Keith M. Ramsey

Recommendations for Metrics for Multidrug-Resistant Organisms in Healthcare Settings : SHEA/HICPAC Position Paper

The assessment of MDRO infection and colonization should include the identification of known carriers, the detection of hospital-specific and healthcare-associated acquisition, an estimation of the burden of serious infection, an understanding of the reservoir affecting the transmission of MDROs, and an evaluation of the effect of intervention. Several strategies can be used to obtain data that aid in this assessment. We have defined and categorized the recommended metrics for each of these aspects of measuring MDRO infection and colonization, for use by healthcare facilities.

Active Surveillance Screening of MRSA and Eradication of the Carrier State Decreases Surgical-Site Infections Caused by MRSA

BACKGROUND Surgical-site infections (SSI), because of MRSA, are a challenge for acute care hospitals. The current study examines the impact of best practices and active surveillance screening for MRSA on reduction of MRSA SSIs. STUDY DESIGN Beginning February 2007, all admissions to a 761-bed tertiary care hospital were screened for MRSA by nasal swab using polymerase chain reaction-based testing. Positive nasal carriers of MRSA were treated before operation. The subset of patients undergoing procedures that are part of the Surgical Infection Prevention Project were followed for MRSA SSIs. SSI rates (per 100 procedures) were determined using the National Nosocomial Infection Surveillance definitions. MRSA SSI rates were compared before and after the MRSA screening intervention. Differences were analyzed using Fishers exact test and chi-square with Yates continuity correction. Where specimens were available, genotyping of MRSA was performed using a commercially available assay. RESULTS After universal MRSA surveillance, 5,094 patients underwent Surgical Infection Prevention Project procedures. The rate of MRSA SSI decreased from 0.23% to 0.09%. The reduction was most pronounced in joint-replacement procedures (0.30% to 0%; p = 0.04). No other differences were statistically significant. Of the seven patients in whom MRSA SSI developed after universal screening, four had positive MRSA screens; none had received preoperative eradication of MRSA. In two of these patients, the genotype of MRSA detected on screening and in SSI was genetically indistinguishable. CONCLUSIONS Surveillance for MRSA and eradication of the carrier state reduces the rate of MRSA SSI.

Outbreak of Mycobacterium mucogenicum bloodstream infections among patients with sickle cell disease in an outpatient setting.

OBJECTIVE To study an outbreak of Mycobacterium mucogenicum bloodstream infections in an outpatient setting. DESIGN Outbreak investigation and retrospective chart review. SETTING University outpatient clinic. Patients. Patients whose blood cultures tested positive for M. mucogenicum in May or June 2008. METHODS An outbreak investigation and a review of infection control practices were conducted. During the process, environmental culture samples were obtained. Isolates from patients and the environment were genotyped with the DiversiLab typing system to identify the source. Chart reviews were conducted to study the management and outcomes of the patients. RESULTS Four patients with sickle cell disease and implanted ports followed in the same hematology outpatient clinic developed blood cultures positive for M. mucogenicum. A nurse in the clinic had prepared intravenous port flushes on the sink counter, using a saline bag that was hanging over the sink throughout the shift. None of the environmental cultures grew M. mucogenicum except for the tap water from 2 rooms, 1 of which had a faucet aerator. The 4 patient isolates and the tap water isolate from the room with the aerator were found to have greater than 98.5% similarity. The subcutaneous ports were removed, and patients cleared their infections after a course of antibiotic therapy. CONCLUSION The source of the M. mucogenicum bacteremia outbreak was identified by genotyping analysis as the clinic tap water supply. The preparation of intravenous medications near the sink was likely an important factor in transmission, along with the presence of a faucet aerator.

A case control study of environmental and occupational exposures associated with methicillin resistant Staphylococcus aureus nasal carriage in patients admitted to a rural tertiary care hospital in a high density swine region

BackgroundDistinct strains of methicillin resistant Staphylococcus aureus (MRSA) have been identified on livestock and livestock workers. Industrial food animal production may be an important environmental reservoir for human carriage of these pathogenic bacteria. The objective of this study was to investigate environmental and occupational exposures associated with nasal carriage of MRSA in patients hospitalized at Vidant Medical Center, a tertiary hospital serving a region with intensive livestock production in eastern North Carolina.MethodsMRSA nasal carriage was identified via nasal swabs collected within 24 hours of hospital admission. MRSA carriers (cases) were gender and age matched to non-carriers (controls). Participants were interviewed about recent environmental and occupational exposures. Home addresses were geocoded and publicly available data were used to estimate the density of swine in residential census block groups of residence. Conditional logistic regression models were used to derive odds ratio (OR) estimates and 95% confidence intervals (CI). Presence of the scn gene in MRSA isolates was assessed. In addition, multi locus sequence typing (MLST) of the MRSA isolates was performed, and the Diversilab® system was used to match the isolates to USA pulsed field gel electrophoresis types.ResultsFrom July - December 2011, 117 cases and 119 controls were enrolled. A higher proportion of controls than cases were current workforce members (41.2% vs. 31.6%) Cases had a higher odds of living in census block groups with medium densities of swine (OR: 4.76, 95% CI: 1.36-16.69) and of reporting the ability to smell odor from a farm with animals when they were home (OR: 1.51, 95% CI: 0.80-2.86). Of 49 culture positive MRSA isolates, all were scn positive. Twenty-two isolates belonged to clonal complex 5.ConclusionsAbsence of livestock workers in this study precluded evaluation of occupational exposures. Higher odds of MRSA in medium swine density areas could reflect environmental exposure to swine or poultry.

Severe Human Metapneumovirus Infection in Hospitalized Children

Human metapneumovirus is a recently discovered pathogen that causes upper and lower respiratory tract disease in children. This study describes the course of illness in hospitalized children with this infection. During a 6-month period, 11 children were diagnosed with human metapneumovirus infection by reverse transcription-polymerase chain reaction. Oxygen supplementation was required for 82% of patients. Severe disease developed in 45%, and mechanical ventilation was required. An apparent life-threatening event was the indication for hospitalization of 27% of patients infected with human metapneumovirus. Children with underlying asthma or neuromuscular disease had a prolonged hospitalization.

Correlation between Methicillin-Resistant Staphylococcus aureus Nasal Sampling and S. aureus Pneumonia in the Medical Intensive Care Unit

Pneumonia in the Medical Intensive Care Unit Author(s): Ramzy H. Rimawi, MD; Keith M. Ramsey, MD; Kaushal B. Shah, MD; Paul P. Cook, MD Source: Infection Control and Hospital Epidemiology, Vol. 35, No. 5 (May 2014), pp. 590-593 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/675838 . Accessed: 08/04/2014 23:04

The Impact of a “Search and Destroy” Strategy for the Prevention of Methicillin-Resistant Staphylococcus aureus Infections in an Inpatient Rehabilitation Facility

To determine how the implementation of a methicillin‐resistant Staphylococcus aureus (MRSA) control program in an inpatient rehabilitation facility (IRF) affects MRSA health care−associated infections (MRSA‐HAIs).

Medical and Household Characteristics Associated with Methicillin Resistant Staphylococcus aureus Nasal Carriage among Patients Admitted to a Rural Tertiary Care Hospital

Background Methicillin resistant Staphylococcus aureus (MRSA) poses a threat to patient safety and public health. Understanding how MRSA is acquired is important for prevention efforts. This study investigates risk factors for MRSA nasal carriage among patients at an eastern North Carolina hospital in 2011. Methods Using a case-control design, hospitalized patients ages 18 – 65 years were enrolled between July 25, 2011 and December 15, 2011 at Vidant Medical Center, a tertiary care hospital that screens all admitted patients for nasal MRSA carriage. Cases, defined as MRSA nasal carriers, were age and gender matched to controls, non-MRSA carriers. In-hospital interviews were conducted, and medical records were reviewed to obtain information on medical and household exposures. Multivariable conditional logistic regression was used to derive odds ratio (OR) estimates of association between MRSA carriage and medical and household exposures. Results In total, 117 cases and 119 controls were recruited to participate. Risk factors for MRSA carriage included having household members who took antibiotics or were hospitalized (OR: 3.27; 95% Confidence Interval (CI): 1.24–8.57) and prior hospitalization with a positive MRSA screen (OR: 3.21; 95% CI: 1.12–9.23). A lower proportion of cases than controls were previously hospitalized without a past positive MRSA screen (OR: 0.40; 95% CI: 0.19–0.87). Conclusion These findings suggest that household exposures are important determinants of MRSA nasal carriage in hospitalized patients screened at admission.

Co-Reactivation of Cytomegalovirus and Human Herpesvirus-6 Among ICU Patients: There's Smoke, But Is There Fire?

Shaw M. Akula, PhD Department of Microbiology and Immunology The Brody School of Medicine at East Carolina University Greenville, NC Co-Reactivation of Cytomegalovirus and Human Herpesvirus-6 Among ICU Patients: There’s Smoke, But Is There Fire?* 11. Su SH, Wang F, Hai J, et al: The effects of intracranial pressure monitoring in patients with traumatic brain injury. PLoS One 2014; 9:e87432 12. Kostić A, Stefanović I, Novak V, et al: Prognostic significance of intracranial pressure monitoring and intracranial hypertension in severe brain trauma patients. Med Pregl 2011; 64:461–465 13. Griesdale DE, Örtenwall V, Norena M, et al: Adherence to guidelines for management of cerebral perfusion pressure and outcome in patients who have severe traumatic brain injury. J Crit Care 2015; 30:111–115 14. Bouzat P, Marques-Vidal P, Zerlauth JB, et al: Accuracy of brain multimodal monitoring to detect cerebral hypoperfusion after traumatic brain injury*. Crit Care Med 2015; 43:445–452 15. Honeybul S, Gillett GR, Ho K: Futility in neurosurgery: A patient-centered approach. Neurosurgery 2013; 73:917–922

Poster 414 The Impact of an Acute Care Hospital's Active Surveillance Program for Methicillin-resistant Staphylococcus aureus (MRSA) on Clinical Infections With MRSA in an Associated Inpatient Rehabilitation Facility

hilar lymph node that was too small to biopsy. Recommended follow-up imaging 3 months later demonstrated a significant increase in the size of the lesion. He was found to have poorly differentiated squamous cell lung carcinoma and subsequently underwent radiation therapy. A follow-up positron emission tomography suggested resolution of the tumor. He is currently able to ambulate well with a walker and is independent with all activities of daily living. Discussion: This is a case of a patient with chronic symptomatic alcoholic neuropathy who presented with acute worsening of neuropathic symptoms secondary to a paraneoplastic syndrome from an occult cancer. A diagnosis of paraneoplastic syndrome facilitated the early treatment of the tumor and resulted in resolution of the paraneoplastic symptoms. Conclusions: This case demonstrates the importance of considering alternate diagnoses when a patient with a preexisting neuropathic condition presents with changes not consistent with the underlying neuropathy.