Stewardship / Resistance Scan for Nov 28, 2018

News brief

Study finds MRSA, VRE co-colonization is common in nursing homes

A study by researchers from the University of Michigan has found frequent co-colonization of vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) among patients in nursing facilities.

In the prospective cohort study, published yesterday in the American Journal of Infection Control, researchers analyzed microbial culture data from newly admitted patients at six nursing facilities in southeast Michigan from November 2013 through November 2015. They wanted to investigate the epidemiology of VRE and MRSA co-colonization because of concerns that MRSA can acquire the vancomycin-resistance gene vanA and develop resistance to vancomycin, which further limits treatment options.

The cultures were obtained from various anatomic sites and from open wounds and indwelling device insertion sites to determine colonization status, and demography, comorbidity, and antimicrobial use data were collected to determine factors predictive of co-colonization.

In total, 508 patients were enrolled in the study, with an average length of stay of 28.5 days. Overall prevalence of MRSA and VRE co-colonization in the patients was 8.7%, 8.9% for MRSA alone, and 23.4% for VRE alone—a number the authors note is significantly higher than previously-reported VRE prevalence estimates in post-acute care facilities (5% to 18%). Multivariate analysis found that indwelling device use (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.2 to 13.7), antibiotic use (OR, 2.5; 95% CI 1.4 to 4.2), diabetes (OR, 1.9; 95% CI, 1.0 to 3.8), and open wounds (OR, 1.9; 95% CI, 1.0 to 3.6) were independent predictors of co-colonization.

"Co-colonization with MRSA and VRE was frequent and perhaps driven by a high prevalence of VRE in our study population," the authors write. They conclude that future studies are needed to investigate the role VRE transmission, the presence of wounds, and targeted screening and prevention measures play in patient co-colonization.
Nov 27 Am J Infect Control study

Study: UV disinfection tied to lower C diff levels in high-burden units

Adding ultraviolet (UV) disinfection to terminal cleaning protocols was tied to reduced Clostridioides difficileinfection rates, researchers from the Mayo Clinic reported yesterday in the American Journal of Infection Control.

C diff spores are known to resist standard cleaning, and hospitals are exploring other methods to cut contamination levels. The study took place in hospital wards that have high C diff burden, including hematology and bone marrow transplant units and a medical-surgical unit. Bleach cleaning was already being used on the wards to reduce C diff levels, but infection rates still remained high.

Researchers used the UV intervention after patient discharge and terminal cleaning in three units and used three similar units as controls. At baseline, C diff infection rates were similar for both groups of units.

Intervention rooms got pulsed xenon UV disinfection for a 6-month period between October 2014 and March 2015. Disinfection was performed in three positions in 5-minute cycles after terminal cleaning and before the bed was made. Drawers and doors inside the room were left open, phone and blood pressure cuffs were hung, television remotes were on the tray table, pillows were on the window ledges, and curtains were positioned to allow the grip to be disinfected. One of the three cycles was completed in the bathroom.

After 6 months, the C diff infection rate in the intervention rooms decreased to 11.2 per 10,000 patient days, compared to 28.7 per 10,000 patient days in the control rooms. Also, researchers found a reduction in vancomycin-resistant enterococci (VRE) acquisition in units that got UV disinfection.

The team noted that the study was the first direct head-to-head comparison in the same hospital using UV disinfection in addition to bleach.

They said based on the results, the hospital continued UV disinfection in more units with high C diff burden and the devices have been well received by staff, patients, and families. However, they noted that the pulsed light was an annoyance to staff and other patients in intensive care units with glass doors. UV disinfection added about 25 minutes to room processing time, they said.

Though UV devices were expensive and incur additional costs for training, high C diff infection rates can also take a high financial toll, the group wrote. UV disinfection could be a cost-saving measure, depending on baseline C diff infection rates and performance on other healthcare-associated infection measures, they added.
Nov 27 Am J Infect Control abstract

News Scan for Nov 28, 2018

News brief

New York, New Jersey record more measles cases

Both New York and New Jersey reported more cases of measles in ongoing outbreaks in communities near New York City.

Rockland County, New Jersey, reported 4 more cases, bringing its total to 80. And health officials in New York confirmed 5 more cases in an Orthodox Jewish community in Brooklyn. Outbreak totals there now stand at 29.

According the Rockland County health department, the current outbreak began in September with a case in an unvaccinated foreign traveler. Subsequent cases have been in unvaccinated residents.

In New York, the index case involved an unvaccinated child who contracted the virus in Israel in October, where this is a large, ongoing measles outbreak. "If you plan to travel to Israel, protect yourself against measles and get vaccinated at least two weeks in advance of your trip. If you have traveled to Israel and you have a fever, cough, red eyes, runny nose and body rash, contact your doctor," NYC Health said on its website.

Both health departments recommend vaccination. Typically, the measles vaccine is given in two doses, one between the ages of 12 and 15 months, and a second before kindergarten. In Rockland County, children 6 months through 11 months are encouraged to start the vaccine now.
Nov 27 Rockland County statement
Nov 28 NYC Health statement

MERS outbreaks in Saudi Arabia led to increased PPE use

According to a study yesterday in the American Journal of Infection Control, the MERS-CoV epidemic that began in Saudi Arabia in 2012 resulted in more use of personal protective equipment (PPE) among Saudi healthcare workers.

To conduct the study, the authors tracked the use of gloves, surgical masks, N95 respirators, alcohol-based hand sanitizer, and soap during April and May of 2013 at a Saudi hospital, which had 17 positive and 82 negative cases of MERS-CoV (Middle East respiratory syndrome coronavirus) from Apr 1 through Jun 3 of that year. Use was compared with the previous year, before any MERS cases were diagnosed at the hospital, and the months immediately following the first confirmed cases.

The researchers determined that PPE use rose from 2,947.4 to 10,283.9 per 1,000 patient-days compared with the period before MERS cases. Hand hygiene compliance rates increased from 73% just before the occurrence of the first MERS case to 88% during MERS cases (P = .0001).

"The monthly added cost was $16,400 for the included infection control items, such as hand sanitizers, soap, surgical masks, and N95 respirators," the authors wrote. "Such an increase is a challenge and adds cost to the health care system."
Nov 27 Am J Infect Control study

Study: 11% of adults over 60 contract RSV in winter

Though the dangers of respiratory syncytial virus (RSV) among infants are well-documented, less is known about how the seasonal virus affects adults. A new study from investigators at the Marshfield Clinic Research Institute in Wisconsin tracked RSV among adults over the age of 60 from the 2004-05 winter through the 2015-16 season to determine the virus's epidemiology and burden of disease.

The study results are published in Open Forum Infectious Diseases.

According to the study, 13% of patients over the age of 60 who had acute respiratory symptoms tested positive for RSV (241 of 1,832 individuals). The clinical outcome was serious in 47 (19%) of patients, moderate in 155 (64%), and mild in 41 (17%). Twenty-nine patients were hospitalized (13 in the emergency department), and 23 developed pneumonia.

Patients who were older than 75 and those with chronic obstructive pulmonary disease were more likely to suffer more serious outcomes.

"Moderate or serious outcomes, including change in therapy, hospital admission, and pneumonia, occurring in over 80% of patients with laboratory-confirmed RSV infection," the authors concluded, noting that RSV was the second most common viral pathogen in this age-group.
Nov 27 Open Forum Infect Dis study