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Prevalence and Nosocomial Spread of Methicillin-Resistant Staphylococcus aureus in a Long-Term-Care Facility in Slovenia

Published online by Cambridge University Press:  21 June 2016

Tjasa Zohar Cretnik ,
Petra Vovko ,
Matjaz Retelj ,
Borut Jutersek ,
Tatjana Harlander ,
Jana Kolman  and
Marija Gubina
Tjasa Zohar Cretnik
Affiliation:
Microbiology Department, Public Health Institute Celje, Celje, Slovenia
Petra Vovko*
Affiliation:
Microbiology Department, Public Health Institute Novo mesto, Novo mesto, Slovenia
Matjaz Retelj
Affiliation:
Microbiology Department, Public Health Institute Novo mesto, Novo mesto, Slovenia
Borut Jutersek
Affiliation:
Microbiology Department, Public Health Institute Celje, Celje, Slovenia
Tatjana Harlander
Affiliation:
Microbiology Department, Public Health Institute Novo mesto, Novo mesto, Slovenia
Jana Kolman
Affiliation:
University Medical Centre Ljubljana, Slovenia
Marija Gubina
Affiliation:
Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
*
Microbiology Laboratories, Public Health Institute Novo mesto, Mej vrti 5, SI-8000 Novo mesto, Sloveniapetra.vovko@zzv-nm.si
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Abstract

Objectives:

To determine the prevalence and incidence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among residents and healthcare workers (HCWs) of a long-term-care facility (LTCF), to assess possible routes of nosocomial spread, and to determine genetic relatedness of the isolates.

Setting:

A 351-bed community LTCF for the elderly.

Design and Participants:

Study investigators made two visits, approximately 3 months apart, to the facility. Samples for cultures were obtained from 107 residents during the first visit, 91 residents during the second visit, and 38 HCWs.

Results:

The prevalence of MRSA colonization among residents was 9.3% during the first visit and 8.8% during the second visit. During the first visit, two HCWs were colonized. During the second visit, no HCWs were colonized. The colonization of HCWs suggested a potential role in the transmission of MRSA. Molecular typing showed that two of three roommates in one room had the same strain, whereas two in another room differed from one another. All isolates, except one, belonged to two related clonal groups. It seems that the clonal group to which most isolates belonged had the greatest potential for spreading among both residents and HCWs.

Conclusions:

Similar prevalence rates of MRSA colonization have been found in other European countries, but such studies have usually involved residents with better functional status than that of the participants in this study. Nosocomial spread of MRSA occurred in the facility examined, but not frequently. More attention should be focused on the hand hygiene of HCWs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 184 - 190
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Bradley, SF. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999;106:2S–10S.CrossRefGoogle ScholarPubMed
2.Hsu, CC. Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infect Control Hosp Epidemiol 1991;12:416–421.CrossRefGoogle ScholarPubMed
3.Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.CrossRefGoogle ScholarPubMed
4.Mulhausen, PL. Infection and control of nosocomial infection in extended care facilities. In: Wenzel, RP, Willig, SH, eds. Prevention and Control of Nosocomial Infections. Baltimore, MD: Lippincott Williams & Wilkins; 1997:283–306.Google Scholar
5.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.CrossRefGoogle ScholarPubMed
6.Murphy, S, Denman, S, Bennett, RG, et al.Methicillin-resistant Staphylococcus aureus colonization in a long-term-care facility. J Am Geriatr Soc 1992;40:213–217.CrossRefGoogle ScholarPubMed
7.Reboli, AC, John, JF, Platt, CG, Cantey, JR. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans' Affairs Medical Center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol 1990;11:291–296.CrossRefGoogle Scholar
8.Strausbaugh, LJ, Jacobson, C, Yost, T. Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four-year perspective. Infect Control Hosp Epidemiol 1993;14:331–336.Google Scholar
9.Boyce, JM. Methicillin-resistant Staphylococcus aureus in nursing homes: putting the problem in perspective. Infect Control Hosp Epidemiol 1991;12:413–415.CrossRefGoogle Scholar
10.Boyce, JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term-care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.CrossRefGoogle ScholarPubMed
11.Cox, RA, Bowie, PE. Methicillin-resistant Staphylococcus aureus colonization in nursing home residents: a prevalence study in Northamptonshire. J Hosp Infect 1999;43:115–122.CrossRefGoogle ScholarPubMed
12.Fraise, AP, Mitchell, K, O'Brien, SJ, Oldfield, K, Wise, R. Methicillin-resistant Staphylococcus aureus (MRSA) in nursing homes in a major UK city: an anonymized point prevalence survey. Epidemiol Infect 1997;118:1–5.CrossRefGoogle Scholar
13.Heuck, D, Fell, G, Hamouda, O, Claus, H, Witte, W. MRSA colonization among residents of nursing homes and homes for the elderly [in German]. Hygiene und Medizin 2000;25:191–192.Google Scholar
14.Heudorf, U, Bremer, U, Heuck, D. MRSA colonization among residents of nursing homes, homes for the elderly, and a geriatric clinic in the city of Frankfurt am Main in 1999 [in German]. Gesundheitswesen 2001;63:447–454.CrossRefGoogle Scholar
15.Mulhausen, PL, Harrell, LJ, Weinberger, M, Kochersberger, GG, Feussner, JR. Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. Am J Med 1996;100:24–31.CrossRefGoogle ScholarPubMed
16.Namnyak, S, Adhami, Z, Wilmore, M, et al.Methicillin-resistant Staphylococcus aureus: a questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brentwood. J Infect 1998;36:67–72.CrossRefGoogle ScholarPubMed
17.O'Sullivan, NP, Keane, CT. The prevalence of methicillin-resistant Staphylococcus aureus among the residents of six nursing homes for the elderly. J Hosp Infect 2000;45:322–329.CrossRefGoogle ScholarPubMed
18.European Antimicrobial Resistance Surveillance System. EARSS Annual Report 2001. Bilthoven, the Netherlands: European Antimicrobial Resistance Surveillance System; 2002.Google Scholar
19.Lorencic-Robnik, S, Kotnik-Kevorkijan, B, Golle, A. MRSA: results of sensitivity testing of Staphylococcus aureus in the teaching hospital in Maribor. Presented at the Microbiological Symposium on Microbes and Antibiotics; June 22-23, 2001; Ljubljana, Slovenia.Google Scholar
20.Müller-Premru, M, Krizan-Hergouth, V, Seme, K, Gubina, M, Skerl, M. MRSA: results of sensitivity testing of Staphylococcus aureus in the Medical Centre Ljubljana. Presented at the Microbiological Symposium on Microbes and Antibiotics; June 22-23, 2001; Ljubljana, Slovenia.Google Scholar
21.Kolman, J, Gubina, M, Müller-Premru, M, et al. Antimicrobial susceptibility of Slovenian isolates of Staphylococcus aureus and Streptococcus pneumoniae from blood cultures and cerebrospinal fluids, collected for the EARSS Project. Presented at the Microbiological Symposium on Microbes and Antibiotics; June 22-23, 2001; Ljubljana, Slovenia.Google Scholar
22.Klavs, I, Bufon, LT, Skerl, M, et al.Prevalence of and risk factors for hospital acquired infections in Slovenia: results of the first national survey, 2001. J Hosp Infect 2003;54:149–157.CrossRefGoogle ScholarPubMed
23.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23(suppl):S3–S40.CrossRefGoogle ScholarPubMed
24.European Committee for Standardization. Chemical Disinfectants and Antiseptics: Hygienic Handrub. Test Method and Requirements (Phase2/Step2). Brussels: Central Secretariat; 1997.Google Scholar
25.Kluytmans, J, Van Griethuysen, A, Willemse, P, Van Keulen, P. Performance of CHROMagar selective medium and oxacillin resistance screening agar base for identifying Staphylococcus aureus and detecting methicillin resistance. J Clin Microbiol 2002;40:2480–2482.CrossRefGoogle ScholarPubMed
26.Simor, AE, Goodfellow, J, Louie, L, Louie, M. Evaluation of new medium, oxacillin resistance screening agar base, for the detection of methicillin-resistant Staphylococcus aureus from clinical specimens. J Clin Microbiol 2001;39:3422.CrossRefGoogle ScholarPubMed
27.Zohar Cretnik, T, Storman, A, Jutersek, B. Detection of multiresistant bacteria by the use of surveillance cultures. Presented at the Microbiological Symposium on Microbes and Antibiotics; June 22-23, 2001; Ljubljana, Slovenia.Google Scholar
28.Hussain, Z, Stoakes, L, Garrow, S, et al.Rapid detection of mecA-positive and mecA-negative coagulase-negative staphylococci by an anti-penicillin binding protein 2a slide latex agglutination test. J Clin Microbiol 2000;38:2051–2054.CrossRefGoogle ScholarPubMed
29.Louie, L, Matsumura, SO, Choi, E, Louie, M, Simor, AE. Evaluation of three rapid methods for detection of methicillin resistance in Staphylococcus aureus. J Clin Microbiol 2000;38:2170–2173.CrossRefGoogle ScholarPubMed
30.Yamazumi, T, Furata, I, Diekema, DJ, Pfaller, MA, Jones, RN. Comparison of the Vitek gram-positive susceptibility 106 card, the MRSA-Screen latex agglutination test, and mecA analysis for detecting oxacillin resistance in a geographically diverse collection of clinical isolates of coagulase-negative staphylococci. J Clin Microbiol 2001;39:3633–3636.CrossRefGoogle Scholar
31.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M100-S10.Google Scholar
32.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M7-A5.Google Scholar
33.Swenson, JM, Spargo, J, Tenover, FC, Ferraro, MJ. Optimal inoculation methods and quality control for the NCCLS oxacillin agar screen test for detection of oxacillin resistance in Staphylococcus aureus. J Clin Microbiol 2001;39:3781–3784.CrossRefGoogle ScholarPubMed
34.Chung, M, de Lencastre, H, Matthews, P, et al.Molecular typing of methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis: comparison of results obtained in a multilaboratory effort using identical protocols and MRSA strains. Microb Drug Resist 2000;6:189–198.CrossRefGoogle Scholar
35.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
36.Blanc, DS, Struelens, MJ, Deplano, A, et al.Epidemiological validation of pulsed-field gel electrophoresis patterns for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2001;39:3442–3445.CrossRefGoogle ScholarPubMed
37.Bradley, SF. Methicillin-resistant Staphylococcus aureus in nursing homes: epidemiology, prevention and management. Drugs Aging 1997;10:185–198.CrossRefGoogle ScholarPubMed
38.Mueller-Premru, M, Gubina, M, Kaufmann, ME, Primozic, J, Cookson, BD. Use of semi-quantitative and quantitative culture methods and typing for studying the epidemiology of central venous catheter-related infections in neonates on parenteral nutrition. J Med Microbiol 1999;48:451–460.CrossRefGoogle ScholarPubMed
39.O'Sullivan, NP, Keane, CT. Risk factors for colonization with methicillin-resistant Staphylococcus aureus among nursing home residents. J Hosp Infect 2000;45:206–210.CrossRefGoogle ScholarPubMed
40.Voss, A, Doebbeling, BN. The worldwide prevalence of methicillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 1995;5:101–106.CrossRefGoogle ScholarPubMed
41.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
42.Okuma, K, Iwakawa, K, Turnidge, JD, et al.Dissemination of new methicillin-resistant Staphylococcus aureus clones in the community. J Clin Microbiol 2002;40:4289–4294.CrossRefGoogle ScholarPubMed
43.Hoefnagels-Schuermans, A, Borremans, A, Peetermans, W, et al.Origin and transmission of methicillin-resistant Staphylococcus aureus in an endemic situation: differences between geriatric and intensive-care patients. J Hosp Infect 1997;36:209–222.CrossRefGoogle Scholar
44.Gosbell, IB, Neville, SA, Mercer, JL, Fernandes, LA, Fernandes, CJ. Evaluation of the MRSA-Screen Test in detecting oxacillin resistance in community and hospital isolates of Staphylococcus aureus. Pathology (Phila) 2001;33:493–495.Google ScholarPubMed
45.Tarzi, S. Kennedy, P, Stone, S, Evans, M. Methicillin-resistant Staphylococcus aureus: psychological impact of hospitalization and isolation in an older adult population. J Hosp Infect 2001;49:250–254.CrossRefGoogle Scholar
46.Washio, M, Nishisaka, S, Kishikawa, K, et al.Incidence of methicillin-resistant Staphylococcus aureus (MRSA) isolation in a skilled nursing home: a third report on the risk factors for the occurrence of MRSA infection in the elderly. J Epidemiol 1996;6:69–73.CrossRefGoogle Scholar
47.Armstrong-Evans, M, Litt, M, McArthur, MA, et al.Control of transmission of vancomycin-resistant Enterococcus faecium in a long-term-care facility. Infect Control Hosp Epidemiol 1999;20:312–317.CrossRefGoogle ScholarPubMed
48.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
49.Ostrowsky, BE, Trick, WE, Sohn, AH, et al.Control of vancomycin-resistant Enterococcus in health care facilities in a region. N Engl J Med 2001;344:1427–1433.CrossRefGoogle ScholarPubMed
50.Silverblatt, FJ, Tibert, C, Mikolich, D, et al.Preventing the spread of vancomycin-resistant enterococci in a long-term care facility. J Am Geriatr Soc 2000;48:1211–1215.CrossRefGoogle ScholarPubMed