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[Nosocomial infection with methicillin resistant Staphylococcus aureus in 14 human immunodeficiency virus infected
M Eulalia Valencia1, A Enríquez, V Soriano
1Servicio de Enfermedades Infecciosas, Centro de Investigación Clínica, Instituto de Salud Carlos III, Madrid.
Background:
Methicillin-resistant Staphylococcus aureus (MRSA) frequently occurs with nosocomial infections. Although human immunodeficiency virus (HIV) infected subjects spend a long time in hospital, the transmission of MRSA nosocomial infections in this group of patients has not been previously reported previously.
Patients And Methods:
A clinical sample of 14 HIV infected patients from an Infectious Diseases Unit, in whom MRSA had been isolated, were evaluated as part of a 6 months prospective study. The measures employed in assessing infectivity were the prospective surveillance of all those isolated and the search for carriers in associated health-workers.
Results:
The potential index case was a patient with an isolated MRSA pneumonia. From him, it was transmitted to his cohabitors and to the rest of the Unit. All the patients had AIDS and 13 presented with MRSA-associated symptoms. Five were admitted 30 days previously and 12 had intravenous catheters. The mean time for the appearance of the infection was 16 days. In the antibiotic investigations multiresistance was confirmed and in the 13 symptomatic cases systemic treatment with vancomycin was indicated requiring replacement by teicoplanin in 50% due to adverse reactions. Two years later, the 14 patients had died but only one in relation to MRSA. Of the health-workers, one carrier was detected. The line of decolonization with mupirocin was efficatious.
Conclusions:
The MRSA nosocomial infection in HIV infected patients took place in subjects who were immunodepressed and had a prolonged mean time of hospitalization. The treatment with vancomycin and/or teicoplanin was effective in the majority of the cases.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) nosocomial infections occurred in human immunodeficiency virus (HIV) patients with prolonged hospital stays. Treatment with vancomycin or teicoplanin was largely effective, though one MRSA carrier was found among staff.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Context:
- Nosocomial infections are a significant concern in healthcare settings.
- Methicillin-resistant Staphylococcus aureus (MRSA) poses a particular challenge due to its resistance.
- Human immunodeficiency virus (HIV) infected patients have prolonged hospitalizations, increasing infection risk.
Purpose:
- To investigate the transmission and outcomes of MRSA nosocomial infections in HIV-infected patients.
- To identify risk factors and effective treatment strategies for MRSA in this vulnerable population.
- To assess the role of healthcare workers in MRSA transmission within an infectious diseases unit.
Summary:
- A prospective study evaluated 14 HIV-infected patients with MRSA isolation.
- The index case transmitted MRSA to others in the unit; all patients had AIDS, with most symptomatic and requiring intravenous catheters.
- MRSA infection appeared after a mean of 16 days, with multiresistance confirmed. Vancomycin/teicoplanin treatment was effective, and mupirocin decolonization was successful for a detected healthcare worker carrier.
Impact:
- Highlights the risk of MRSA nosocomial transmission in immunocompromised patients with prolonged hospital stays.
- Demonstrates the effectiveness of vancomycin and teicoplanin in treating MRSA infections in HIV patients.
- Underscores the importance of surveillance and decolonization protocols to control MRSA spread in hospitals.