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Ali Rabaan - saudi aramco medical services

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  • NICE SIR
    WELL ORGANIZED
    INFORMATIVE
    THANKS MASALAAM
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  • Faire le lien entre biothreat et méthodes moléculaires pour introduire le bénéfice de la sample prep intégrée ds GX
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  • Includes reagents for the detection of MRSA as well as quality controls.
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  • Transcript

    • 1. Molecular Detection of MRSA and its Impact on Infection Control Dr. Ali Rabaan, M.Med.Sci, PhD. Head of Molecular Microbiology Laboratory Saudi Aramco Medical Services Organization
    • 2. Outlines
      • History of MRSA and Antibiotics.
      • Why We Worried About It.
      • Prevalence.
      • Transmission.
      • Factors Enhance the Emergence and Transmission.
      • Impact of Molecular Testing on Infection Control.
      • Molecular Testing of MRSA.
    • 3. Staphylococcus aureus
      • Gram positive cocci.
      • Arranged in a grape-like structure.
      Lowy. N Engl J Med . 1998;339:520-532 .
    • 4.  
    • 5. Why We Are Worried
      • Greater morbidity and mortality.
      • Hospitalization and supportive care.
      • Increased use of:
        • Laboratory and diagnostic tests.
        • Infection control procedures.
        • Housekeeping procedures.
        • More expensive antimicrobials
        • (Very limited choices).
        • Length of hospital stay (9 days).
      • Rubinstein and Zhanel. Lancet Infect Dis 2007.
      • Lynch and Zhanel. Sem Resp Crit Care Med 2005.
    • 6. www.thelancet.com Vol 367 Month xx, 2006
    • 7. Prevalence of MRSA in Saudi Arabia
      • Prevalence is unknown, and varies geographically.
      • In Jeddah, the prevalence increased from 2% in 1988 to 33% in 1998 (T. Madni et al, 2001).
      • Another study in Jeddah, MRSA comprised 7.5%/year of all S. aureus (T. Austin et al, 1994).
      • In Riyadh, the prevalence ranged from 12 to 49.4% in six major hospitals (Baddour et al, 2006).
    • 8. Prevalence of MRSA infection in Saudi Aramco
      • A study conducted from 1999 to 2003 (J. Al-Tawfiq, 2006).
      • A total of 5162 S. aureus isolates.
      • MRSA constitutes 6% (308) of all isolates.
      • Currently ~15%.
    • 9. Who Gets MRSA Anyone can get MRSA!
    • 10.  
    • 11. MRSA Colonization sites
      • Nose/throat.
      • Axilla.
      • Groin.
      • Wounds.
      • IV access sites.
      • Urinary catheter exit sites.
    • 12. Transmission
      • Direct person to person contact.
      • Sharing of towels or personal hygiene items.
      • Athletic equipment.
      • Clothes.
      • Drug use equipment.
      • Contact sports.
      • Food-borne.
    • 13. Factors that Facilitate Transmission Contaminated Surfaces and Shared Items Cleanliness Crowding Compromised Skin Antimicrobial Use Defense Offense Frequent Contact
    • 14. Practice of HCW Hospital of Saint Raphael, New Haven, CT http://www.handhygiene.org/
    • 15.  
    • 16.
      • A male infant suffering Pierre Robin syndrome. He was intubated and mechanically ventilated 4 days after birth. Because of respiratory insufficiency. A suspected respiratory tract infection (amoxicillin/clavulanic acid).
      • Became bacteraemic after 3 days (amoxicillin and cefotaxime).
      • Blood culture grew methicillin-susceptible S. aureus (MSSA) (flucloxacillin).
      • He seemed to recover, but amoxicillin/clavulanic acid was reinstated for 10 more days on day 32 after the respiratory tract infection had recurred.
    • 17. MRSA screening Options
      • Microbiology culture.
      • Molecular Testing.
    • 18. Microbiology Culture
      • Gold standard: sensitive but slow.
      • 48 hr broth enrichment.
      • Dedicated skilled lab personnel.
      • Confirm identification and resistance
      • patterns of multiple colonies.
      • Restricted to lab opening hours.
      • Report final results in 48 - 120 hours (5 days). Good solution if it is not urgent (e.g. elective surgery/planned hospital stay).
    • 19. Why Utilize Molecular Testing
    • 20. infection control and hospital epidemiology April 2010, vol. 31, no. 4
    • 21.  
    • 22.  
    • 23.  
    • 24.  
    • 25. PAGE | Conventional PCR/ 1 st generation rt-PCR
      • Test-to-result time theoretically rapid  5h
      • Labor-intensive
      • Dedicated skilled personnel
      • Several separated lab rooms
      • Batch-testing required for cost-efficiency
      • Average time-to-report 36 h (24-72)
      Raw Sample Prep 2 - 4 hours PCR Amplification 1.5 - 2.5 hours Fluorescence Detection 1 - 2 hours
    • 26. Molecular testing
      • Cepheid GeneXpert ® MRSA.
      • Continuous and individual patient random access.
      • Fully automated.
      • All testing processes - sample preparation, real-time PCR amplification and detection - are performed in a closed single testing cartridge.
      • Individual patient results in 56 minutes.
      • Very easy to implement.
      • Can be performed “near-patient”.
    • 27. Handling 56 minutes maximum
    • 28. In House MRSA Validation Study
      • Analytical sensitivity (lower limit of detection) is 80 CFU/swab.
      • Analytical specificity showed No cross-reactivity with other microorganisms and it cab be detected in mixed population.
      • Comparative study included 51 clinical and volunteer samples. All results are correlated with Microbiology results.
    • 29. Why we introduce GeneXpert MRSA in Saudi Aramco
      • To reduce the turn around time (TAT) of MRSA result.
      • To release the results within 120 minutes and our target is at least 90%.
    • 30. Monitoring of Rapid MRSA Molecular assay results in Saudi Aramco
      • A total of 1071 samples processed from October 15, 2008 to April 19, 2009. MRSA comprised (64) 6.4%
      • Analysis of data obtain from laboratory information system (LIS) showed the following:
      • A total of 250 specimens were processed from Jan to Feb, 2009.
      • Nursing department 21% delay.
      • Lab triage section 17% delay.
      • From receiving to resulting 77% delay.
      • From ordering to resulting 77% delay.
      • Samples processed by techs 44-100% delay.
    • 31. Time allocation for MRSA Sample Processing
      • 1. Nursing department =10 minutes.
      • 2. Lab triage section =10 minutes.
      • 3. Molecular or Microbiology lab =100 minutes.
    • 32. Monitoring of Rapid MRSA Molecular assay in Saudi Aramco Month # of specimens % results within 2 hours % of results beyond 2 hours Jan-Feb 09 250 23 77 March 09 195 53 47 April 09 161 75 25 May 09 164 69 31
    • 33. Limitations of the assay
      • Increasingly, several reports about presence of SCC WITHOUT mecA
      • MRSA SCCmec True positive
      • S. aureus False positive
      orfX mecA orfX SCC orfX mecA
    • 34.  
    • 35. Old versus New Kit Old kit % old kit New Kit % New Kit Negative 552 78 453 71 Positive 134 19 50 8 Error 11 1.5 17 2.7 Invalid 2 0.3 61 9.6 No result 7 1 6 1 Total 706 634
    • 36. Limitations
      • Mutations or polymorphisms in primer or probe binding regions may affect detection of new or unknown MRSA variants resulting in a false negative result.
      • Blood or mucus or both have been shown to cause inhibition in 4.2% of nasal swab specimens.
      • A positive test result does not necessarily indicate the presence of viable organism.
      • Therapeutic success or failure cannot be assessed using this test because DNA might persist following antimicrobial therapy.
      orfX mecA
    • 37.  
    • 38. Summary
      • MRSA is a global health problem.
      • MRSA is transmitted easily between patients and HCWs and vice versa.
      • Rapid molecular assay helps very effectively in infection control.
    • 39.  
    • 40.  
    • 41.
      • Thank you