Investigation of Hospital-Onset Methicillin-Resistant Staphylococcus aureus Bloodstream Infections at Eight High Burden Acute Care Facilities in the United States, 2016.

Autor: Ham, D.C., See, I., Novosad, S., Crist, M., Mahon, G., Fike, L., Spicer, K., Talley, P., Flinchum, A., Kainer, M., Kallen, A.J., Walters, M.S., Ham, D Cal, See, Isaac, Novosad, Shannon, Crist, Matthew, Mahon, Garrett, Fike, Lucy, Spicer, Kevin, Talley, Pamela
Zdroj: Journal of Hospital Infection; Jul2020, Vol. 105 Issue 3, p502-508, 7p
Abstrakt: 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. [ABSTRACT FROM AUTHOR]
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