Rudrik, Jeffrey Hageman, Jean B. Finks, E. Wells, T. Dyke, M.
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Rudrik, Jeffrey Hageman, Jean B. Finks, E. Wells, T. Dyke, M. Wilkins, J. Rudrik, C. Finks, J. Hageman, J. Patel ; St. Husain, L. Heddurshetti Open modal Abstract Vancomycin-resistant Staphylococcus aureus VRSA infections, which are always methicillin-resistant, are a rare but serious public health concern. We examined 2 cases in Michigan in Both patients had underlying illnesses. Isolates were vanA-positive. Vancomycin continues to be used as a first-line antimicrobial agent for the treatment of infection with methicillin-resistant Staphylococcus aureus MRSA.
Because alternative treatments are limited, development of resistance to vancomycin can make treatment of MRSA infections increasingly difficult. Fortunately, only 7 cases of vancomycin-resistant S.
Initial isolate identification and antimicrobial drug susceptibility testing were conducted by 2 independent Michigan hospitals. The length of this period is flexible: start date depends on recent culture results, patient care settings, and clinical assessment; end date is determined by 2 negative cultures, which are submitted weekly posttherapy. To develop a list of potential patient contacts, we assessed healthcare visits, community activities, and personal acquaintances from this period.
Contacts were then screened for VRSA, starting with persons who had had the most extensive contact 8. Swabs of bilateral anterior nares and open wounds were collected from each contact and spread onto blood agar TSA with sheep blood and mannitol salt agar both from Remel, Lenexa, KS, USA. Serial swabs were collected from contacts who had ongoing exposure. Infection control practices were assessed at all facilities that had provided care to each patient.
Figure 1 Figure 1. Vancomycin-resistant Staphylococcus aureus VRSA culture, treatment, and period of potential transmissibility timelines, 2 patients, February —April Top, patient 1; bottom, patient 2; pos, positive; neg, negative. The patient had recently received vancomycin and ceftriaxone for 7 months to treat osteomyelitis of the right metatarsals. On December 13, , VRSA, VRE, and Citrobacter youngae were cultured from a left plantar foot wound of a year-old patient patient 2 who had inadequately controlled insulin-dependent diabetes.
This patient had no documented history of MRSA infection and had recently received vancomycin and levofloxacin for 4 weeks to treat osteomyelitis of the left metatarsals. Figure 2 Figure 2. The isolate from patient 1 was additionally susceptible to chloramphenicol.
The period of potential transmissibility for patient 1 began October 5, a total of 7 days before the date of positive culture, because of possible exposures during a recent hospitalization; the period ended February The period of potential transmissibility for patient 2 began December 13, the date of positive culture, and ended March 4 Figure 1. Contacts for patient 1 were evaluated at 7 locations and for patient 2 at 5 locations.
No contacts of either patient were positive for VRSA. No infection control breaches were identified. Conclusions These 2 recent cases are consistent with cases reported in the review by Sievert et al. However, patient 2 did not have a documented history of MRSA infection or colonization. Despite attempts, only 1 laboratory has reported in vitro transfer of vancomycin resistance from VRE to S. Although VRSA infection continues to be rare and no transmission has been identified, it remains a serious public health concern, especially in Michigan where 7 of the 9 US cases have occurred.
MDCH continues to educate healthcare providers about correct infection control strategies 11 and prudent antimicrobial drug use. MDCH field staff educate patients and their household contacts about wound care, hand and personal hygiene, and the importance of regular monitoring and control of diabetes, a common underlying condition with VRSA infection. Before targeted prevention strategies can be developed, more research is needed to improve understanding of the microbiologic, clinical, and epidemiologic risk factors for VRSA.
Her primary research interest is the epidemiology of antimicrobial drug—resistant infections. Top Acknowledgment We thank D. Sievert, J. Rudrick, J.
Patel, L. McDonald, M. Wilkins, and J. Hageman 1 for their availability to discuss our investigations and advise us and for their continued work in organism identification and characterization. Clark, Gregory E. Fosheim, David Lonsway, and Wenming Zhu for assistance with laboratory tests. Vancomycin-resistant Staphylococcus aureus in the United States, — Clin Infect Dis. Methods for dilution antimicrobial susceptibility test for bacteria that grow aerobically; approved standard M7-A7.
Wayne PA : The Institute; Staphylococcus, Micrococcus, and other catalase-positive cocci that grow aerobically. Manual of clinical microbiology. Washington: ASM Press; ;— Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing; 18th informational supplement MS J Clin Microbiol. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database.
Vancomycin-resistant Staphylococcus aureus isolates associated with Inclike vanA plasmids in Michigan. Antimicrob Agents Chemother. Investigation and control of vancomycin-intermediate and -resistant Staphylococcus aureus; a guide for health departments and infection control personnel.
Division of Healthcare Quality Promotion (DHQP)
Guideline for isolation precautions preventing transmission of infectious agents in healthcare settings, Personal Author: Siegel, Jane D. The following developments led to revision of the guideline: 1. The transition of healthcare delivery from primarily acute care hospitals to other healthcare settings e. Accordingly, the revised guideline addresses the spectrum of healthcare delivery settings. The emergence of new pathogens e. The successful experience with Standard Precautions, first recommended in the guideline, has led to a reaffirmation of this approach as the foundation for preventing transmission of infectious agents in all healthcare settings. The recommended practices have a strong evidence base.
Healthcare-associated Infections (HAI)
ShareCompartir It is estimated there are over 1 million firefighters and an additional , Emergency Medical Technicians and other first responders engaged in emergency medical service EMS operations. These EMS responders routinely are exposed to a wide range of hazards, including blood borne pathogens that require the use of personal protective equipment PPE. NFPA , edition NIOSH and its partners evaluated the PPE commercially available at the time of the research through extensive laboratory testing and user wear assessment to determine appropriate technical performance levels necessary to protect EMS responders. The majority of the research effort was undertaken during and NFPA standards are recognized by numerous industries as the basis for equipment quality and performance.
Improved Criteria for Emergency Medical Protective Clothing
Minus Related Pages The mission of the Division of Healthcare Quality Promotion DHQP is to protect patients; protect healthcare personnel; and promote safety, quality, and value in both national and international healthcare delivery systems. Activities In carrying out its mission, DHQP: Measures, validates, interprets, and responds to data relevant to healthcare-associated infections HAIs ; antibiotic resistance; sepsis; adverse drug events; blood, organ and tissue safety; and immunization safety; and other related adverse events or medical errors in healthcare affecting patients and healthcare personnel; investigates and responds to new and emerging infections and related adverse events among patients and healthcare personnel; develops and maintains the National Healthcare Safety Network NHSN , which provides facilities, states, regions, and the nation with data needed to identify problem areas, measure progress of prevention efforts, and ultimately eliminate healthcare-associated infections; assesses rates of infections caused by resistant-bacteria in the U.