Demographics, clinical features and results of urine samples among 187 patients with complaints of urethritis.

<p>Demographics, clinical features and results of urine samples among 187 patients with complaints of urethritis.</p

Resource use and costs of screening procedures.

a<p>Costs for Xpert MRSA include: platform costs (price GeneXpert 56000 €), depreciation (5 years) and 8%maintenance costs when 17000 patients per year are screened.</p>b<p>Antibiogram includes cefoxitine 30 µg and mupirocin 20 µg (Oxoïd, Basingstoke, UK).</p>c<p>Excluding VAT.</p

Flow of study patients.

<p>Flow of study patients.</p

Demographic data of study participants, patient care practices and exposure to MRSA carriers in study wards by intervention arm.

a<p>Excluding baseline period.</p

Time for MRSA reporting and rate of MRSA acquisition by intervention arm.

<p>Time for MRSA reporting and rate of MRSA acquisition by intervention arm.</p

Impact of Rapid Molecular Screening at Hospital Admission on Nosocomial Transmission of Methicillin-Resistant <i>Staphylococcus aureus</i>: Cluster Randomised Trial

<div><p>Design</p><p>Cluster randomised crossover trial with seven wards randomly allocated to intervention or control arm.</p><p>Setting</p><p>Medical and surgical wards of a university hospital with active MRSA control programme.</p><p>Participants</p><p>All patients hospitalized >48 h in study wards and screened for MRSA on admission and discharge Intervention: Rapid PCR-based screening test for MRSA compared with control screening test by enrichment culture using chromogenic agar.</p><p>Objective</p><p>We determined the benefit of PCR-detection versus culture-based detection of MRSA colonisation upon patient admission on early implementation of isolation precautions and reduction of hospital transmission of MRSA.</p><p>Main outcome</p><p>Cumulative rate of MRSA hospital acquisition of in patients screened negative on admission.</p><p>Randomization</p><p>The sequential order of inclusion of study wards in each arm was randomised by assigning a number to each ward and using a computer generated list of random numbers.</p><p>Findings</p><p>Of 3704 eligible patients, 67.8% were evaluable for the study. Compared with culture, PCR-screening reduced the median test reporting time from admission from 88 to 11 hours (p<0.001) and the median time from admission to isolation from 96 to 25 hours (p<0.001). MRSA acquisition was detected in 36 patients (3.2%) in the control arm and 34 (3.2%) in the intervention arm. The incidence density rate of hospital acquired MRSA was 2.82 and 2.57/1,000 exposed patient-days in the control and intervention arm, respectively (risk ratio 0.91 (95% confidence interval, 0.60–1.39). Poisson regression model adjusted for colonisation pressure, compliance with hand hygiene and antibiotic use indicated a RR 0.99 (95% CI, 0.69 to 1.44).</p><p>Interpretation</p><p>Universal PCR screening for MRSA on admission to medical and surgical wards in an endemic setting shortened the time to implement isolation precautions but did not reduce nosocomial acquisition of MRSA.</p><p>Trial registration</p><p>clinicaltrials.gov <a href="http://clinicaltrials.gov/ct2/show/NCT00846105?term=NCT00846105&rank=1" target="_blank">NCT00846105</a></p></div

Distribution of Sp1 isolates (N = 136) according to virulence genes profile by (A)) unweighted pair group method with arithmetic mean (UPGMA) dendrogram based on similarity matrix (B) Multi-Dimensional Scaling (MDS) based on similarity matrix.

<p>2.A: Every row represents one strain, the dark plot means the presence of the gene, colour represents the country of isolation (blue = France, red = Africa).2.B: MDS is a visualization method displaying in <i>3</i>-dimensional space the information contained in the similarity matrix. Every dot represents a group of strains sharing an identical combination of virulence genes. The more different the gene combinations are, the more distant the dots are. Colours represent the region of isolation (blue = France, red = Africa).</p

Minimum spanning tree of Sp1 invasive isolates according to MLVA genotypes and either continent of origin (1a, N = 136) or <i>ply</i> allele (1b, N = 62).

<p>The size of the circle reflects the number of isolates identified, the distance between circles reflects the degree of genetic divergence, the circle colors represent either the continent (1.a) or the <i>ply</i> allele type (1.b), the colours outside of circles indicate major clonal groupings (MLVA CCs). MLVA = Multi locus variable number tandem repeats analysis, CC = Clonal Complex, N = number.</p

Prevalence of virulence factor genes in major African and French Clonal Complexes causing meningitis.

<p><u>Legend:</u></p><p>^a Genotypic analysis performed using the following parameters: clonal complexes (CC) defined as MLVA types having a maximum distance of changes at 2 loci and a minimum cluster size of 2 types</p><p>^b PMEN clones listed in <a href="http://www.sph.emory.edu/PMEN/" target="_blank">www.sph.emory.edu/PMEN/</a>.</p><p>^c<i>pspA</i> not typable in 3 African and 3 French isolates, both families present in 1 French isolate, no family 3 identified</p><p>^d<i>nanA</i> and <i>nanB</i> not reported because present in 100% of the strain collection</p><p>^e Presence of a truncated gene with lower PM amplified product in 6 French isolates</p><p>Abbreviations: MLVA = Multi Locus Variable number tandem repeats Analysis, Sp = serotype, CC = Clonal Complex, CSF = cerebrospinal fluid, N = number, PMEN = pneumococcal molecular epidemiological network; <i>ply</i> coding for Pneumolysin, <i>pspA</i> for Pneumococcal surface protein A (all types+ family 1/2), <i>pspC</i> for Pneumococcal surface protein C (all types and group 4), <i>pavA</i> for Pneumococcal adhesion and virulence A, <i>lytA</i> for Autolysin A, <i>phtA</i>, <i>B</i>, <i>D</i>, <i>E</i> for Polyhistidine triad complex A, B, D, E, <i>nanA</i>, <i>B</i>, <i>C</i> for Neuraminidase A, B, C, <i>rrgA</i> for detection of Pilus-1 islet, <i>sipA</i> for detection of Pilus2 islet, <i>pcpA</i> for Pneumococcal choline binding protein A, <i>psrp</i> for Pneumococcal serine-rich protein.</p><p>Prevalence of virulence factor genes in major African and French Clonal Complexes causing meningitis.</p

Prevalence of vaccine candidate antigens among invasive isolates according to PCV13 (VTs) or non-PCV13 (NVTs) serotypes inside the French (3.a) and African (3.b) collections.

<p>It illustrates the theoretical coverage achievable by each antigen in a monovalent or combined (PhtD+PcpA) hypothetical vaccination in terms of percentage of IPD strains circulating at the time of the study likely to express the vaccine-included protein. The <i>ply</i> gene is not represented since present by definition in 100% of our collection. The prevalence of the combination <i>phtD</i> + <i>pcpA</i> genes was arbitrarily calculated taking into account the presence of at least one of the two genes. Abbreviations: Sp = serotype, IPD = invasive pneumococcal disease, N = number, PCV13 = 13 valent pneumococcal conjugate vaccine, VT = PCV13 included serotype, NVT = non-PCV13 included serotype.</p