Although the role of pets in household transmission of meticillin-resistant Staphylococcus aureus (MRSA) has been examined previously, only minor attention has been given to the role of the abiotic household environment independent of, or in combination with, colonisation of pets and human beings to maintain transmission cycles of MRSA within the household. This report reviews published work about household transmission of S aureus and other staphylococci and describes contamination of household environmental surfaces and colonisation of pets and people. Household microbial communities might have a role in transfer of antimicrobial resistance genes and could be reservoirs for recolonisation of people, although additional research is needed regarding strategies for decontamination of household environments. Household-based interventions should be developed to control recurrent S aureus infections in the community, and coordination between medical and veterinary providers could be beneficial.

https://www.thelancet.com/pdfs/journals/laninf/PIIS1473-3099(12)70156-1.pdf

Household transmission of meticillin-resistant Staphylococcus aureus and other staphylococci.

BACKGROUND: Staphylococcus aureus is a major cause of infection in both adult and pediatric populations. After several decades of increasing prevalence, the proportion of S aureus infections due to methicillin-resistant S aureus has been reported to be in decline in adults. Data for similar changes in pediatric populations are limited. METHODS: Evaluation of S aureus susceptibility data for pediatric patients receiving care in the US Military Health System was performed. Microbiology and demographic data were collected for years 2005 through 2014. Trends in antibiotic susceptibility results were evaluated. Clinical and demographic characteristics were explored to assess for association with antibiotic susceptibilities. RESULTS: In this study, 41 745 S aureus isolates from 39 207 pediatric patients were included. An overall increase in susceptibility of isolates to oxacillin was noted over this 10-year period; with over 60% of isolates oxacillin-susceptible in 2014. S aureus susceptibility to clindamycin declined over the study period; notably methicillin-susceptible S aureus susceptibility to clindamycin declined from 90% to 83% (P CONCLUSIONS: Similar to recent trends seen in adults, the proportion of pediatric S aureus infections secondary to methicillin-resistant S aureus appear to be decreasing, as is variability in US geographical resistance rates. Increasing clindamycin resistance among methicillin-susceptible S aureus should raise caution in the use of empirical clindamycin in presumed S aureus infection. Clinicians should be aware of regional susceptibility patterns when choosing empirical regimens.

Changing Susceptibility of Staphylococcus aureus in a US Pediatric Population.

Platelets are the chief effector cells in hemostasis. However, recent evidence suggests they have multiple roles in host defense against infection. Reports by us and others showed that platelets functionally contribute to protection against Staphylococcus aureus infection. In the current study, the capacity of mouse platelets to participate in host defense against S. aureus infection was determined by assessing two possibilities. First, we determined the ability of platelets to kill S. aureus directly; and, second, we tested the possibility that platelets enhance macrophage phagocytosis and intracellular killing of S. aureus In this study we report evidence in support of both mechanisms. Platelets effectively killed two different strains of S. aureus. A clinical isolate of methicillin-resistant S. aureus was killed by platelets (>40% killing in 2 h) in a thrombin-dependent manner whereas a methicillin-sensitive strain was killed to equal extent but did not require thrombin. Interestingly, thrombin-stimulated platelets also significantly enhanced peritoneal macrophage phagocytosis of both methicillin-resistant S. aureus and methicillin-sensitive S. aureus by >70%, and restricted intracellular growth by >40%. Enhancement of macrophage anti-S. aureus activities is independent of contact with platelets but is mediated through releasable products, namely IL-1β. These data confirm our hypothesis that platelets participate in host defense against S. aureus both through direct killing of S. aureus and enhancing the antimicrobial function of macrophages in protection against S. aureus infection.

Platelets Mediate Host Defense against Staphylococcus aureus through Direct Bactericidal Activity and by Enhancing Macrophage Activities.

The birth of a first child is an important event in a woman’s life Delivery psychological impacts vary depending on whether delivery has been positively or negatively experienced Delivery experience determinants have been identified but the understanding of their expression according to the mode of delivery is poorly documented The purpose of the study was to determine important elements associated with women’s first delivery experience according to the mode of delivery: vaginal or caesarean section Qualitative approach using thematic content analysis of in-depth interviews conducted between 4 and 6 weeks’ postpartum, in 24 primiparous women who delivered at Geneva University Hospital in 2012 Perceived control, emotions, and the first moments with the newborn are important elements for the experience of childbirth Depending on the mode of delivery these are perceived differently, with a negative connotation in the case of caesarean section Other elements influencing the delivery experience were identified among all participants, irrespective of the mode of delivery They included representations, as well as the relationship with caregivers and the father in the delivery room, privacy, unexpected sensory experiences, and ownership of the maternal role Women’s and health professionals’ representations sometimes led to a hierarchy based on the mode of delivery and use of analgesia The mode of delivery directly impacts on certain key delivery experience determinants as perceived control, emotions, and the first moments with the newborn The ability/inability of the woman to imagine a second pregnancy is a good indicator of the birth experience Certain health professional gestures or attitudes can promote a positive delivery experience We recommend to better prepare women during prenatal classes for the eventuality of a caesarean section delivery and to offer all women and, possibly, their partners, the opportunity to talk about the experience of childbirth during the postpartum period The results of this study suggest that further research is required on the social representations of women and health professionals regarding the existence of a hierarchy associated with the mode of delivery

/pdf/impact-of-mode-of-delivery-on-the-birth-experience-in-first-5dk6bl1rnv.pdf

Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study.

Objective: The purpose of this study was to investigate the effect of wavelength and methicillin-resistant Staphylococcus aureus (MRSA) density on the bactericidal effect of 405 and 470 nm light. Background data: It is recognized that 405 and 470 nm light-emitting diode (LED) light kill MRSA in standard 5×106 colony-forming units (CFU)/mL cultures; however, the effect of bacterial density on the bactericidal effect of each wavelength is not known. Methods: In three experiments, we cultured and plated US300 MRSA at four densities. Then, we irradiated each plate once with either wavelength at 0, 1, 3, 45, 50, 55, 60, and 220 J/cm2. Results: Irradiation with either wavelength reduced bacterial colonies at each density (p<0.05). More bacteria were cleared as density increased; however, the proportion of colonies cleared, inversely decreased as density increased—the maximum being 100%, 96%, and 78% for 3×106, 5×106, and 7×106 CFU/mL cultures, respectively. Both wavelengths had similar effects on the s...

Wavelength and Bacterial Density Influence the Bactericidal Effect of Blue Light on Methicillin-Resistant Staphylococcus aureus (MRSA)

We sought to describe maternal satisfaction with childbirth among women planning either cesarean or vaginal birth. We enrolled primiparous women planning cesarean birth and a comparison group planning vaginal birth. After delivery, the maternal subjective experience was assessed with a visual analogue satisfaction scale and the Salmon questionnaire, with scale scores for these aspects of the maternal experience of birth: fulfillment, distress, and difficulty. The sample included 160 women planning vaginal birth and 44 women planning cesarean. Eight weeks postpartum, women planning cesarean reported higher satisfaction ratings ( P = 0.023), higher scores for fulfillment ( P = 0.017), lower scores for distress ( P = 0.010), and lower scores for difficulty ( P < 0.001). The least favorable scores were associated with unplanned cesarean ( N = 48). Women planning cesarean reported a more favorable birth experience than women planning vaginal birth, due in part to low satisfaction associated with unplanned cesarean. Maternal satisfaction with childbirth may be improved by efforts to reduce unplanned cesarean, but also by support for maternal-choice cesarean.

/pdf/mothers-satisfaction-with-planned-vaginal-and-planned-1lwld1vzii.pdf

Mothers' satisfaction with planned vaginal and planned cesarean birth.

Mothers satisfaction with planned vaginal and planned cesarean birth

A six-fold increase in pediatric MRSA infections, prompted us to examine the clinical profile of children with MRSA infections seen at Mercy Children's Hospital, Toledo, Ohio and to characterize the responsible strains. Records were reviewed of pediatric patients who cultured positive for MRSA from June 1 to December 31, 2007. Strain typing by pulsed field gel electrophoresis (PFT) and DiversiLab, SCCmec typing, and PCR-based lukSF-PV gene (encodes Panton-Valentine leukocidin), arginine catabolic mobile element (ACME) and cap5 gene detection was performed. Chart review of 63 patients with MRSA infections revealed that 58(92%) were community acquired MRSA (CAMRSA). All CAMRSA were skin and soft tissue infections (SSTI). Twenty five (43%) patients were aged < 3 yrs, 19(33%) aged 4-12 and 14(24%) aged 13-18. Nineteen (76%) of those aged < 3 yrs had higher incidence of perineal infections compared to only 2(11%) of the 4-12 yrs and none of the 13-18 yrs of age. Infections in the extremities were more common in the older youth compared to the youngest children. Overall, there was a significant association between site of the infection and age group (Fisher's Exact p-value < 0.001). All CAMRSA were USA300 PFT, clindamycin susceptible, SCCmec type IVa and lukSF-PV gene positive. Nearly all contained ACME and about 80% were cap5 positive. Of the 58 USA300 strains by PFT, 55(95%) were also identified as USA300 via the automated repetitive sequence-based PCR method from DiversiLab. CAMRSA SSTI of the perineum was significantly more common among toddlers and that of the extremities in older children. The infecting strains were all USA300 PFT. Further studies are needed to identify the unique virulence and colonization characteristics of USA300 strains in these infections.

/pdf/higher-incidence-of-perineal-community-acquired-mrsa-38uavrcnfz.pdf

Higher incidence of perineal community acquired MRSA infections among toddlers.

In certain health care settings, most notably in rehabilitation and palliative care, patients are expected and encouraged to articulate treatment goals and desired outcomes. In obstetrics, patients may voice their preferences via birth plans.1 Birth plans are currently used by women planning both vaginal and cesarean deliveries but have been most often discussed in the context of labor and vaginal delivery.

Maternal preferences are important considerations in the management of childbirth, and therefore caregivers should seek information about the values and expectations of obstetric patients. This is particularly important as obstetric providers grapple with an apparent increase in planned cesarean birth.2 Pregnant women strongly prefer a delivery that is safest for their babies and themselves.3 Studies indicate that some women widely perceive cesarean delivery to be as safe as or safer than vaginal birth.4–7 Indeed, some mothers request or agree to cesarean birth because of this belief.4 However, other than an expectation of a safe birth experience, very little is known about what women who request cesarean value regarding the birth experience. In particular, it is not known whether maternal goals for childbirth differ among women who anticipate cesarean versus vaginal birth.

We previously described maternal satisfaction with childbirth among women planning either cesarean or vaginal birth.8 In this study, we sought to describe maternal wishes, goals, and expectations for childbirth among women planning cesarean birth compared with a group of women planning vaginal birth. In contrast with other studies exploring women’s reasons for choosing primary cesarean,4–7 our focus was on goals for childbirth among women who had already selected cesarean as a mode of delivery. Our objectives were (1) to develop a framework for describing maternal goals for childbirth, (2) to contrast the goals articulated by women planning vaginal birth with those planning cesarean birth, (3) to investigate goal achievement in both groups, and (4) to investigate the relationship between goal achievement and satisfaction. To our knowledge, there are no current studies comparing maternal goals between planned vaginal and cesarean delivery. Our aim was to investigate whether choice of delivery route would be strongly associated with the type of goals expressed. We also investigated whether goal achievement would be associated with satisfaction with the birth experience in both groups.

/pdf/maternal-goals-for-childbirth-associated-with-planned-44iiosut7m.pdf

Alexis Mccullough

Papers

Mothers' satisfaction with planned vaginal and planned cesarean birth.

Mothers satisfaction with planned vaginal and planned cesarean birth

Higher incidence of perineal community acquired MRSA infections among toddlers.

Maternal goals for childbirth associated with planned vaginal and planned cesarean birth.