The epidemiology of patient to patient transmission of MRSA among critical care patients
AdvisorHarris, Anthony D.
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AbstractBackground: Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterial pathogen that leads to an increase in morbidity and mortality. To decrease the spread of MRSA, there is a need to elucidate factors that lead to patient-to-patient transmission in critical care settings. Objectives: Aim 1: To understand if patient-to-patient transmission via HCP mediator differs between high-risk activities by determining the odds of MRSA contamination of the patient from the gown and gloves of the health care personnel (HCP). Aim 2: To determine if isolates found on the gown and gloves of HCP are similar to patient isolates after performing an HCP-patient interaction, using comparative genomic techniques. Methods: Aim 1: This was an observational study of MRSA-positive patients and the HCP who cared for them. We conducted a simulation study of patient-to-patient transmission of MRSA from a HCP vector to a manikin (proxy for the subsequent patient). Using a generalized linear mixed model, we determined the odds of manikin contamination after performing HCP-patient interactions. Aim 2: We selected 95 patient MRSA isolates and their co-isolated HCP gown or glove MRSA isolates using a stratified sampling method. Comparative genomics analyses such as phylogenetic analysis, spa-typing, multi-locus sequence typing (MLST), large-scale blast score ratio (LSBSR), and single nucleotide variant (SNV) analysis were used to achieve this aim’s objective. Results: Aim 1: We observed 103 HCP-patient interactions with 65 MRSA-positive patients and found that subsequent transmission of MRSA from HCP gown and gloves to the manikin proxy occurred 10.7% of the time. There was no association between high-contact patient care activities and MRSA contamination of the manikin following patient care activity (p-value=0.1). Aim 2: Using multiple typing methods, we found that the majority of our isolates were genetically similar. The phylogenetic analysis revealed that 85.2% of paired isolates were similar, and the spa-typing and the LSBSR found that more than 75% of our paired isolates were concordant. However, SNV and MLST identified more than 40% of our paired isolates as discordant. Conclusion: The studies conducted demonstrated patient-to-patient transmission of MRSA via HCP vector, indicating the importance of contact precautions and infection control practices.
DescriptionEpidemiology and Preventive Medicine
University of Maryland, Baltimore
patient to patient transmission
Infectious Disease Transmission, Patient-to-Professional
Infectious Disease Transmission, Professional-to-Patient
Methicillin-Resistant Staphylococcus aureus
Identifier to cite or link to this itemhttp://hdl.handle.net/10713/15794
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