Trafficking of methicillin-resistant staphylococci and co-colonization with vancomycin-resistant enterococci

To determine the trafficking of methicillin-resistant staphylococci between the hospital and community as well as the occurrence of co-colonization with vancomycin-resistant enterococci [VRE]. From November 2005 to April 2006, methicillin-resistant Staphylococcus aureus [MRSA] and methicillin-resistant coagulase-negative Staphylococcus [MRCoNS]-positive patients at the Salmaniya Medical Complex, Bahrain were assessed for VRE co-colonization. Characterization of vancomycin resistance genotype by PCR was carried out. Close family contacts were screened for MRSA and pulsed-field gel electrophoresis [PFGE] analysis of MRSA isolates from patient-family member pairs was conducted. One hundred and eighty-two patients [93 MRSA; 89 MRCoNS] and 356 family members were enrolled. Seven MRSA and 41 MRCoNS strains were isolated from the family members. PFGE analysis revealed the presence of variants of a single MRSA clone among patients and their relatives. A total of 112 patients [62 MRSA; 50 MRCoNS] provided stool for VRE screening. Of these 13 stool specimens [11.6%] were VRE-positive. All the VRE isolates were from MRSA-positive patients, thus positivity rate among MRSA patients was 20.9% [n/N = 13/62]. These were predominantly Enterococcus gallinarum with vanC1 genotype and one strain was Enterococcus faecium [vanB genotype]. Two E. gallinarum isolates harbored an additional vanB gene. The majority of VRE isolates were from patients in medical and surgical units [n/N = 10/13; 77%]. Male gender, prolonged hospitalization and presence of co-morbidities were significantly associated with MRSA/VRE co-colonization [p < 0.05]. MRSA/VRE co-colonization with MRSA trafficking between the hospital and community environment is a public health concern occurring in our setting

Impact of educationl interventions on the quality of blood culture specimens

Blood cultures [BC] are among the most important specimens for detection of etiologic agents in severe infections. At Salmaniya Medical Complex [SMC], the number of BCs increased from 10580 in 2002 to 13123 for 2004. The specimens likely to be contaminated averages 4.5 percent of the total BC processed with consumption of human and financial resources. We assessed the impact of an educational intervention aimed at decreasing false positivity to internationally accepted levels [<3 percent]. During October-November 2004, BC received at the Microbiology Laboratory at SMC were examined for appropriateness. During the ensuing two investigational months [December 2004- January 2005] an educational intervention was carried out which included phone calls, personal visits in the Wards, practical and theoretical sessions with the health care workers, distribution of Guidelines and attachment of online messages to reports. In the post-intervention period [February -March 2005], the appropriateness parameters were reassessed. Fifty-nine percent of BC received was inappropriate with no significant changes before and after the educational intervention. Although we were able to decrease the number of volume-appropriate bottles likely contaminated and reduce the number of cultures likely contaminated, the figures were still above the international benchmark value. We observed an increase in the number of bottles containing less than the minimal requirement of 3ml of blood. Education per se is not effective in reducing contamination and costs. To succeed the best approach will be to rely on dedicated phlebotomists team which can be a cost effective solution saving between USD720,00 and 1.3 million annually