Last data update: May 06, 2024. (Total: 46732 publications since 2009)
Records 1-10 (of 10 Records) |
Query Trace: Fosheim G[original query] |
---|
Methicillin-resistant Staphylococcus aureus colonization of the groin and risk for clinical infection among HIV-infected adults
Peters PJ , Brooks JT , McAllister SK , Limbago B , Lowery HK , Fosheim G , Guest JL , Gorwitz RJ , Bethea M , Hageman J , Mindley R , McDougal LK , Rimland D . Emerg Infect Dis 2013 19 (4) 623-629 Data on the interaction between methicillin-resistant Staphylococcus aureus (MRSA) colonization and clinical infection are limited. During 2007-2008, we enrolled HIV-infected adults in Atlanta, Georgia, USA, in a prospective cohort study. Nares and groin swab specimens were cultured for S. aureus at enrollment and after 6 and 12 months. MRSA colonization was detected in 13%-15% of HIV-infected participants (n = 600, 98% male) at baseline, 6 months, and 12 months. MRSA colonization was detected in the nares only (41%), groin only (21%), and at both sites (38%). Over a median of 2.1 years of follow-up, 29 MRSA clinical infections occurred in 25 participants. In multivariate analysis, MRSA clinical infection was significantly associated with MRSA colonization of the groin (adjusted risk ratio 4.8) and a history of MRSA infection (adjusted risk ratio 3.1). MRSA prevention strategies that can effectively prevent or eliminate groin colonization are likely necessary to reduce clinical infections in this population. |
Correlation between animal nasal carriage and environmental methicillin-resistant Staphylococcus aureus isolates at U.S. horse and cattle farms
Peterson AE , Davis MF , Awantang G , Limbago B , Fosheim GE , Silbergeld EK . Vet Microbiol 2012 160 539-43 Animals on farms may be a potential reservoir and environmental source of methicillin-resistant Staphylococcus aureus (MRSA). Expanded surveillance methods for animal-associated MRSA are needed. To develop an environmental sampling method and to determine the correlation between animal and environmental MRSA positivity in the farm setting, we sampled horses, cattle, and their local environments at several farms in the mid-Atlantic United States. We obtained nasal swabs from 13 racehorses at first visit, and 11 racehorses at the same farm eight weeks later. We also sampled 26 pleasure horses and 26 beef cattle from two additional farm sites. Sterilized electrostatic cloths were used to collect dry dust samples from environmental surfaces in proximity to animals; cloths were cultured using a broth enrichment protocol. We described isolates by genotype and antimicrobial susceptibility phenotype. None of the samples (nasal or environmental) were positive from the pleasure horse farm or the cattle farm. On the racehorse farm, 8/13 (61%) nasal and 5/7 (71%) environmental samples were positive for MRSA at the first visit. Isolates found were indistinguishable by pulsed-field gel electrophoresis (PFGE) genotype. We observed significant positive correlation between nasal carriage of MRSA in animals and our ability to isolate MRSA from dry surface samples of their local environments. The methods presented here may aid in surveillance efforts for equine and other animal MRSA. This study successfully applies existing MRSA surveillance methods for indoor, high animal density settings to outdoor and low-density farms. |
Impact of USA300 methicillin-resistant Staphylococcus aureus on clinical outcomes of patients with pneumonia or central line-associated bloodstream infections
Lessa FC , Mu Y , Ray SM , Dumyati G , Bulens S , Gorwitz RJ , Fosheim G , Devries A , Schaffner W , Nadle J , Gershman K , Fridkin SK . Clin Infect Dis 2012 55 (2) 232-41 BACKGROUND: Many assumed high morbidity and mortality would accompany the emergence of MRSA USA300 infections as a cause of healthcare-associated infections (HAIs). We evaluated patients with invasive MRSA infections to assess differences in outcomes between infections caused by USA100 and USA300. METHODS: Population-based data for invasive MRSA infections were used to identify two cohorts: (1) non-dialysis patients with central line-associated bloodstream infections (CLABSI); and (2) patients with community-onset pneumonia (PNEUMO) during 2005-2007 from 6 US metropolitan areas. Medical records of patients with confirmed MRSA USA100 or USA300 were reviewed. Logistic regression and, when appropriate, survival analysis was performed to evaluate mortality, early and late complications, and length of stay. RESULTS: A total of 236 and 100 patients were included in the CLABSI and PNEUMO cohorts, respectively. USA300 was the only independent predictor of early complications for PNEUMO patients (OR=2.6, P=.02). Independent predictors of CLABSI late complications included intensive care unit (ICU) admission before MRSA culture (aOR=2.1, P=.01) and Charlson comorbidity index (aOR=2.6; P=.003), but not strain type. PNEUMO patients were significantly more likely to die if they were older (P=.02), black (P<.001) or infected with USA100 strain (P=.02); while those with CLABSI were more likely to die if they were older (P<.001), had comorbidities (P<.001) or had an ICU admission before MRSA culture (P=.001). CONCLUSIONS: USA300 was associated with early complications in PNEUMO patients. However, it was not associated with mortality for either PNEUMO or CLABSI patients. Concerns regarding higher mortality from HAIs caused by USA300 may not be warranted. |
Prevalence of methicillin-resistant Staphylococcus aureus as an etiology of community-acquired pneumonia
Moran GJ , Krishnadasan A , Gorwitz RJ , Fosheim GE , Albrecht V , Limbago B , Talan DA . Clin Infect Dis 2012 54 (8) 1126-1133 BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown. METHODS: We prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter-spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed. RESULTS: Of 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%-5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department. CONCLUSIONS: Methicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation. (See the Editorial Commentary by Mandell and Wunderink, on pages 1134-6.) |
Evaluation of the impact of direct plating, broth enrichment, and specimen source on recovery and diversity of methicillin-resistant Staphylococcus aureus among HIV-infected outpatients
McAllister SK , Albrecht VS , Fosheim GE , Lowery HK , Peters PJ , Gorwitz R , Guest JL , Hageman J , Mindley R , McDougal LK , Rimland D , Limbago B . J Clin Microbiol 2011 49 (12) 4126-30 We compared recovery of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) from nasal and groin swabs of 600 HIV-infected outpatients by selective and non-selective direct plating and broth enrichment. Swabs were collected at baseline, 6-month and 12-month visits, cultured by direct plating to Mannitol Salt Agar (MSA), CHROMagar MRSA (CM), and overnight broth enrichment with sub-culture to MSA (Broth). MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), SCCmec typing and PCR for the Panton-Valentine leukocidin. At each visit 13-15% of patients were colonized with MRSA and 30-33% with methicillin-susceptible S. aureus (MSSA). Broth, CM and MSA detected 95%, 82% and 76% of MRSA-positive specimens, respectively. MRSA recovery was significantly higher from Broth compared to CM (p ≤ 0.001) or MSA (p ≤ 0.001); there was no significant difference in recovery between MSA and CM. MSSA recovery also increased significantly using Broth compared to MSA (p ≤ 0.001). Among specimens collected from the groin, Broth, CM, and MSA detected 88%, 54%, and 49% of the MRSA-positive isolates, respectively. Broth enrichment had a greater impact on recovery of MRSA from the groin than from the nose compared to both CM (p ≤ 0.001) and MSA (p ≤ 0.001). Overall, 19% of MRSA-colonized patients would have been missed with nasal culture only. USA500/Iberian and USA300 were the most common MRSA strains recovered, and USA300 was more likely than other strain types to be recovered from the groin than from the nose (p=0.05). |
Comparison of Staphylococcus aureus from skin and soft-tissue infections in US emergency department patients, 2004 and 2008
Talan DA , Krishnadasan A , Gorwitz RJ , Fosheim GE , Limbago B , Albrecht V , Moran GJ . Clin Infect Dis 2011 53 (2) 144-149 BACKGROUND: In the past decade, new methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged as a predominant cause of community-associated skin and soft-tissue infections (SSTIs). Little information exists regarding trends in MRSA prevalence and molecular characteristics or regarding antimicrobial susceptibility profiles of S. aureus isolates. METHODS: We enrolled adults with acute, purulent SSTIs presenting to a US network of 12 emergency departments during August 2008. Cultures and clinical information were collected. S. aureus isolates were characterized by antimicrobial susceptibility testing, pulsed-field gel electrophoresis, and toxin genes detection. The prevalence of S. aureus and MRSA and isolate genetic characteristics and susceptibilities were compared with those from a similar study conducted in August 2004. RESULTS: The prevalence of MRSA was 59% among all SSTIs during both study periods; however, the prevalence by site varied less in 2008 (38%-84%), compared with 2004 (15%-74%). Pulsed-field type USA300 continued to account for almost all MRSA isolates (98%). Susceptibility to trimethoprim-sulfamethoxazole, clindamycin, and tetracycline among MRSA isolates remained greater than 90% in 2008. A higher proportion of MRSA infections were treated with an agent to which the infecting isolate was susceptible in vitro in 2008 (97%), compared with 2004 (57%). CONCLUSIONS: Similar to 2004, MRSA remained the most common identifiable cause of purulent SSTIs among patients presenting to a network of US emergency departments in 2008. The infecting MRSA isolates continued to be predominantly pulsed-field type USA300 and susceptible to recommended non-beta-lactam oral agents. Clinician prescribing practices have shifted from MRSA-inactive to MRSA-active empirical antimicrobial regimens. |
Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic
Radcliffe R , Meites E , Briscoe J , Gupta R , Fosheim G , McAllister SK , Jensen B , Noble-Wang J , Del Rosario M , Hageman J , Patel PR . Am J Infect Control 2011 40 (2) 144-9 BACKGROUND: Recent outbreaks in ambulatory care settings have highlighted infection control breaches as risk factors for disease transmission. In May 2009, 3 patients were hospitalized with severe methicillin-susceptible Staphylococcus aureus (MSSA) infections after receiving epidural injections at a West Virginia outpatient pain clinic. METHODS: We conducted a retrospective cohort study evaluating clinic patients who received injections during a 3-week period. A case was defined as laboratory-confirmed infection or clinical evidence of infection ≤ 14 days after a patient received an injection. Infection control procedures were assessed. MSSA isolates from patient infections and clinic staff nasal swabs were genotyped by using pulsed-field gel electrophoresis. RESULTS: Eight (7%) of 110 cohort patients met the case definition; 6 (75%) cases were laboratory confirmed. Eight (12%) of 69 patients who received epidural injections were case patients compared with none of the other 41 patients (P = .02). During procedures, staff use of face masks and preparation of patient skin were suboptimal; epidural injection syringes were reused to access shared medication vials. MSSA isolates from 2 patients and 1 staff member were indistinguishable by pulsed-field gel electrophoresis. CONCLUSION: Infection control breaches likely facilitated MSSA transmission to patients receiving epidural injections. Adhering to correct infection control practices in ambulatory care settings is critical to prevent disease transmission. |
Multiplex real-time PCR assay for detection of methicillin-resistant Staphylococcus aureus and associated toxin genes.
Fosheim G , Nicholson A , Albrecht V , Limbago B . J Clin Microbiol 2011 49 (8) 3071-3 We describe a real-time PCR assay for the detection of methicillin-resistant Staphylococcus aureus and genes encoding TSST-1 and PVL. Rapid screening and detection of toxins is a useful tool for surveillance studies and outbreak investigations involving large numbers of isolates. |
Methicillin-resistant Staphylococcus aureus colonization in HIV-infected outpatients is common and detection is enhanced by groin culture
Peters PJ , Brooks JT , Limbago B , Lowery HK , McAllister SK , Mindley R , Fosheim G , Gorwitz RJ , Guest JL , Hageman J , Fridge J , Rimland D . Epidemiol Infect 2010 139 (7) 1-11 Although high rates of clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) have been reported in HIV-infected adults, data on MRSA colonization are limited. We enrolled HIV-infected adults receiving care at the Atlanta VA Medical Center. Swabs from each participant's nares and groin were cultured with broth enrichment for S. aureus. Of 600 HIV-infected adults, 79 (13%) were colonized with MRSA and 180 (30%) with methicillin-susceptible S. aureus. MRSA pulsed-field gel electrophoresis types USA300 (n=44, 54%) and USA500/Iberian (n=29, 35%) predominated. Inclusion of groin swabs increased MRSA detection by 24% and USA300 detection by 38%. In multivariate analysis, MRSA colonization compared to no MRSA colonization was associated with a history of MRSA clinical infection, rarely or never using condoms, and contact with prisons and jails. In summary, the prevalence of MRSA colonization was high in this study of HIV-infected adults and detection of USA300 was enhanced by groin culture. |
Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus isolates causing invasive disease in the United States
McDougal LK , Fosheim GE , Nicholson A , Bulens SN , Limbago BM , Shearer JE , Summers AO , Patel JB . Antimicrob Agents Chemother 2010 54 (9) 3804-11 USA300 methicillin-resistant Staphylococcus aureus (MRSA) isolates are usually resistant only to oxacillin, erythromycin, and, increasingly, levofloxacin. Of these, oxacillin and levofloxacin resistances are chromosomally encoded. Plasmid-mediated clindamycin, mupirocin, and/or tetracycline resistance has been observed among USA300 isolates, but these descriptions were limited to specific patient populations or isolated occurrences. We examined the antimicrobial susceptibilities of invasive MRSA isolates from a national surveillance population in order to identify USA300 isolates with unusual, possibly emerging, plasmid-mediated antimicrobial resistance. DNA from these isolates was assayed for the presence of resistance determinants and the presence of a pSK41-like conjugative plasmid. Of 823 USA300 isolates, 72 (9%) were tetracycline resistant; 69 of these were doxycycline susceptible and tetK positive, and 3 were doxycycline resistant and tetM positive. Fifty-one (6.2%) isolates were clindamycin resistant and ermC positive; 22 (2.7%) isolates were high-level mupirocin resistant (mupA positive); 5 (0.6%) isolates were trimethoprim-sulfamethoxazole (TMP-SMZ) resistant, of which 4 were dfrA positive; and 7 (0.9%) isolates were gentamicin resistant and aac6'-aph2'' positive. Isolates with pSK41-like plasmids (n = 24) were positive for mupA (n = 19), dfrA (n = 6), aac6'-aph2'' (n = 6), tetM (n = 2), and ermC (n = 8); 20 pSK41-positive isolates were positive for two or more resistance genes. Conjugative transfer of resistance was demonstrated between four gentamicin- and mupirocin-resistant and three gentamicin- and TMP-SMZ-resistant USA300 isolates; transconjugants harbored a single pSK41-like plasmid, which was PCR positive for aac6'-aph2'' and either mupA and/or dfrA. USA300 and USA100 isolates from the same state with identical resistance profiles contained pSK41-like plasmids with indistinguishable restriction and Southern blot profiles, suggesting horizontal plasmid transfer between USA100 and USA300 isolates. |
- Page last reviewed:Feb 1, 2024
- Page last updated:May 06, 2024
- Content source:
- Powered by CDC PHGKB Infrastructure