MRSA hospital return tied to extensive antibiotic exposure, C diff infection
Secondary analysis of patients from a postdischarge decolonization trial of methicillin-resistant Staphylococcus aureus (MRSA) carriers found that re-hospitalization for MRSA was associated with extensive exposure to non-MRSA antibiotics and Clostridioides difficile infection (CDI), researchers reported today in Infection Control & Hospital Epidemiology.
The CLEAR (Changing Lives to Eradicate Antibiotic Resistance) Trial, conducted from March 2011 through April 2014, found that a postdischarge decolonization regimen (5 days of mupirocin plus chlorhexidine bathing and mouthwash) among MRSA infected or colonized adult inpatients reduced MRSA infection by 30% in the year following hospital discharge, compared with those who received only education about MRSA.
For the secondary analysis, researchers from University of California Irvine School of Medicine identified trial participants who were re-hospitalized owing to a new MRSA infection following trial enrollment. Their aim was to quantify antibiotics given to those patients and any hospital-onset CDI risk.
The researchers identified 123 trial participants with 154 hospitalizations for MRSA infection. The most common type of MRSA infection included skin and other soft-tissue infection (37%), bone and joint infection (30%), and pneumonia (14%). Fifty-six patients required intensive care unit stays, and 10 patients died. Overall, 25 hospitalizations involved only anti-MRSA antibiotics, and 129 hospitalizations involved empiric antibiotic therapy targeting more than MRSA, with a total of 7.9 days of therapy of non-MRSA antibiotics. Six cases of CDI occurred among the 154 hospitalizations, for an incidence of 3.9%, which exceeds the national incidence rate of hospital-onset CDI (0.3%)
The study authors say the findings highlight the importance of effective MRSA prevention strategies, such as postdischarge decolonization.
“Our study highlights the value of eradicating MDROs [multidrug-resistant organisms], such as MRSA, to prevent acquisition of or infection with another antibiotic-associated pathogen such as C. difficile,” they wrote.
Apr 16 Infect Control Hosp Epidemiol abstract
Feb 14, 2019, CIDRAP News story on the CLEAR Trial
H1N1v flu infects Wisconsin child
The Centers for Disease Control and Prevention (CDC) today reported a variant H1N1 influenza (H1N1v) case in Wisconsin, the third variant flu case to be reported for the 2020-21 flu season.
In its weekly FluView report, the CDC said the child was not hospitalized and completely recovered. An investigation found that he or she had direct contact with pigs and that no human-to-human transmission was linked to the infection.
The case is the first involving H1N1v to be reported in 2021 and brings the number of variant cases this flu season to three. Two H3N2v cases were reported earlier. Infections involving both variant types have been linked to swine exposure in settings such as summer agricultural fairs.
Apr 16 CDC FluView report
Ten countries report more vaccine-derived polio cases
Ten countries—eight in Africa and two in the Middle East—reported new polio cases, all involving vaccine-derived types, according to the latest weekly update from the Global Polio Eradication Initiative (GPEI).
In Africa, the eight countries are Burkina Faso, the Republic of Congo, Ivory Coast, the Democratic Republic of the Congo (DRC), Guinea, Mali, Senegal, and Sierra Leone. All involved circulating vaccine-derived poliovirus type 2 (cVDPV2). Burkina Faso’s case, in Dori, is counted with its 2020 total, which is now 61. The Republic of Congo’s case, in Brazzaville, marks its first case for 2021. Ivory Coast has one new case, in Abidjan, counted in its 2020 total, which is now at 60. In the DRC, one new case was reported, involving a patient in Sud Ubangi province, which is the country’s first case of 2021.
Elsewhere in Africa, Guinea reported five cases in four locations, the first for the new year. Mali has two new cases, both in Mopti, that are included in its 2020 count, which is now at 45. Senegal has one more case, which involves a patient from Diourbel, lifting its total this year to three. And finally, Sierra Leone has two cases in Northern and Eastern provinces, its first cases of the new year.
In the Middle East, Afghanistan reported 4 more cVDP2 cases in three locations, boosting its 2021 total to 32. Yemen reported 3 circulating vaccine-derived poliovirus type 1 (cVDPV1) cases, all in Saadah, bringing its overall total to 33.
Apr 15 GPEI update