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PubMedDate not supplied

Susceptibility testing interpretive criteria and drug stability for cefdinir, cefetamet, and cefpodoxime against Neisseria gonorrhoeae.

Cefdinir, cefetamet, and cefpodoxime, three orally administered cephalosporins, were tested against 100 strains of Neisseria gonorrhoeae having various antimicrobial susceptibility patterns. Triplicate testing of each organism strain was performed for all agar dilution and disk diffusion tests. Cefdinir was the most active compound (MIC90) micrograms/ml) especially against gonococci with chromosomal-mediated resistance to penicillin. The recommended susceptible interpretive criteria were as follows: for the 5-micrograms cefdinir disk, > or = 31 mm (MIC correlate, < or = 0.25 microgram/ml); for the 10-micrograms cefetament disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml; for the 30-micrograms cefetamet disk, > or = 31 mm (MIC correlate, < or = 0.5 microgram/ml); and for the 10-micrograms cefpodoxime disk, > or = 29 mm (MIC correlate, < or = 0.5 microgram/ml). No organisms resistant to these new cephalosporins were detected. Cefdinir, cefetamet, and defpodoxime were stable in GC agar medium for at least 21 days when stored at 2 degrees-5 degrees C.

Cefdinir↗

PubMed1996

Changing trends in the antimicrobial susceptibility of clinical isolates of Acinetobacter baumannii.

Acinetobacter baumannii has recently emerged as an important nosocomial pathogen because of its resistance to the majority of commonly used antimicrobial agents. Therefore, the pattern of isolation of Acinetobacter baumannii in our laboratory and the in vitro susceptibilities to various antimicrobial agents were studied. One hundred and two clinical isolates of previously identified Acinetobacter calcoaceticus var. anitratus from different patients were collected from the Diagnostic Bacteriology section of the Department of Pathology, Singapore General Hospital. The strains were reclassified according to recent taxonomic changes using phenotypic tests and tested for beta-lactamase production using Cefinase disks. In vitro sensitivities to various antimicrobial agents were determined using the disk diffusion method. Of the 103 A. calcoaceticus var. anitratus species, 99 were identified as A. baumannii, 2 as A. junii and 1 as A. haemolyticus. Majority of the A. baumannii isolates were from wound sites (63.6%) and from patients in the general wards (70.7%). beta-lactamase activity was present in all these isolates. The most active agent against all A. baumannii isolates was imipenem. However, 14 of the strains were resistant to imipenem, 8 of which came from the burns ward. Two-thirds of isolates from burn patients were completely resistant to all the antimicrobial agents tested. Almost all isolates previously identified as A. calcoaceticus var. anitratus in our laboratory are A. baumannii strains. Imipenem is the most effective antimicrobial agent; however, the high rate of imipenem resistance especially among burn patients is a source of major concern.

Acinetobacter calcoaceticus↗

PubMed1996

Quality control guidelines for amoxicillin, amoxicillin-clavulanate, azithromycin, piperacillin-tazobactam, roxithromycin, ticarcillin, ticarcillin-clavulanate, trovafloxacin (CP 99,219), U-100592, and U-100766 for various National Committee for Clinical Laboratory Standards susceptibility testing methods. Results from multicenter trials.

Quality control guidelines for standardized antimicrobial susceptibility test methods are critical to the continuing accuracy of the tests. In this report, quality control limits were proposed for 22 organism-antimicrobial combinations with minimum inhibitory concentration (MIC) ranges of three or four log2 dilution steps. Disk diffusion zone diameter ranges were proposed for azithromycin compared with Neisseria gonorrhoeae ATCC 49226 and ticarcillin with and without clavulanic acid tested against Staphylococcus aureus ATCC 25923. The data from five or six participating laboratories produced > or = 94.7% of results within proposed MIC limits, and 94.3%-99.0% of zones were found within suggested zone guidelines. These proposed quality control ranges should be validated by in-use results from clinical laboratories.

Acetamides↗

PubMed2006

Antimicrobial resistance in Salmonella enterica serovar Dublin isolates from beef and dairy sources.

Salmonella enterica serovar Dublin (S. Dublin) is a cattle-adapted Salmonella serovar, so if antimicrobial resistance in S. Dublin arises as a result of antimicrobial use this most likely occurs within the cattle reservoir without impact from antimicrobial use in humans. We tested the antimicrobial resistance of bovine-origin S. Dublin isolates from 1986 through 2004 using a standard disk diffusion method. High proportions of isolates throughout the time period were resistant to one or more antimicrobials, and a marked increase in resistance to ceftazidime occurred between 2000 and 2004. Dairy-origin isolates were more likely to be resistant to several antibiotics than were isolates from beef operations where exposure to antimicrobials is likely to be less frequent. Plasmid analysis of a subset of isolates also supported the hypothesis that antimicrobial resistance traits in the cattle-adapted serovar Dublin were acquired within the bovine host environment.

Animals↗

PubMedDate not supplied

Antibiotic susceptibility testing (agar disk diffusion and agar dilution) of clinical isolates of Enterococcus faecalis and E. faecium: comparison of Mueller-Hinton, Iso-Sensitest, and Wilkins-Chalgren agar media.

Forty-two isolates of Enterococcus faecalis and 56 isolates of Enterococcus faecium, including 8 vancomycin-resistant strains, were examined for comparative susceptibility to 27 antimicrobial drugs with the agar dilution method, employing Mueller-Hinton (MHA), Iso-Sensitest (ISTA), and Wilkins-Chalgren (WCA) agar. The Bauer-Kirby agar disk diffusion method was used to comparatively test 24 of the agents in parallel. The enterococci yielded better growth on ISTA and WCA. However, WCA completely antagonized co-trimoxazole and, though less, fosfomycin. Importantly, WCA slightly reduced the activities of teicoplanin (minimal inhibitory concentrations, MICs, raised up to twofold) and vancomycin (MICs raised two- to fourfold) against enterococci and staphylococcal quality control strains. Therefore, WCA was judged unsuitable for susceptibility testing of enterococci. For E. faecalis no discrepancies between agar dilution MICs and inhibition zone diameters were encountered with augmentin, ampicillin, ampicillin-sulbactam, chloramphenicol, mupirocin, oxacillin, teicoplanin, and co-trimoxazole. Overall, MHA yielded fewer very major (category I) and major (category II) discrepancies than ISTA. However, numerous minor (category III), slight (category IV), minimal (category V), and/or negligible (category VI) discrepancies were encountered with ciprofloxacin, doxycycline, erythromycin, fosfomycin, fusidic acid, meropenem, ofloxacin and rifampin. With respect to E. faecium, only cefotaxime, mupirocin, oxacillin, and teicoplanin yielded nondiscrepant results. Several very major (I) and major (II) discrepancies were observed with augmentin, ampicillin, ampicillin-sulbactam, doxycycline, fusidic acid, imipenem, and penicillin G. Minor discrepancies (categories III-VI) were particularly numerous with augmentin, chloramphenicol, ciprofloxacin, doxycycline, and piperacillin. The largest numbers of negligible (VI) discrepancies were noted with fosfomycin, fusidic acid, and ofloxacin. It is recommended to test one cephalosporin (cefuroxime or the like) in parallel for educational purposes and to exclude fosfomycin, fusidic acid, and rifampin from test batteries because of the wide scatter of test results. The large number of minimal (V) discrepancies of ciprofloxacin against E. faecalis, the numerous minor (III) and slight (IV) discrepancies of chloramphenicol against E. faecium, and the not insignificant number of very major (I) and minor (III) discrepancies observed with meropenem against isolates of E. faecalis necessitated proposals for new disk intermediate susceptibility criteria.

Agar↗

PubMedDate not supplied

Proposed quality control guidelines for National Committee for Clinical Laboratory Standards Susceptibility Tests using the veterinary antimicrobial agent tiamulin.

Quality control guidelines for standardized antimicrobial susceptibility test methods are critical for the continuing accuracy of these clinical tests. In this report, quality control limits were proposed for the veterinary antimicrobial agent tiamulin with minimum inhibitory concentration (MIC) ranges of three or four log(2) dilution steps in two different medium formulations. Disk diffusion zone diameter ranges were proposed for tiamulin tested against Actinobacillus pleuropneumoniae ATCC 27090 (12-18 mm) and Staphylococcus aureus ATCC 25923 (25-32 mm). The data from eight participating laboratories produced 100% of results within proposed MIC limits (8-32 microg/mL), and 95.8-97.0% of zones were found within suggested zone diameter QC guidelines. These proposed QC ranges should be validated by in-use results from veterinary clinical laboratories.

Actinobacillus Infections↗

PubMed1985

Susceptibility testing with the sensititer breakpoint broth microdilution system.

The antimicrobial susceptibility profiles of a total of 318 aerobic and facultatively anaerobic bacteria (255 gram-negative bacilli and 63 gram-positive cocci) were determined, using a new commercially available breakpoint broth microdilution procedure (Sensititer Breakpoint System (SBS), Gibco Diagnostics, Inc., Madison, WI) that categorizes test results in the form of susceptibility categories: susceptible, intermediate, and resistant. Results obtained with the SBS were compared with those achieved with a standardized disk diffusion procedure. Among a total of 4,414 organism-antimicrobic comparisons, concordance between the results of the SBS and the disk diffusion procedure was observed in 3,888 cases (88.1%). Four hundred twenty-three (9.6%) minor discrepancies, 45 (1.0%) major discrepancies, and 58 (1.3%) very major discrepancies were noted. Arbitration of major and very major discrepancies with a full-range minimum inhibitory concentration (MIC) procedure confirmed the results of the SBS in 53.4% of cases. A single organism-antimicrobial combination, the nonenterococcal streptococci tested against the aminoglycosides, yielded a significant number of very major errors which were arbitrated in favor of the disk diffusion result. These errors were probably due to poor growth of the test organism in the broth medium used for performing the SBS test (i.e., cation-supplemented Mueller-Hinton broth). With this exception, the SBS was found to be at least as accurate as the standardized disk diffusion procedure.

Anti-Bacterial Agents↗

PubMed1996

Minimum inhibitory concentration breakpoints and disk diffusion inhibitory zone interpretive criteria for tilmicosin susceptibility testing against Pasteurella spp. associated with bovine respiratory disease.

Tilmicosin is a novel macrolide antibiotic developed for exclusive use in veterinary medicine. The first tilmicosin-containing product was approved to treat bovine respiratory disease associated with pasteurellae. The development of antimicrobial susceptibility testing guidelines for tilmicosin was predicated on the relationship of clinical efficacy studies that demonstrated a favorable therapeutic outcome, on pharmaco-kinetic data, and on in vitro test data, as recommended by the National Committee for Clinical Laboratory Standards (NCCLS). The NCCLS-approved breakpoints for the MIC dilution testing are resistant > or = 32 micrograms/ml, intermediate 16 micrograms/ml, and susceptible < or = 8 micrograms/ml. The zone of inhibition interpretive criteria for disk diffusion testing with a 15-micrograms disk are resistant < or = 10 mm, intermediate 11-13 mm, and susceptible > or = 14 mm.

Animals↗

PubMed1983

Susceptibility testing of multidrug-resistant Staphylococcus aureus with the Sceptor microdilution system.

The antimicrobial susceptibilities of Staphylococcus aureus isolates were concurrently determined by the Sceptor system (BBL Microbiology Systems, Cockeysville, Md.) and by the standard disk diffusion method. For the methicillin-resistant isolates, there was greater than 98% agreement between the two test results with penicillin G, erythromycin, clindamycin, tetracycline, gentamicin, and tobramycin. Major disagreements (susceptible by one method and resistant by the other) were 7% for methicillin, 13.5% for cephalothin, 3.5% for cefamandole, and 27% for amikacin. The major discrepancies for methicillin were eliminated by supplementing the inoculum broth with salt. For methicillin-susceptible isolates, agreement between the two methods was 96 to 100% for all antibiotics except amikacin.

Anti-Bacterial Agents↗

PubMed1985

Effect of the source of Mueller-Hinton agar and resistance frequency on the detection of methicillin-resistant Staphylococcus aureus.

Inconsistencies in the results of disk diffusion tests of oxacillin against Staphylococcus aureus that occurred when using commercially prepared Mueller-Hinton agar from different sources led us to evaluate the ability of media from different sources to detect resistance to oxacillin, methicillin, and nafcillin in S. aureus. Mueller-Hinton agar from five manufacturers was prepared in our laboratory and used for standard disk diffusion and agar dilution tests. Ten oxacillin-resistant S. aureus isolates, of which three were definitive-resistant and seven were occult-resistant, were examined. All definitive-resistant strains were resistant to all three antimicrobial agents on four out of five agars. The occult-resistant strains were consistently detected as resistant on only one of the agars. With only slight differences, oxacillin, methicillin, and nafcillin resistance was more readily detected by disk diffusion and agar dilution when initially incubated at 30 degrees C, and extended incubation improved the detection. The frequency of resistance within a population of occult-resistant cells was low compared with the frequency within a population of definitively resistant cells. The heterogeneity of colony morphology and apparent growth rates within a population of occult-resistant cells contributed to the problem of detecting some resistant isolates. Definitive-resistant isolates were characterized by a very high and stable frequency of resistance. Occult-resistant strains were characterized by a lower frequency of resistance, although the true frequency of resistance may be difficult to ascertain because of heterogeneity in growth rates.

Agar↗

PubMed2006

Effect of farnesol on Staphylococcus aureus biofilm formation and antimicrobial susceptibility.

Staphylococcus aureus is among the leading pathogens causing bloodstream infections able to form biofilms on host tissue and indwelling medical devices and to persist and cause disease. Infections caused by S. aureus are becoming more difficult to treat because of increasing resistance to antibiotics. In a biofilm environment particularly, microbes exhibit enhanced resistance to antimicrobial agents. Recently, farnesol was described as a quorum-sensing molecule with possible antimicrobial properties. In this study, the effect of farnesol on methicillin-resistant and -susceptible strains of S. aureus was investigated. With viability assays, biofilm formation assessment, and ethidium bromide uptake testing, farnesol was shown to inhibit biofilm formation and compromise cell membrane integrity. The ability of farnesol to sensitize S. aureus to antimicrobials was assessed by agar disk diffusion and broth microdilution methods. For both strains of staphylococci, farnesol was only able to reverse resistance at a high concentration (150 microM). However, it was very successful at enhancing the antimicrobial efficacy of all of the antibiotics to which the strains were somewhat susceptible. Therefore, synergy testing of farnesol and gentamicin was performed with static biofilms exposed to various concentrations of both agents. Plate counts of harvested biofilm cells at 0, 4, and 24 h posttreatment indicated that the combined effect of gentamicin at 2.5 times the MIC and farnesol at 100 microM (22 microg/ml) was able to reduce bacterial populations by more than 2 log units, demonstrating synergy between the two antimicrobial agents. This observed sensitization of resistant strains to antimicrobials and the observed synergistic effect with gentamicin indicate a potential application for farnesol as an adjuvant therapeutic agent for the prevention of biofilm-related infections and promotion of drug resistance reversal.

Biofilms↗

PubMedDate not supplied

[Evaluation of antimicrobial sensitivity of 87 clinical isolates of vancomycin-resistant enterococci].

OBJECTIVES: 1) To evaluate the antimicrobial susceptibility pattern of vancomycin-resistant enterococci to the antimicrobial agents that are commonly used to treat enterococci infections and to some alternative drugs. 2) To evaluate the accuracy of E test for susceptibility testing enterococci. MATERIAL AND METHOD: We evaluated 87 clinical VRE isolates that were selected from a previous study which analyzed 1936 clinical isolates collected and processed in 97 US medical centers in the last quarter of 1992. The isolates were identified to the species level by using the API 20S System, the Vitek gram-positive identification cards and a modified version of the conventional method proposed by Facklam and Collins. The in vitro susceptibility testing was performed by broth microdilution, E test and disk diffusion methods, following the criteria described by the National Committee for Clinical Laboratory Standards (NCCLS). The VRE isolates were tested against antimicrobial agents commonly used to treat enterococci infections (vancomycin, teicoplanin, ampicillin, penicillin, gentamicin and streptomycin) and against ten potential alternative drugs (chloramphenicol, doxycycline, sparfloxacin, ciprofloxacin, clinafloxacin, erythromycin, spectinomycin, trospectomycin, trimetoprim-sulfametoxazol and novobiocin). RESULTS: Our results showed a high rate of resistance to ampicillin and penicillin (86%). High level resistance to gentamicin and streptomycin was demonstrated by 82% and 85% respectively. Although teicoplanin and vancomycin belong to the same antibiotic group (glycopeptide), 29% of VRE were susceptible to teicoplanin. Among the alternative drugs, trospectomycin, doxycyclin and chloramphenicol showed the highest in vitro activity, with 94%, 92% and 82% susceptibility respectively. In addition, erythromycin, trimetoprim-sulfametoxazol and ciprofloxacin showed the highest rates of resistance (98%, 83% and 69%, respectively). CONCLUSION: The treatment options for infections caused by vancomycin-resistant enterococci seem to be very narrow since a small percentage of those isolates were susceptible to the other antimicrobial agents commonly used to treat these infections and only a few of the alternative drugs tested showed good in vitro activity. Many regimens using various antibiotic combinations have been tested against VRE, most of them with fluoroquinolones. However further studies are necessary to evaluate the clinical role of these antibiotic combinations.

Anti-Bacterial Agents↗

PubMed2006

An outbreak of Salmonella Abortusovis abortions in sheep in south Croatia.

The aim of the study was to give an account of the epidemic of abortions in sheep caused by Salmonella enterica ssp. enterica serovar Abortusovis, which occurred in Dalmatia, south Croatia, in winter 2003-2004. Five sheep flocks with rate of abortion ranging from 22% to 38% during the last-third of gestation were examined. Salmonella Abortusovis was isolated from 13 vaginal smears and two fetuses. Direct inoculation was found to be superior to pre-enrichment and enrichment in selective broth for Salmonella Abortusovis isolation. The isolates were biochemically identified, and characterized by serotyping and polymerase chain reaction based on the amplification of the IS200 sequence specific for Salmonella Abortusovis. A fragment of 900 bp was detected in all Salmonella Abortusovis isolates. The sensitivity testing of the isolates, carried out by the disk diffusion method and the determination of the minimal inhibitory concentrations, resulted in a high sensitivity to almost all antimicrobials used. Only two isolates were moderately sensitive to oxytetracycline, whereas one isolate showed resistance to streptomycin. Campylobacter fetus ssp. fetus and Listeria monocytogenes were excluded as causative agents of abortion in sheep by culture testing, and brucellosis, leptospirosis, Q fever and chlamydiosis by serological testing.

Abortion, Veterinary↗

PubMedDate not supplied

A pilot programme of MRSA surveillance in India. (MRSA Surveillance Study Group).

This surveillance study was conducted simultaneously at three centres across India. A total of 13,610 test samples from various sites were obtained. Microbiological methods employed were similar at the three centres. Identification of S aureus was based on the recognition of the production of coagulase with positive isolates being recorded as S aureus. Both tube coagulase tests and slide coagulase test were performed. Antimicrobial susceptibility testing of the isolated strains of staphylococcus aureus and staphylococcus epidermidis to various antimicrobial discs were carried out according to standardized disk diffusion method recommended by NCCLS. Of the total 739 cultures of S aureus, 235 (32%) were found to be multiply resistant with the individual figures for resistance being 27% (Bombay), 42.5% (Delhi) and 47% (Bangalore). MRSA is emerging to be a significant problem pathogen in the surgical setting with vancomycin probably the only reliable choice for these infections.

Cross Infection↗

PubMed1999

Nasopharyngeal carriage of multidrug-resistant Streptococcus pneumoniae in institutionalized HIV-infected and HIV-negative children in northeastern Romania.

OBJECTIVES: The study compared nasopharyngeal carriage of resistant pneumoniae in human immunodeficiency virus (HIV)-seropositive and -seronegative children. METHODS: Nasopharyngeal colonization with Streptococcus pneumoniae was investigated during May 1996 in 162 HIV-negative infants and children (age range, 1-38 mo) and 40 HIV-infected children (age range, 39-106 mo) living in an orphanage in Iasi, northeastern Romania. The HIV-infected children lived separated from the other children and were cared for by a different staff. Streptococcus pneumoniae was isolated from 12 of 40 (30%) HIV-infected and from 81 of 160 (50%) HIV-negative children. Antimicrobial susceptibility to penicillin and ceftriaxone was determined by E-test, and to another five antibiotics by disk diffusion. Serotyping was performed by the Quellung method on 81 of 93 (87%) isolates. RESULTS: Serotypes 6A, 6B, 19A, and 23F together represented 98% of all isolates. Ninety-nine percent of S. pneumoniae isolates were resistant to penicillin, and 74% were highly resistant to penicillin (minimum inhibitory concentration [MIC] > 1 mg/mL); MIC50 and MIC90 to penicillin of the isolates were 2 mg/mL and 8 mg/mL, respectively. Eighty-nine of ninety-one isolates were susceptible to ceftriaxone; 99%, 87%, 87%, 48%, and 21% of the isolates were resistant to trimethoprim-sulphamethoxazole, erythromycin, clindamycin, tetracycline, and chloramphenicol, respectively. Eighty-two (89%) isolates were multidrug resistant (resistant to =/>3 antibiotic classes); 37 of 92 (40%) isolates were resistant to 5 or more antibiotic classes, and 16 of these 37 (43%) belonged to serotype 19A. All serotype 19 isolates were highly resistant to penicillin. CONCLUSIONS: No significant differences were observed in the resistance rates of S. pneumoniae in HIV-infected children compared to HIV-negative children. Multidrug-resistant pneumococci were highly prevalent in this Romanian orphanage in both HIV-negative and older HIV-infected children. The observed high prevalence of multidrug-resistant pneumococci (coupled with high penicillin resistance) with a limited number of circulating serotypes emphasizes the need to further evaluate the conjugate vaccines in children at risk for invasive pneumococcal infection.

Anti-Bacterial Agents↗

PubMed1994

Biochemical traits and antimicrobial susceptibility of Streptococcus suis isolated from slaughtered pigs.

A total of 522 Streptococcus suis isolates were recovered from the tonsils of slaughtered pigs by culturing on media containing different specific antisera. The serogroup reactions were determined by coagglutination. The most frequently isolated serotype was serotype 4 (representing 28.7% of the isolates), followed by serotype 3 (24.9%) and serotype 2 (22.6%). Typable isolates were examined by growth in 6.5% NaCl, amylase activity, acetoin production, susceptibility to optochin and production of acid from mannitol, melibiose, raffinose, salicin, sorbitol and trehalose. Finally, all isolates were tested for antimicrobial susceptibility against ampicillin, cephalotin, lincomycin, neomycin, penicillin, spiramycin and trimethoprim-sulphamethoxazole using the disk-diffusion technique. All isolates were amylase-positive and acetoin-negative, and failed to grow in 6.5% NaCl broth. Nine isolates were optochin-susceptible. Moreover, 10 isolates produced acid from mannitol, 21 produced acid from sorbitol, and 36 and 37 did not produce acid from salicin and trehalose, respectively. Six salicin- and trehalose-negative isolates and two mannitol- and sorbitol-fermenting isolates were found. Biochemical differences between serotypes were not observed. The most active drugs against S. suis were the beta-lactam antibiotics, although only 83.3%, 70% and 78.5% of isolates were susceptible to ampicillin, cephalotin and penicillin, respectively. Half of the isolates were resistant to trimethoprim-sulphamethoxazole, and resistance to lincomycin, neomycin and spiramycin appeared to be very high.

Abattoirs↗

PubMed2002

Prevalence and antimicrobial susceptibility of Salmonella serotypes in patients from Ribeirão Preto, São Paulo, Brazil, between 1985 and 1999.

Salmonella strains isolated from 1,138 samples representing 28,199 biological materials (stool, urine, blood and other fluids), collected between January 1985 and January 1999 at a reference University Hospital in Ribeirão Preto, São Paulo, Brazil, were studied. The most frequently detected serotypes were Salmonella enterica subspecies enterica serotype 4,5,12:i:- (S. I 4,5,12:i:) (21.2%), S. agona (15.8%) and S. enteritidis (11.3%). A changing pattern of Salmonella serotypes was observed between 1985-1999. S. agona, which represented 27% of Salmonella serotypes isolated from 1985-1989, declined to 4% during the period from 1995 to 1999. S. enteritidis isolation remained below 1% until 1989; rose to 5.9% between 1990 and 1994, and increased to 32.3% between 1995-1999. S. I 4,5,12:i:-; S. enteritidis; S. typhimurium; S. dublin and S. infantis, showed low to moderate resistance profiles to most antimicrobial drugs. Nalidixic acid and tetracycline were the most and the least effective drugs, respectively, in the disk diffusion tests. We encountered changes in salmonellosis epidemiology in this geographical region.

Adult↗

PubMed1993

Guidelines for management of patients with methicillin-resistant Staphylococcus aureus in acute care hospitals and long-term care facilities. The MRSA Interagency Advisory Committee in conjunction with the Connecticut Department of Public Health and Addiction Services, July 1993.

Methicillin-resistant Staphylococcus aureus (MRSA) is a bacterium that can colonize or infect people. MRSA strains are not more virulent than methicillin susceptible strains. Colonized and infected patients represent the most important reservoir of MRSA in hospitals. MRSA is transmitted by direct person-to-person contact, usually on the hands of health care workers. Limiting the spread of MRSA is desirable because the organism is resistant to oxacillin, nafcillin, cephalosporins, and imipenem. Treatment of choice for MRSA infection is usually intravenous vancomycin. The preferred methods for antimicrobial susceptibility testing of S. aureus include oxacillin-salt screening plates, microdilution broth tests with 2% NaCI, and disk diffusion tests incubated for 24 hours at 35 degrees C. Hospitals and LTCFs should monitor the incidence of nosocomial transmission of MRSA in their facility. Hospital admission because of MRSA infection is acceptable medical practice because treatment can best be accomplished in an acute care setting. However, given special circumstances, treatment of MRSA infection can be accomplished in an extended care facility or at home. This decision is based on the clinical judgement of the attending physician. Hospital admission solely because of MRSA colonization is unwarranted. MRSA colonization is not a contraindication to discharge from an acute care hospital to home or another facility. When a hospitalized patient who is colonized with MRSA no longer needs to receive acute nursing care (i.e. their MRSA infection and/or other acute medical problems are under control), they can be discharged. If they are discharged to another institution, that institution should be notified in advance that the patient is colonized with MRSA.

Cross Infection↗