 neonates admitted to the NICU tested positive for MRSA (56 Pre-EIP and 18 With-EIP). MRSA cases were collected using laboratory and electronic medical record review. Cases were reported as infections per 1,000 patient days (IP-1000). Statistical analysis with two-sample t-tests assuming unequal variance and chi squared tests for independence were performed. RESULTS: There was a significant decrease in MRSA IP-1000 from 1.90 Pre-EIP to 0.93 With-EIP (p=0.0006). The prevalence of MRSA clusters, defined as three infections within a 30-day period, decreased from 0.27 Pre-EIP compared to 0.03 With-EIP (p=0.0004). However, The Pre-EIP cohort had a younger average gestational age (30.2 vs 33.8 weeks, p=0.001), higher rates of very low birth weight (59% vs 28%, p=0.021), and fewer inborn neonates (88% vs 100%, p=0.115) - factors known to increase risk of MRSA infection. CONCLUSION: These findings suggest that EIP may have contributed to the reduction in MRSA clusters observed in this community NICU. Findings are limited by differences in cohort risk factors, small study population, variabilities in infection precautions throughout the pandemic, and the inherent bias of retrospective cohort analysis. This underscores the importance of prevention strategies and highlights the potential benefits of continued enhanced infection precautions in reducing the transmission of MRSA in vulnerable inpatient populations.Item Hospital-Onset Bloodstream Infection Rates after Discontinuing Active Surveillance Cultures for Methicillin-Resistant Staphylococcus aureus in a Regional Burn Center(2018-02-21) Drum, Bayless; Sreeramoju, Pranavi; Reed, W. Gary; Arnoldo, BrettInfections caused by antibiotic resistant bacteria including methicillin-resistant Staphylococcus aureus (MRSA) are associated with increased morbidity and mortality in hospitalized patients. Active surveillance culture (ASC) programs that involve identifying asymptomatically colonized patients and placing them on contact precautions have been promoted to control the spread of hospital-onset (HO) infections. Burn patients are particularly susceptible to staphylococcal infection, but a complete understanding of the effectiveness of ASC programs in preventing HO infections among burn patients is limited. The objective of this retrospective observational study is to describe the epidemiology of MRSA among patients in an academic medical center burn unit including the impact of removal of an ASC program on HO MRSA blood stream infections (BSI) in order to inform control efforts in this population. This study was done in the Burn Intensive Care Unit and Burn Acute Care Unit of Parkland Memorial Hospital. The study period was December 2011 to February 2016. The ASC program was discontinued in August 2014. The rate of MRSA HO-BSIs during the period with ASCs was 1.23 per 1,000 patient days. The rate was 1.28 in the follow-up period without the ASC program in place. The difference in incidence between the two periods was not statistically significant (P= 0.91). We conclude that ASCs and contact isolation of colonized patients may not be critical to reducing the incidence of HO-BSI caused by MRSA.Item Pathologic Fracture Secondary to Acute Hematogenous Osteomyelitis in Children in New Zealand(2022-05) Atadja, Louise Aseye; Chang, Mary; Boyle, Matthew; Copley, Lawson A. B.BACKGROUND: Acute hematogenous osteomyelitis is a common pediatric musculoskeletal infection that has been well studied in the literature. Moderate to severe cases of osteomyelitis may weaken and destabilize the bone architecture leading to complications like pathologic fracture. The purpose of this study was to investigate the risk factors for the development of pathologic fracture following acute hematogenous osteomyelitis for children in New Zealand. METHODS: Nine patients who were treated for a pathologic long-bone fracture secondary to Staphylococcus aureus osteomyelitis between January 2009 to December 2019 at the Starship Children's Hospital in Auckland, New Zealand were identified. These patients were compared with a age and sex matched control group of twenty-seven children with Staphylococcus aureus osteomyelitis without a pathologic fracture. A retrospective review of patient's clinical records, lab and microbiological findings was performed. RESULTS: Patients who developed a fracture presented with osteomyelitis at a mean age of 5.3 years (range, 0.1 to 8.6 years). The mean time from initial osteomyelitis onset to pathologic fracture was 49 days (range, nine to 116 days). Patients with an increased NZ deprivation score and those of Pacific-Islander ethnicity differed significantly between the two groups. For initial clinical presentation, it was found that swelling, reduced range of motion and erythema, and higher CRP levels showed significant differences between the two groups. Length of stay, PICU admission and increased readmissions also showed significant differences between the two groups. The management strategy of the pathologic fracture group was also presented. CONCLUSIONS: Patients presenting with more severe acute infections are at significant risk of pathologic fracture following osteomyelitis. Prophylactic treatment plans such as early immobilization and casting may be necessary in patients presenting with these risk factors to prevent the long and difficult treatment of pathologic fracture.Item Preventing hospital-acquired infections from Semmelweis to SENIC: medicine's need for the "aggregate view"(1985-02-28) Haley, Robert W.Item Staphylococcal diseases(1959-10-01) Sanford, Jay P.