Study suggests contact precautions for MRSA, VRE can be safely removed
A study conducted in 15 hospitals found that discontinuing contact precautions for methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) did not result in increased healthcare-associated infection (HAI) rates, researchers reported today in Infection Control & Hospital Epidemiology.
To determine the impact of removing contact precautions for MRSA and VRE, which are recommended by the Centers for Disease Control and Prevention to reduce transmission but are controversial because of associations with patient harms, the researchers performed a retrospective, quasi-observational study at 15 acute care hospitals in a Pennsylvania healthcare system. Twelve of the hospitals (the intervention hospitals) had removed MRSA and VRE contact precautions after a policy change recommended doing so, and 3 (non-intervention hospitals) continued them.
The researchers compared HAI rates at the hospitals during the 12 months before and after discontinuation. To predict conditions where contact precautions may safely be removed, they correlated selected baseline hospital characteristics and infection prevention practices with HAI rate changes.
Aggregated HAI rates from intervention hospitals before and after discontinuation of contact precautions were 0.14 and 0.15 MRSA HAI per 1,000 patient days (P = .74), 0.05 and 0.05 VRE HAI per 1,000 patient days (P = .96), and 0.04 and 0.04 MRSA laboratory-identified (LabID) events per 100 admissions (P = .57). No statistically significant rate changes occurred between the intervention and non-intervention hospitals.
All successful hospitals had low baseline MRSA and VRE HAI rates and high hand hygiene adherence. No correlations were found between rate changes after discontinuation and the assessed hospital characteristics and infection prevention factors, although there was an increase in MRSA HAIs in hospitals with a higher proportion of semiprivate rooms (P = .04).
"Our results suggest that contact precautions for endemic MRSA and VRE can be safely removed under the right conditions without increasing HAI in a large, diverse health system, which would lead to significant cost savings on isolation gowns," the study authors write. "The exact conditions necessary require further investigation, but this study supports the importance of high rates of hand hygiene and low rates of HAI with MRSA and VRE."
Dec 1 Infect Control Hosp Epidemiol abstract
Intensive malaria control measures linked to reduced antibiotics in kids
Implementation of intensive malaria control efforts in Uganda was associated with a 70% reduction in antibiotic use in children, researchers reported yesterday in BMC Medicine.
In the study, Ugandan, US, and UK researchers analyzed the medical records of two cohorts of children (ages 6 months to 10 years) in a high-transmission area of Uganda where distribution of long-lasting insecticidal nets (in 2013 and 2017) and sustained indoor residual spraying (IRS) of insecticides (in 2014, with repeated rounds through 2019) were initiated. They then compared the incidence of antimalarial and antimicrobial treatments—which are frequently used for the acute bacterial and viral infections that are common in malaria-endemic settings—before and after the vector control measures were implemented.
Comparing the period prior to the implementation of IRS to the period after IRS had been sustained for 4 to 5 years, the adjusted incidence of malaria treatments decreased from 2.68 to 0.05 per person-year (incidence rate ratio [IRR], 0.02; 95% confidence interval [CI], 0.01 to 0.03; P < 0.001), and the adjusted incidence of antibiotic treatments decreased from 4.14 to 1.26 per person-year (IRR, 0.30; 95% CI, 0.27 to 0.34; P < 0.001).
The reduction in antibiotic usage was primarily associated with fewer episodes of symptomatic malaria and fewer episodes of fever with sub-microscopic parasitemia, both of which were frequently treated with antibiotics.
The study authors say the high number of antibiotic treatments averted (mostly amoxicillin) could help reduce selection pressure and help slow the spread of antimicrobial resistance in Uganda and other countries where malaria is endemic.
"We found that investments in malaria control may have broader health benefits for children beyond malaria," they wrote. "Future studies should investigate the association between malaria control and antibiotic prescribing practices in other settings to further explore the impact on health systems and to inform strategies to mitigate the overuse of antibiotics and the threat of antimicrobial resistance in malaria-endemic settings."
Nov 30 BMC Med study