Last data update: May 13, 2024. (Total: 46773 publications since 2009)
Records 1-3 (of 3 Records) |
Query Trace: Gaynes RP[original query] |
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Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage in residents of Veterans Affairs long-term care facilities: role of antimicrobial exposure and MRSA acquisition
Stone ND , Lewis DR , Johnson TM 2nd , Hartney T , Chandler D , Byrd-Sellers J , McGowan JE Jr , Tenover FC , Jernigan JA , Gaynes RP . Infect Control Hosp Epidemiol 2012 33 (6) 551-7 OBJECTIVE: To identify risk factors associated with methicillin-resistant Staphylococcus aureus (MRSA) acquisition in long-term care facility (LTCF) residents. DESIGN: Multicenter, prospective cohort followed over 6 months. SETTING: Three Veterans Affairs (VA) LTCFs. Participants. All current and new residents except those with short stay (<2 weeks). METHODS: MRSA carriage was assessed by serial nares cultures and classified into 3 groups: persistent (all cultures positive), intermittent (at least 1 but not all cultures positive), and noncarrier (no cultures positive). MRSA acquisition was defined by an initial negative culture followed by more than 2 positive cultures with no subsequent negative cultures. Epidemiologic data were collected to identify risk factors, and MRSA isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Among 412 residents at 3 LTCFs, overall MRSA prevalence was 58%, with similar distributions of carriage at all 3 facilities: 20% persistent, 39% intermittent, 41% noncarriers. Of 254 residents with an initial negative swab, 25 (10%) acquired MRSA over the 6 months; rates were similar at all 3 LTCFs, with no clusters evident. Multivariable analysis demonstrated that receipt of systemic antimicrobials during the study was the only significant risk factor for MRSA acquisition (odds ratio, 7.8 [95% confidence interval, 2.1-28.6]; [Formula: see text]). MRSA strains from acquisitions were related by PFGE to those from a roommate in 9/25 (36%) cases; 6 of these 9 roommate sources were persistent carriers. CONCLUSIONS: MRSA colonization prevalence was high at 3 separate VA LTCFs. MRSA acquisition was strongly associated with antimicrobial exposure. Roommate sources were often persistent carriers, but transmission from roommates accounted for only approximately one-third of MRSA acquisitions. |
Hospitalization earlier than 1 year prior to admission as an additional risk factor for methicillin-resistant Staphylococcus aureus colonization
McAllister L , Gaynes RP , Rimland D , McGowan Jr JE . Infect Control Hosp Epidemiol 2010 31 (5) 538-40 Our case-control study sought to identify risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission among patients with no known healthcare-related risk factors. We found that patients whose most recent hospitalization occurred greater than 1 year before their current hospital admission were more likely to have MRSA colonization. In addition, both the time that elapsed since the most recent hospitalization and the duration of that hospitalization affected risk. |
A multicenter study on optimizing piperacillin-tazobactam use: lessons on why interventions fail
Gaynes RP , Gould CV , Edwards J , Antoine TL , Blumberg HM , Desilva K , King M , Kraman A , Pack J , Ribner B , Seybold U , Steinberg J , Jernigan JA . Infect Control Hosp Epidemiol 2009 30 (8) 794-6 We examined interventions to optimize piperacillin-tazobactam use at 4 hospitals. Interventions for rotating house staff did not affect use. We could target empiric therapy in only 35% of cases. Because prescribing practices seemed to be institution specific, interventions should address attitudes of local prescribers. Interventions should target empiric therapy and ordering of appropriate cultures. |
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