BACKGROUND: The risk factors, microbial etiology, differentiation, and clinical features of purulent and non-purulent cellulitis are not well defined in Taiwan. METHODS: We conducted a retrospective cohort study of hospitalized adults with cellulitis in Taiwan in 2013. The demographic characteristics, underlying diseases, clinical manifestations, laboratory and microbiological findings, treatments, and outcomes were compared for patients with purulent and non-purulent cellulitis. RESULTS: Of the 465 patients, 369 had non-purulent cellulitis and 96 had purulent cellulitis. The non-purulent group was significantly older (p = 0.001) and was more likely to have lower limb involvement (p < 0.001), tinea pedis (p = 0.003), stasis dermatitis (p = 0.025), a higher Charlson comorbidity score (p = 0.03), and recurrence at 6 months post-infection (p = 0.001) than the purulent group. The purulent group was more likely to have a wound (p < 0.001) and a longer hospital stay (p = 0.001) and duration of antimicrobial therapy (p = 0.003) than the non-purulent group. The etiological agent was identified in 35.5 % of the non-purulent cases, with β-hemolytic streptococci the most frequent cause (70.2 %). The etiological agent was identified in 83.3 % of the purulent cases, with Staphylococcus aureus the predominant pathogen (60 %): 50 % of these were methicillin-resistant S. aureus (MRSA). In multivariable analysis, purulent group (odds ratio (OR), 5.188; 95 % confidence interval (CI), 1.995-13.493; p = 0.001) was a positive predictor of MRSA. The prescribed antimicrobial agents were significantly different between the purulent and non-purulent groups, with penicillin the most frequently used antimicrobial agent in the non-purulent group (35.2 %), and oxacillin the most frequent in the purulent group (39.6 %). The appropriate antimicrobial agent was more frequently prescribed in the non-purulent group than in the purulent group (83.2 % vs. 53.8 %, p < 0.001). CONCLUSIONS: The epidemiology, clinical features, and microbiology of purulent and non-purulent cellulitis were significantly different in hospitalized Taiwanese adults. Purulence was a positive predictor of MRSA as the causal agent of cellulitis. These findings provide added support for the adoption of the IDSA guidelines for empirical antimicrobial therapy of cellulitis in Taiwan.

Historiskt sett har personer med smittsamma infektioner uteslutits från samhället. Personerna har setts med avsky och rädsla från omgivningen med risk för att överföra smittan. Multiresistenta bakterier (MRB) är ett ökande problem världen över och orsakar stort lidande för patienter. Syftet med litteraturstudien var att undersöka patienters upplevelse av att vara smittbärare av meticillinresistenta staphylococcus aureus (MRSA). Litteraturstudiens resultat baseras på nio vetenskapliga artiklar, där resultatet utföll i två kategorier. I kategorin känslan av att vara smittsam framkom underkategorierna att vara smutsig, skuld och skam samt rädsla och oro. I kategorin känslan av att vara annorlunda framkom underkategorierna känna sig kränkt, ilska och frustration samt känna sig stigmatiserad. För att patienter med MRSA-smitta ska få en god vård krävs det att vårdpersonalen har evidensbaserad kunskap. Därför skulle det vara av stort intresse att forskning i framtiden fokuserar på patienters upplevelse av att vara smittbärare. Ytterligare forskning behövs inom området på grund av ett ökat globalt problem med MRB. / Historically, people with contagious infections has been excluded from society. The characters have been seen with disgust and fear from the environment with the risk of transmitting the infection. Multi-drug resistant bacteria (MRB) is a growing problem worldwide and causes great suffering for patients. The purpose of this study was to investigate patients' experience of being carriers of methicillin-resistant staphylococcus aureus (MRSA). Literature study results are based on nine scientific articles, which precipitated the result of two categories. In the category of feeling of being contagious emerged subcategories to be dirty, guilt and shame and fear and anxiety. In the category of the feeling of being different subcategories emerged feel hurt, anger and frustration, and feel stigmatized. For patients with MRSA infection should get good care requires that health professionals have evidence-based knowledge. Therefore, it would be of great interest to future research focusing on patient experience of being contaminated. Further research is needed in this area because of the increasing global problem of MRB.

Background: Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus (MRSA) represent the most worrying Gram-negative and Gram-positive nosocomial pathogens of the present age. They are of increasing concern in the clinical environment due to their multi-drug resistance and the dwindling therapeutic options available. A. baumannii is the most frequently isolated clinical species of the genus, and is able to rapidly acquire resistance. Hypermutators, most frequently deficient in mismatch repair (MMR) via defects in the mutS gene, have been associated with antimicrobial resistance in several bacterial populations. To date, however, the potential role of MMR-deficient mutators in the development of resistance in clinical Acinetobacter spp. has not been investigated. Biocides, most notably chlorhexidine (CHX), are increasingly used in the hospital environment to prevent bacterial spread. This has led to concerns about the development of reduced biocide susceptibility and associated antibiotic resistance in hospital bacterial populations, where there is frequent exposure to both of these factors. The effect of CHX upon defined clinical MRSA isolates is examined here. Methods: The mutS gene of clinical Acinetobacter spp. isolates with varying sensitivities was sequenced and compared to establish whether any variations were present. Mutation studies were performed on isolates by challenging them with ciprofloxacin to determine whether different mutS types correlated with any variation in their ability to develop significant fluoroquinolone resistance. The response of clinical MRSA isolates to a range of CHX concentrations was examined with susceptibility testing methods, and effects were compared with standard strains. Determination of post-exposure minimum inhibitory concentrations (MICs) of a range of antibiotics enabled evaluation of whether exposure to CHX had an effect on susceptibility to antibiotics. Results: Variation was observed in the mutS gene of clinical Acinetobacter spp. isolates, with greater homology observed as resistance increased. A highly conserved and previously unreported amino acid sequence was discovered in resistant isolates. Nonresistant isolates with this ‘R-type’ mutS sequence appeared to have a greater ability to develop significant ciprofloxacin resistance. Clinical MRSA isolates had varying susceptibility to CHX, and there were differences in the susceptibility of standard strains compared to clinical isolates. CHX residues exerted a prolonged minimal inhibitory effect, and several increases in antibiotic MICs following CHX exposure were observed. Conclusions: The correlation of the mutS sequence with mutation ability suggests that defects in the mutS gene may have a role to play in the ability of certain Acinetobacter spp. to rapidly acquire resistance. This could have implications for the treatment of Acinetobacter spp. infections, and may enable quick determination of which clinical isolates have the potential to develop clinically significant resistance. Incomplete eradication due to the prolonged minimal effect of CHX residues may act as a selective pressure in the hospital environment, allowing survival of reduced susceptibility MRSA isolates. Increases in antibiotic MICs following CHX exposure is of grave concern for the future of biocide usage.

Bakgrund: Antibiotikaresistenta bakterier är idag ett stort hot mot folkhälsan. Det här arbetet fokuserar på MRSA och lyfter fram problematiken som dess spridning innebär för patienten, samhället och vårdpersonal. MRSA-bärarskap kan ge både fysiskt och psykiskt lidande och en infektion orsakad av MRSA kan i värsta fall leda till döden för patienten. Sjuksköterskan har en viktig roll i att upprätthålla sin kompetens och arbeta preventivt för att förhindra spridning av MRSA. Syfte: Syftet var att identifiera och beskriva faktorer som leder till spridning av MRSA vid vårdarbetet av patienter på somatisk vårdavdelning. Metod: En litteraturstudie där 11 kvantitativa och en kvalitativ artikel analyserades utifrån Graneheim och Lundmans (2004) metod för innehållsanalys. Artiklarna kvalitetsgranskades med hjälp av Forsberg och Wengströms (2016) granskningsmallar. Resultat: Resultatet delades in i fem huvudkategorier med nio underkategorier som var och en visar på kompetensbrist hos sjuksköterskor. Litteraturstudien påvisar att faktorerna som leder till spridning av MRSA kan vara flera och att hela vårdteamet bär ett ansvar för att förhindra smittspridning. Sjuksköterskans roll i vårdteamet är att undervisa patienter och närstående, följa gällande rutiner och att upprätthålla sin egen kompetens för att arbeta evidensbaserat. Slutsats: Förhindra spridning av antibiotikaresistenta bakterier är en av sjuksköterskans viktigaste arbetsuppgifter i sin roll att lindra lidande hos patienten. Det är många faktorer som kan göra att MRSA sprids, sjuksköterskor måste reflektera och vara självkritiska i sitt arbete på vårdavdelningar. Evidensbaserat arbete var enligt Nightingale sjuksköterskans möjlighet att förhindra lidande för patienten och ligger till grund för den sjuksköterskeutbildning som finns idag. / Background: Antibiotic resistant bacteria are today a major threat to the public health. This work focuses on methicillin resistant staphylococcus aureus, highlighting the problem that it involves for the patient, society and healthcare professionals. MRSA carriership can cause both physical and mental suffering and an infection caused by MRSA can in worst case lead to the patient’s death. Nurses play an important role in maintaining their work skills to prevent MRSA from spreading in the somatic care. Aim: The aim of this study was to identify and describe factors that lead to the spread of MRSA to patients in somatic care. Method: A literature study where 11 quantitative and one qualitative article were analyzed based on Graneheim and Lundman's (2004) method. The articles quality were reviewed using Forsberg and Wengström’s (2016) checklists. Results: The results were divided into five main categories with nine subcategories; each showing that nurses had a lack of competence. The study shows that the factors that lead to the spread of MRSA may be several, and that the entire healthcare team has a responsibility to prevent infection. The nurse's role in the team is to teach patients and close relatives, follow current procedures and maintain their own skills to work evidence based. Conclusion: Preventing the spread of antibiotic resistant bacteria is one of the most important tasks in role of nursing and in alleviating patient suffering. There are many factors that can cause MRSA to spread. Nurses must reflect and be self-critical in their work in health care departments. Evidence based work was, according to Nightingale, the nurse's ability to prevent suffering for the patient and is the baseline in nursing education currently available today.

Introdução: a colonização de indivíduos com HIV/aids por microrganismos patogênicos tem sido associada a maior risco de morbidade e mortalidade, principalmente quando esse microrganismo é o Staphylococcus aureus. Identificar precocemente esta condição permite implementar medidas preventivas do adoecimento a ele relacionado, em nível individual e coletivo. Objetivo: avaliar a prevalência de colonização por Staphylococcus aureus em indivíduos com HIV/aids internados em um hospital escola. Metodologia: estudo de corte transversal, tendo como sujeito pessoas vivendo com HIV/aids, internadas em duas unidades especializadas em HIV/aids de um Hospital Escola do município de Ribeirão Preto- SP. Todos os preceitos éticos foram criteriosamente respeitados. No período de Agosto/2011 a Julho/2012, todos os indivíduos internados foram abordados e para aqueles que aceitaram participar, procedeu-se a coleta de amostra de saliva e secreção nasal, além da coleta de dados sociodemográficos, clínicos e imunológicos, obtidos por meio do prontuário e entrevista individual. As amostras foram encaminhadas e processadas pelo Laboratório de Microbiologia e Sorologia da instituição em estudo. Foram semeadas em meios de cultura ágar sangue e manitol, e após, transferidas para o sistema automatizado Vitek® 2 (BioMérieux(TM)), por meio dos cartões GP Test Kit Vitek® 2, para bactérias gram-positivas. Foram empregados cartões AST-P585 para avaliar a sensibilidade dos Staphylococcus aureus meticilina resistente (MRSA) aos antibióticos. Os dados foram armazenados em planilhas do Microsoft Office Excel 2011 for Mac e organizados por meio do software Statistical Package for the Social Sciences (SPSS), versão 17.0 for Windows. Resultados: De 229 indivíduos com HIV/aids internados nas unidades, 169 constituíram os sujeitos desta pesquisa, dos quais 57,4% eram do sexo masculino, 39,6% apresentaram idade de 40 a 49 anos e 45% tinham o primeiro grau completo. Foram obtidas 338 amostras (169 de secreção nasal e 169 de saliva). A prevalência de colonização por Staphylococcus aureus foi identificada em 20,4% das amostras, com 21,7% de resistência à oxacilina, sendo em secreção nasal 66,7% e em saliva 33,3%. Apresentaram contagem de linfócitos T CD4 abaixo de 200 células/mm3 60,0% dos indivíduos com MRSA nasal e 80,0% estavam em uso de antimicrobianos. Em 40,0% dos indivíduos com MRSA na saliva carga viral foi igual ou superior a 500.001 cópias/mL, e 80,0% destes também usavam antimicrobianos, MRSA nasal e saliva foi identificado em 60,0% dos indivíduos que não estavam em uso de antirretroviral. Conclusão: a prevalência de colonização por Staphylococcus aureus em indivíduos com HIV/aids foi predominante em secreção nasal, com baixa contagem de linfócitos T CD4, com história de internação prévia, uso de antimicrobiano e ausência do uso de antirretroviral, podendo representar importante fonte de infecção. / Introduction: colonization by pathogenic microorganisms in individuals with HIV/AIDS has been associated with increased risk of morbidity and mortality, especially when that organism is Staphylococcus aureus. Early identification of this condition allows implementing preventive measures of illness related to it, both individually and collectively. Objective: to evaluate the prevalence of Staphylococcus aureus colonization in individuals with HIV/AIDS in a teaching hospital. Method: cross-sectional study; the subjects were people living with HIV/AIDS and hospitalized in two specialized HIV/AIDS care units of a Teaching Hospital in the city of Ribeirão Preto. All ethical principles were carefully observed. In the period from August 2011 to July 2012, all subjects hospitalized were approached and, for those who agreed to participate, the collection of saliva and nasal discharge sample was performed, in addition to collecting sociodemographic, clinical and immunological data, obtained through medical record and individual interviews. The samples were forwarded and processed by the Laboratory of Microbiology and Sorology of the institution. They were seeded in blood agar and mannitol-salt-agar culture medium, and thereafter, transferred to the automated system Vitek® 2 (BioMérieux(TM)) through Vitek® 2 Test Cards for Gram-positive bacteria. AST-P585 cards were used to assess the sensitivity of methicillin-resistant Staphylococcus aureus (MRSA) to the antibiotic. Data were stored in spreadsheets of Microsoft Office Excel 2011 for Mac and organized by the Statistical Package for the Social Sciences (SPSS) version 17.0 for Windows. Results: of the 229 individuals with HIV/AIDS hospitalized in the units, 169 were the subjects in this study, of whom 57.4% were male, 39.6% were aged from 40 to 49 years, and 45% had completed elementary school. 338 samples were collected (169 of nasal discharge and 169 of saliva). The prevalence of Staphylococcus aureus colonization was identified in 20.4% of samples, with 21.7% of oxacillin resistance, being 66.7% in nasal discharge and 33.3% in saliva. 60.0% of individuals with MRSA in nasal had lymphocytes T CD4 count below 200 cells/mm3 , and 80.0% were taking antimicrobials. In 40.0% of the individuals with MRSA in saliva, the viral load was equal or higher than 500.001 copies/mL, and 80.0% of these also used antimicrobials; MRSA in nasal and in saliva were detected in 60.0% of individuals who were not taking antiretroviral. Conclusion: the prevalence of Staphylococcus aureus colonization in individuals with HIV/AIDS was prevalent in nasal discharge, had lymphocytes T CD4 low count, with a history of previous hospitalization, antimicrobial use and the absence of antiretroviral use, and it may represent an important source of infection.

No description available.

<p>The purpose of this study was to describe the level of knowledge that nurse students in term 6 have about Methicillin-Resistant Staphylococcus aureus (MRSA) and basic hygiene routines. The data collection was carried out by questionnaires. The questionnaire contained questions about knowledge regarding MRSA and basic hygiene routines. The questionnaires were handed out at an obligatory tuition occasion and all of the nurse students who were present (n=57) were asked to take part. The sample consisted of 45 women and 12 men. The youngest participant was 22 years old and the oldest participant was 52 years old. The main results showed a large variation regarding the participants knowledge on the subjects. Regarding questions about basic hygiene routines the majority had given the right answers. The number of right answers in the survey on questions about the participants knowledge of MRSA was lower. Only 12 % had given the right answer to the question about common symptoms of MRSA infection. Regarding the question about whether the nurse students considered themselves knowledgeable enough about MRSA for their future occupation, 32% had answered "to a high degree".</p> / <p>Syftet med studien var att beskriva vilka kunskaper sjuksköterskestuderande i termin 6 har om Methicillinresistenta Staphylococcus aureus (MRSA) och basala hygienrutiner. Datainsamlingen genomfördes med enkäter. Enkäten innehöll frågor om kunskaper gällande MRSA samt basala hygienrutiner. Enkäterna delades ut vid ett obligatoriskt undervisningstillfälle och samtliga, vid undervisningstillfället närvarade sjuksköterskestudenter (n =57) tillfrågades om deltagande. Undersökningsgruppen bestod av 45 kvinnor och 12 män. Yngsta deltagaren var 22 år och den äldsta deltagaren var 52 år. Huvudresultatet visade en stor variation gällande deltagarnas kunskaper i ämnena. På frågor angående basala hygienrutiner hade majoriteten svarat rätt. På de frågor som berörde deltagarnas kunskaper om MRSA var antalet rätta svar i undersökningen lägre. Endast 12 % hade svarat rätt på frågan om symtom som är vanliga vid MRSA infektion. På frågan om sjuksköterskestudenterna ansåg att de hade tillräckliga kunskaper om MRSA för sitt kommande yrke som sjuksköterskor svarade 32 % ”i hög grad”.</p>

The purpose of this study was to describe the level of knowledge that nurse students in term 6 have about Methicillin-Resistant Staphylococcus aureus (MRSA) and basic hygiene routines. The data collection was carried out by questionnaires. The questionnaire contained questions about knowledge regarding MRSA and basic hygiene routines. The questionnaires were handed out at an obligatory tuition occasion and all of the nurse students who were present (n=57) were asked to take part. The sample consisted of 45 women and 12 men. The youngest participant was 22 years old and the oldest participant was 52 years old. The main results showed a large variation regarding the participants knowledge on the subjects. Regarding questions about basic hygiene routines the majority had given the right answers. The number of right answers in the survey on questions about the participants knowledge of MRSA was lower. Only 12 % had given the right answer to the question about common symptoms of MRSA infection. Regarding the question about whether the nurse students considered themselves knowledgeable enough about MRSA for their future occupation, 32% had answered "to a high degree". / Syftet med studien var att beskriva vilka kunskaper sjuksköterskestuderande i termin 6 har om Methicillinresistenta Staphylococcus aureus (MRSA) och basala hygienrutiner. Datainsamlingen genomfördes med enkäter. Enkäten innehöll frågor om kunskaper gällande MRSA samt basala hygienrutiner. Enkäterna delades ut vid ett obligatoriskt undervisningstillfälle och samtliga, vid undervisningstillfället närvarade sjuksköterskestudenter (n =57) tillfrågades om deltagande. Undersökningsgruppen bestod av 45 kvinnor och 12 män. Yngsta deltagaren var 22 år och den äldsta deltagaren var 52 år. Huvudresultatet visade en stor variation gällande deltagarnas kunskaper i ämnena. På frågor angående basala hygienrutiner hade majoriteten svarat rätt. På de frågor som berörde deltagarnas kunskaper om MRSA var antalet rätta svar i undersökningen lägre. Endast 12 % hade svarat rätt på frågan om symtom som är vanliga vid MRSA infektion. På frågan om sjuksköterskestudenterna ansåg att de hade tillräckliga kunskaper om MRSA för sitt kommande yrke som sjuksköterskor svarade 32 % ”i hög grad”.

Syftet med föreliggande litteraturstudie var att beskriva upplevelsen av att vara bärare av meticillin-resistensta Stafylococcus aureus (MRSA) samt att kvalitetsbedöma de valda artiklarnas urval och bortfall. Artikelsökning i databaserna Cinahl, Medline och PsycInfo resulterade i inkludering av 12 artiklar. I resultatet framkom faktorerna: Upplevelsen av att vara smittbärare, MRSA:s påverkan på det dagliga livet, Stöd eller frånvaro av stöd från familj och vänner, Information och kunskap, Bemötande från vårdpersonal samt Upplevelsen av isolering. I resultatet framkom att personer bärare av MRSA upplevde rädsla att smitta andra, framförallt sina familjemedlemmar, och avstod från fysiskt kontakt. Personerna upplevde begränsningar i arbetslivet, i dagliga livet samt begränsningar av fysisk aktivitet. Stöd från familj och vänner hade stora betydelser för personernas anpassning till livet som bärare av MRSA. Flera personer med MRSA upplevde att de hade brister i kunskap och information om MRSA, vilket påverkade dem negativt. Positivt bemötande från vårdpersonal gjorde att personerna anpassade sig lättare till sin situation. Isoleringsvård upplevdes antingen som positiv eller som diskriminerande och en begränsning till deras självständighet. Urvalsprocessen beskrevs i tio artiklar och bortfall beskrevs i elva artiklar. Slutsatsen blev att personer med MRSA upplevde adekvat information om sitt tillstånd som en påverkande faktor vid livsstilsförändring. Brister som uppstod vid kunskapsförmedling, i relationer till vänner och familj samt i bemötandet från vårdpersonal upplevdes som negativa erfarenheter. / The aim of this study was to describe the experience of being a carrier of methicillin-resistant Staphylococcus aureus (MRSA) and to evaluate the quality of the selected articles sample and dropouts. Articles were search in databases Cinahl, Medline and PsycInfo which resulted in an inclusion of 12 articles. The result showed factors: The experience of being a carrier, MRSA's impact on daily life, Support or absence of support from family and friends, Information and knowledge, Encounter from health professionals and The experience of isolation. The result showed that individuals carrying MRSA experienced fear of infecting others, especially their family members, and refrained from physical contact. Participants experienced restrictions in the workplace, in everyday life, and limitation of physical activity. Support from family and friends had great meaning for persons adjusting to life as carriers of MRSA. Several people with MRSA felt that they were deficient in knowledge and information on MRSA, which affected them adversely. Positive attitude from health workers led to a facilitated adaption to the carriers’ situation. Isolation care was either percieved as a positive experience or caused discrimination in which subjects felt that their autonomy was restricted. The sample process was described in ten articles and dropouts were described in eleven articles. The conclusion of this study was that people with MRSA felt that adequate information about their condition as an influencing factor to lifestyle change. Deficiencies in sharing of knowledge, in relationships with friends and family as well as in the encounter with health professionals were perceived as negative experiences.

Our investigation sought to identify the incidence of treatment failure and its associated costs in patients with methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) treated in the primary care setting. Thirteen clinics participated in this multi-site, observational study. Clinicians consented patients and collected clinical information, pictures, and wound swabs; isolates were processed in the principal investigator's laboratory. Treatment failure was defined as the occurrence of one or more of the following within 90 days: (1) change in antibiotic therapy, (2) subsequent need for incision and drainage, (3) SSTI at new site, (4) SSTI at same site, (5) emergency department visit, or (6) hospitalization. Cost estimates were obtained from the Agency for Healthcare Research and Quality (AHRQ) and Centers for Medicare and Medicaid Service's National Average Drug Acquisition Costs (NADAC). Patients were considered to have “moderate or complicated” SSTIs if they had a lesion ≥ 5cm in diameter, diabetes mellitus, or both. Patients not exhibiting these characteristics were classified as having “mild or uncomplicated” infections. Ninety-eight patients were enrolled. Most patients were of Hispanic ethnicity and more than half of all patients had a body mass index (BMI) ≥ 30kg/m2. The most common treatment modality was incision and drainage (I&D) plus antibiotics (57%). Treatment failure occurred in 21% of all patients at a mean additional cost of $1,933.71. Patients with moderate or complicated SSTIs who received I&D experienced significantly more treatment failures compared mild or uncomplicated patients who received I&D (36% vs. 10%; p = 0.04). The additional cost of treatment failure in patients with moderate or complicated SSTIs was nearly twice that of patients with mild or uncomplicated SSTIs ($2,093.40 vs. $1,255.02; p = 1.0). Treatment failure occurred sooner, on average, in the moderate or complicated group compared to the mild or uncomplicated group (11.8 days vs. 38.8 days; p = 0.06). Among patients with MRSA SSTIs treated in the primary care setting, the rate of treatment failure is high (21%) and costs are considerable ($1,933.71). / text