Multiclonal methicillin-resistant Staphylococcus aureus (MRSA) outbreak and its control after use of the Veterans Affairs (VA) MRSA bundle in a VA long-term care facility, 2004-2014.

A multiclonal methicillin-resistant Staphylococcus aureus (MRSA) outbreak with 91 infections occurred in our Veterans Affairs (VA) community living center over 46 months. Both similar and unique strains were shown by repetitive polymerase chain reaction to contribute to the outbreak, including 1 strain causing infections over a 33-month period. Most infections were soft tissue infections (67%). For 21 months after the initiation of the VA MRSA bundle, no infections were identified, and low rates of infection have been sustained an additional 4 years. The average annual rate of MRSA infection decreased by 62% (P < .001) from 0.6 per 1,000 resident days for 4 years prior to the bundle implementation to 0.09 per 1,000 resident days for 4 years after the bundle implementation.

Cost-benefit and effectiveness analysis of rapid testing for MRSA carriage in a hospital setting.

A cost-effectiveness analysis was conducted comparing the polymerase chain reaction assay and traditional microbiological culture as screening tools for the identification of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to the pediatric and surgical intensive care units (PICU and SICU) at a 722 bed academic medical center. In addition, the cost benefits of identification of colonized MRSA patients were determined. The cost-effectiveness analysis employed actual hospital and laboratory costs, not patient costs. The actual cost of the PCR assay was higher than the microbiological culture identification of MRSA ($602.95 versus $364.30 per positive carrier identified). However, this did not include the decreased turn-around time of PCR assays compared to traditional culture techniques. Patient costs were determined indirectly in the cost-benefit analysis of clinical outcome. There was a reduction in MRSA hospital-acquired infection (3.5 MRSA HAI/month without screening versus 0.6/month with screening by PCR). A cost-benefit analysis based on differences in length of stay suggests an associated savings in hospitalization costs: MRSA HAI with 29.5 day median LOS at $63,810 versus MRSA identified on admission with 6 day median LOS at $14,561, a difference of $49,249 per hospitalization. Although this pilot study was small and it is not possible to directly relate the cost-effectiveness and cost-benefit analysis due to confounding factors such as patient underlying morbidity and mortality, a reduction of 2.9 MRSA HAI/month associated with PCR screening suggests potential savings in hospitalization costs of $142,822 per month.

Rapid detection of West Nile Virus in birds using the VecTest WNV Antigen Assay.

OBJECTIVE: To determine if the VecTest West Nile Virus Antigen Assay (for testing mosquitoes) could be adapted to detect West Nile virus (WNV) rapidly and accurately in birds for screening purposes. DESIGN: Cloacal swabs and tissue (kidney and spleen) were harvested from 40 fresh dead birds. The VecTest was used for each swab specimen for detection of WNV; PCR was used for each tissue specimen for confirmation of WNV. SETTING: Mississippi Veterinary Diagnostic Laboratory (MVDL) in Jackson Mississippi and College of Veterinary Medicine-Mississippi State University (CVM-MSU) in Starkville Mississippi. SPECIMENS/SUBJECTS: Forty birds of the Corvid family (31 blue jays and 9 American crows) were included in the study. Fresh dead birds that died from no obvious cause were submitted for testing. RESULTS: VecTest results were 35 positives and 5 negatives. PCR results were 35 positives and 5 negatives. CONCLUSION: The VecTest showed 100% accuracy.