Study finds MRSA and VRE can linger in nursing homes
Environmental screening of single-occupancy rooms in a nursing home found high levels of circulation and persistence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE), according to a study published today in Antimicrobial Stewardship & Healthcare Epidemiology.
In the prospective cohort study, researchers screened five high-touch surfaces in a cluster of nine single-occupancy rooms at a nursing home three times a week for 34 weeks. They also screened patients if they agreed to participate. Overall, there were 146 distinct occupancy events captured during the study, with 387 study visits and 4,670 swabs collected.
Screening revealed that all rooms were contaminated with VRE, and eight of nine were also contaminated with MRSA. New contamination of a room with MRSA or VRE was observed in 43 (23%) of 185 opportunities, with potential persistence occurring in 25 (32.9%) of 76 opportunities.
Whole-genome sequencing of 67 non-redundant isolates identified at least 6 enterococcal clades and 10 MRSA clades, indicating a high degree of diversity and likely multiple introductions in the facility during the study period, including one case of a MRSA strain persisting in a clean room before admission of the next patient.
The researchers, who presented the study at the Society for Healthcare Epidemiology (SHEA) spring conference last month, say the findings indicate that active surveillance screening and recurring evaluation of terminal cleaning procedures should be considered in the nursing home setting.
May 16 Antimicrob Steward Healthc Epidemiol abstract
Multiple factors influence antimicrobial use in cats and dogs, data show
In another study presented at the SHEA spring conference and published in Antimicrobial Stewardship & Healthcare Epidemiology today, researchers identified multiple factors associated with antimicrobial prescriptions in dogs and cats.
Using demographic, clinical, and prescription data from the electronic medical record system at a small-animal teaching hospital from 2018 to 2020, the researchers assessed the association between demographic and clinical factors of systemic antimicrobial drug prescriptions in dogs and cats. Across 11,685 dogs with 14,328 admissions (mean age 7.4 years; 47% female), they found that female sex, longer admission, a history of chemotherapy within 30 days of admission, surgery upon admission or within the last 30 days, intensive care unit (ICU) admission, and oxygen support were associated with increased odds of any antimicrobial prescription.
In 3,371 cats with 4,088 admissions (mean age, 8.6 years; 39% female), the researchers found that female sex, longer admission, increased age (older than 8 years), ICU admission, surgery upon admission, and no requirement for oxygen support or urinary catheterization were associated with increased odds of any antimicrobial prescription.
The researchers say the findings can inform veterinary antimicrobial stewardships efforts and may be useful for benchmarking antimicrobial use on an institutional or multi-institutional scale.
May 16 Antimicrob Steward Healthc Epidemiol abstract
Surveillance system linked to antibacterial decline in NICUs
Implementation of a mandatory surveillance system in neonatal ICUs (NICUs) in Germany was associated with a reduction in antibacterial consumption in preterm infants, researchers reported late last week in the Journal of Infection.
For the study, a team of German researchers analyzed data on antibacterial use in 231 NICUs in Germany from 2013—when a module for the assessment of antibacterial use in very low birth weight (VLBW) newborns was added to the German national nosocomial infection surveillance system for neonates (NEO-KISS)—to 2019. NEO-KISS assesses the incidence antibacterial use, healthcare-associated infections, and multidrug-resistance organisms in premature infants during inpatient care. The primary outcome assessed was antibacterial consumption during days of treatment (DOT) per 1,000 patient-days (PD).
In total, 2,090,241 patient-days with 344,929 days of antibacterial use were observed. Over the entire study period, antibacterial consumption was 430.4 DOT/1,000 PD, but consumption declined from 474.3 DOT/1,000 PD in 2013 to 382.1 DOT/1,000 PD in 2019—a 19.5% decrease.
Of all neonates under surveillance, 72.9% received antibacterial therapy. Use of penicillins with extended spectrum, other aminoglycosides, glycopeptide antibacterials, and third-generation cephalosporins decreased, while use of macrolides and combinations of penicillins, including beta-lactamase inhibitors, increased over time.
The analysis also found that severe healthcare-associated infections decreased continually during the study period. Regression analysis identified year of birth as an independent protective factor for the prescription of antibacterials in general.
The study authors say that while the underlying reasons for the reduction cannot be directly identified, they note that implementation of surveillance systems can stimulate activities to improve prescribing on a local and national level, such as establishing benchmarks for antibacterial use.
"Assessment of antibacterial consumption could further help to implement additional targeted antimicrobial stewardship measures potentially further reduce antibacterial consumption and improve antibacterial prescriptions on NICUs beyond VLBW," they wrote.
May 14 J Infect study