Large Outbreak Caused by Methicillin Resistant Staphylococcus pseudintermedius ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention
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{"title"=>"Large outbreak caused by Methicillin resistant staphylococcus pseudintermedius ST71 in a Finnish veterinary teaching hospital - From outbreak control to outbreak prevention", "type"=>"journal", "authors"=>[{"first_name"=>"Thomas", "last_name"=>"Grönthal", "scopus_author_id"=>"56389637300"}, {"first_name"=>"Arshnee", "last_name"=>"Moodley", "scopus_author_id"=>"26967943000"}, {"first_name"=>"Suvi", "last_name"=>"Nykäsenoja", "scopus_author_id"=>"55838950800"}, {"first_name"=>"Jouni", "last_name"=>"Junnila", "scopus_author_id"=>"24331892500"}, {"first_name"=>"Luca", "last_name"=>"Guardabassi", "scopus_author_id"=>"6603591962"}, {"first_name"=>"Katariina", "last_name"=>"Thomson", "scopus_author_id"=>"24729554800"}, {"first_name"=>"Merja", "last_name"=>"Rantala", "scopus_author_id"=>"7005507828"}], "year"=>2014, "source"=>"PLoS ONE", "identifiers"=>{"pui"=>"600170346", "sgr"=>"84908110020", "pmid"=>"25333798", "scopus"=>"2-s2.0-84908110020", "isbn"=>"1932-6203; 1932-6203", "doi"=>"10.1371/journal.pone.0110084", "issn"=>"19326203"}, "id"=>"b3629f77-d79c-3613-864f-be9eed20ed6d", "abstract"=>"INTRODUCTION: The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant Staphylococcus pseudintermedius (MRSP) ST71 SCCmec II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 - January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented.\\n\\nMETHODS: Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCCmec typing.\\n\\nRESULTS: Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI95% 2.3-17.0, P = 0.0003), antimicrobial treatment (OR = 3.8, CI95% 1.0-13.9, P = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI95% 1.1-1.6, P = 0.0007) or in the surgery ward (OR = 1.1, CI95% 1.0-1.3, P = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission.\\n\\nCONCLUSION: Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring MRSP. Rigorous control measures were needed to control the outbreak. We recommend the implementation of a search-and-isolate policy to reduce the burden of MRSP.", "link"=>"http://www.mendeley.com/research/large-outbreak-caused-methicillin-resistant-staphylococcus-pseudintermedius-st71-finnish-veterinary", "reader_count"=>48, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Librarian"=>2, "Student > Doctoral Student"=>3, "Researcher"=>6, "Student > Ph. D. Student"=>5, "Student > Postgraduate"=>5, "Other"=>8, "Student > Master"=>10, "Student > Bachelor"=>5, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>2, "Librarian"=>2, "Student > Doctoral Student"=>3, "Researcher"=>6, "Student > Ph. D. Student"=>5, "Student > Postgraduate"=>5, "Other"=>8, "Student > Master"=>10, "Student > Bachelor"=>5, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>2, "Nursing and Health Professions"=>2, "Biochemistry, Genetics and Molecular Biology"=>2, "Agricultural and Biological Sciences"=>12, "Medicine and Dentistry"=>17, "Pharmacology, Toxicology and Pharmaceutical Science"=>3, "Veterinary Science and Veterinary Medicine"=>6, "Social Sciences"=>1, "Immunology and Microbiology"=>2, "Economics, Econometrics and Finance"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>17}, "Social Sciences"=>{"Social Sciences"=>1}, "Immunology and Microbiology"=>{"Immunology and Microbiology"=>2}, "Economics, Econometrics and Finance"=>{"Economics, Econometrics and Finance"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>12}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>2}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>2}, "Unspecified"=>{"Unspecified"=>2}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>3}, "Veterinary Science and Veterinary Medicine"=>{"Veterinary Science and Veterinary Medicine"=>6}}, "reader_count_by_country"=>{"Sri Lanka"=>1, "Japan"=>1, "Brazil"=>1, "United Kingdom"=>1, "Australia"=>1}, "group_count"=>3}

Scopus | Further Information

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Figshare

  • {"files"=>["https://ndownloader.figshare.com/files/1718983"], "description"=>"<p>In late 2011 a small cluster of ST45 among hospitalized patients contributed to an increase in incidence. From January 2012 onwards the great majority of new MRSP findings have been detected in screening targeted to risk patients on admission. In December 2012 the increase was not due to a cluster, but was due to the detection of different types of MRSPs mainly in patients belonging to risk groups.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205824, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.g001", "stats"=>{"downloads"=>1, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_monthly_cumulative_incidence_of_all_MRSPs_and_MRSPs_displaying_the_outbreak_antibiogram_MRSP_ST71_among_patients_of_the_Small_Animal_Hospital_of_Helsinki_University_from_January_2010_to_December_2012_/1205824", "title"=>"The monthly cumulative incidence of all MRSPs and MRSPs displaying the outbreak antibiogram (MRSP ST71) among patients of the Small Animal Hospital of Helsinki University from January 2010 to December 2012.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718984"], "description"=>"<p>The outbreak period was between November 2010 and January 2012, after which the follow-up period was started. A: hospital closed for 2 days for cleaning and disinfection, B: establishment of cohort ward, C: nurse responsible for hospital hygiene appointed, D: hospital closed for 5 days for cleaning and disinfection, E: veterinarian appointed as infection control officer. S: Screening of hospitalized patients, H: environmental swabs taken.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205825, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.g002", "stats"=>{"downloads"=>0, "page_views"=>15, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_An_epidemic_curve_showing_new_MRSP_ST71_cases_during_the_outbreak_in_2010_8211_2012_at_the_Small_Animal_Hospital_of_Helsinki_University_/1205825", "title"=>"An epidemic curve showing new MRSP ST71 cases during the outbreak in 2010–2012 at the Small Animal Hospital of Helsinki University.", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718985"], "description"=>"<p><i>Staphylococcus pseudintermedius</i> ATCC 49444 is displayed as a control. *Further characterized by multilocus sequence typing and SCC<i>mec</i>-typing.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205826, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.g003", "stats"=>{"downloads"=>2, "page_views"=>25, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Dendrogram_of_47_MRSP_isolates_with_the_outbreak_antibiogram_see_text_/1205826", "title"=>"Dendrogram of 47 MRSP isolates with the outbreak antibiogram (see text).", "pos_in_sequence"=>0, "defined_type"=>1, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718986"], "description"=>"a<p>Severity was judged by the author (TG) on a scale of 1 to 5 after reviewing the patient record on admission and was based on the guidelines provided by the American Society of Anesthesiologists.</p>b<p>The same patient might have had several visits or courses of medication, therefore the cumulative number of days for these variables was recorded until the first positive MRSP specimen (cases), or latest negative MRSP specimen (controls), see text for details.</p>c<p>Enrofloxacin was the only fluoroquinolone used for these patients.</p><p>Variables analyzed from cases and controls during the MRSP outbreak in the Small Animal Hospital of Helsinki University between 2010 and 2011.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205827, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.t001", "stats"=>{"downloads"=>1, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Variables_analyzed_from_cases_and_controls_during_the_MRSP_outbreak_in_the_Small_Animal_Hospital_of_Helsinki_University_between_2010_and_2011_/1205827", "title"=>"Variables analyzed from cases and controls during the MRSP outbreak in the Small Animal Hospital of Helsinki University between 2010 and 2011.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718987"], "description"=>"1<p>Some cases required removal of surgical devices and revision.</p>2<p>Patient had orthopedic surgery and several visits to the hospital, otitis was subsequently diagnosed.</p>3<p>Both patients presented with severe bite wounds; after prolonged hospital stay MRSP was cultured from the wound.</p>4<p>Patient presented with pneumonia, autoimmune myositis and dermal vasculitis; later developed MRSP infection on the skin lesion.</p>5<p>Colonization with MRSP preceded the cystitis.</p><p>Nosocomial infections (n = 27) caused by the MRSP outbreak strain (ST71, SCC<i>mec</i> II–III) in the Small Animal Hospital of Helsinki University between 2010 and 2011.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205828, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.t002", "stats"=>{"downloads"=>5, "page_views"=>23, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Nosocomial_infections_n_27_caused_by_the_MRSP_outbreak_strain_ST71_SCC_mec_II_III_in_the_Small_Animal_Hospital_of_Helsinki_University_between_2010_and_2011_/1205828", "title"=>"Nosocomial infections (n = 27) caused by the MRSP outbreak strain (ST71, SCC<i>mec</i> II–III) in the Small Animal Hospital of Helsinki University between 2010 and 2011.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718988"], "description"=>"<p>*Includes hand disinfection, hygienic work routine, and use of protective clothing in case of dirty procedures.</p><p>The current risk based classification of patients at the Small Animal Hospital of Helsinki University and resulting measures.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205829, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.t003", "stats"=>{"downloads"=>4, "page_views"=>20, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_The_current_risk_based_classification_of_patients_at_the_Small_Animal_Hospital_of_Helsinki_University_and_resulting_measures_/1205829", "title"=>"The current risk based classification of patients at the Small Animal Hospital of Helsinki University and resulting measures.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718989"], "description"=>"<p>OR =  Odds Ratio, CI =  Confidence Interval.</p><p>Risk factors associated with acquisition of MRSP during the outbreak in the Small Animal Hospital of Helsinki University between 2010 and 2011.</p>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205830, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>"https://dx.doi.org/10.1371/journal.pone.0110084.t004", "stats"=>{"downloads"=>2, "page_views"=>16, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/_Risk_factors_associated_with_acquisition_of_MRSP_during_the_outbreak_in_the_Small_Animal_Hospital_of_Helsinki_University_between_2010_and_2011_/1205830", "title"=>"Risk factors associated with acquisition of MRSP during the outbreak in the Small Animal Hospital of Helsinki University between 2010 and 2011.", "pos_in_sequence"=>0, "defined_type"=>3, "published_date"=>"2014-10-15 03:40:00"}
  • {"files"=>["https://ndownloader.figshare.com/files/1718990", "https://ndownloader.figshare.com/files/1718991", "https://ndownloader.figshare.com/files/1718992"], "description"=>"<div><p>Introduction</p><p>The purpose of this study was to describe a nosocomial outbreak caused by methicillin resistant <i>Staphylococcus pseudintermedius</i> (MRSP) ST71 SCC<i>mec</i> II-III in dogs and cats at the Veterinary Teaching Hospital of the University of Helsinki in November 2010 – January 2012, and to determine the risk factors for acquiring MRSP. In addition, measures to control the outbreak and current policy for MRSP prevention are presented.</p><p>Methods</p><p>Data of patients were collected from the hospital patient record software. MRSP surveillance data were acquired from the laboratory information system. Risk factors for MRSP acquisition were analyzed from 55 cases and 213 controls using multivariable logistic regression in a case-control study design. Forty-seven MRSP isolates were analyzed by pulsed field gel electrophoresis and three were further analyzed with multi-locus sequence and SCC<i>mec</i> typing.</p><p>Results</p><p>Sixty-three MRSP cases were identified, including 27 infections. MRSPs from the cases shared a specific multi-drug resistant antibiogram and PFGE-pattern indicated clonal spread. Four risk factors were identified; skin lesion (OR = 6.2; CI<sub>95%</sub> 2.3–17.0, <i>P</i> = 0.0003), antimicrobial treatment (OR = 3.8, CI<sub>95%</sub> 1.0–13.9, <i>P</i> = 0.0442), cumulative number of days in the intensive care unit (OR = 1.3, CI<sub>95%</sub> 1.1–1.6, <i>P</i> = 0.0007) or in the surgery ward (OR = 1.1, CI<sub>95%</sub> 1.0–1.3, <i>P</i> = 0.0401). Tracing and screening of contact patients, enhanced hand hygiene, cohorting and barrier nursing, as well as cleaning and disinfection were used to control the outbreak. To avoid future outbreaks and spread of MRSP a search-and-isolate policy was implemented. Currently nearly all new MRSP findings are detected in screening targeted to risk patients on admission.</p><p>Conclusion</p><p>Multidrug resistant MRSP is capable of causing a large outbreak difficult to control. Skin lesions, antimicrobial treatment and prolonged hospital stay increase the probability of acquiring MRSP. Rigorous control measures were needed to control the outbreak. We recommend the implementation of a search-and-isolate policy to reduce the burden of MRSP.</p></div>", "links"=>[], "tags"=>["risk factors", "Rigorous control measures", "laboratory information system", "MRSP surveillance data", "Methicillin Resistant Staphylococcus pseudintermedius ST 71", "Outbreak Prevention IntroductionThe purpose", "Veterinary Teaching Hospital", "field gel electrophoresis", "ci", "hospital patient record software", "outbreak"], "article_id"=>1205831, "categories"=>["Biological Sciences"], "users"=>["Thomas Grönthal", "Arshnee Moodley", "Suvi Nykäsenoja", "Jouni Junnila", "Luca Guardabassi", "Katariina Thomson", "Merja Rantala"], "doi"=>["https://dx.doi.org/10.1371/journal.pone.0110084.s001", "https://dx.doi.org/10.1371/journal.pone.0110084.s002", "https://dx.doi.org/10.1371/journal.pone.0110084.s003"], "stats"=>{"downloads"=>3, "page_views"=>13, "likes"=>0}, "figshare_url"=>"https://figshare.com/articles/Large_Outbreak_Caused_by_Methicillin_Resistant_Staphylococcus_pseudintermedius_ST71_in_a_Finnish_Veterinary_Teaching_Hospital_From_Outbreak_Control_to_Outbreak_Prevention/1205831", "title"=>"Large Outbreak Caused by Methicillin Resistant <i>Staphylococcus pseudintermedius</i> ST71 in a Finnish Veterinary Teaching Hospital – From Outbreak Control to Outbreak Prevention", "pos_in_sequence"=>0, "defined_type"=>4, "published_date"=>"2014-10-15 03:40:00"}

PMC Usage Stats | Further Information

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Relative Metric

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