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Post-discharge decolonization of patients harboring methicillin-resistant Staphylococcus aureus (MRSA) USA300 strains: secondary analysis of the CLEAR Trial
- Gabrielle M. Gussin, Lauren Heim, Thomas Tjoa, James A. McKinnell, Loren G. Miller, Daniel L. Gillen, Mohamad R.A. Sater, Yonatan H. Grad, Raveena D. Singh, Susan S. Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 44 / Issue 2 / February 2023
- Published online by Cambridge University Press:
- 16 December 2021, pp. 315-318
- Print publication:
- February 2023
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The CLEAR Trial recently found that decolonization reduced infections and hospitalizations in MRSA carriers in the year following hospital discharge. In this secondary analysis, we explored whether decolonization had a similar benefit in the subgroup of trial participants who harbored USA300, using two different definitions for the USA300 strain-type.
7 - Ageing, intellectual disability and desexualisation
- Edited by Paul Simpson, Edge Hill University, Ormskirk, Paul Reynolds, The Open University, Milton Keynes, Trish Hafford-Letchfield, University of Strathclyde
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- Book:
- Desexualisation in Later Life
- Published by:
- Bristol University Press
- Published online:
- 18 April 2023
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- 19 July 2021, pp 117-134
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Summary
Much of the conceptual architecture of the chapter on physical disability (Chapter 6) is relevant to this chapter on intellectual disabilities: intersectional subjectivities; the impairment/disability dichotomy; the social construction of disability; the heteronormative and genito-centric conception of sexual intimacy; the radicalism of crip/queer theorising; and the necessity of critical deconstructions of normative and normalising discourses that produce desexualising impacts upon disabled people. Similarly, there are important issues to explore at policy and interpersonal levels. The intersection of age and intellectual disability is composed by both the impact of ageing on forms of intellectual capacity – typically conditions such as Alzheimer's and other types of dementia – and people who have intellectual disabilities, for whom ageing might exacerbate or provide added complications – such as people with Trisomy 21 (colloquially Down's syndrome). Or put simply, intellectually disabled people growing old and older people growing into intellectual disability. Yet it would be a mistake to simply extend or map the conceptual framings and analysis of physical disabilities onto intellectual disabilities. There are important differences as well as similarities at the intersections of intellectual disabilities with sex and intimacy in later life.
Intellectual (as physical) disability and ageing both bring into question how human difference is categorised and understood according to conceptions of what is bodily or customarily normal. The notion of ‘normal’ dominates conventional understandings of ageing, disability and sex and intimacy, and is the discursive basis for the desexualisation of those people bearing these features. It is precisely the development of crip/queer critiques (and in this chapter, a neurodiverse equivalent), that has problematised and deconstructed these qualities and characteristics: dissembling reproduction; genito-centric and penetrative heteronormativities from sex and intimacy; dissembling ableism and the constitution of hierarchies of ability from disability; and dissembling life course developmental staging from age. This involves recognising that categories of distinctions are degrees of difference and not deficit, and the norm should not be morally and culturally privileged but recognised as a statistical measurement of population or an ideological construct that reflects power-knowledge relations and their deployment as orthodoxies to maintain a status quo (indicatively, Foucault, 1980, 2002).
6 - Ageing, physical disability and desexualisation
- Edited by Paul Simpson, Edge Hill University, Ormskirk, Paul Reynolds, The Open University, Milton Keynes, Trish Hafford-Letchfield, University of Strathclyde
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- Book:
- Desexualisation in Later Life
- Published by:
- Bristol University Press
- Published online:
- 18 April 2023
- Print publication:
- 19 July 2021, pp 95-116
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Summary
Older people experience their sexual and intimate relations as intersectional agents. Their relationships are influenced not simply by age itself, but by gender, ethnicity, sexuality, class and other identarian differences. It is not necessary to subscribe fully to the benefits of intersectionality as a theoretical paradigm to recognise the impact of difference on how older people enjoy or endure the process of ageing (for relevant summaries of intersectionality, see Hancock, 2016; Hill Collins, 2019; May, 2015; Taylor, Hines and Casey, 2011). These differences extend to the sexual and intimate constraints and limitations that constitute desexualisation. This is particularly the case with the intersection of age and physical disability, which becomes more significant as the body ages and its functionality tends to decline. While the rate and form of that decline is differentiated dependent on variables such as robust physical health, income and resources and access to healthcare, the general proposition holds. Bérubé (cited in Gallop, 2019, p 7), commenting on this convergence, sagely observes: ‘[that] many of us will become disabled if we live long enough is perhaps the fundamental aspect of human embodiment’. These changes are exacerbated by the shared cultural prejudices and pathologies that dominate common perceptions of older people and disability. These perceptions produce material physical and regulatory constraints alongside ideological orthodoxies and internalised discursive framings by which older people's sexual agency is diminished and subsumed beneath notions of ‘healthy’ and ‘normal’ sex and intimacy.
Both age and physical disability share common desexualising factors and impacts. Both are steeped in conventionally negative, normative characterisations of physical change across the life course, with changes measured by scientific-medical criteria with a culturally determined functional index. Bodily change or difference impacts on the capabilities and everyday experience of individuals but is considerably
more pronounced and compounded by social and cultural discursive representations. They both carry equivalent prejudices, pathologies and assumptions about sex and intimacy, and communicate subordinated positions within late capitalist modern societies, where the capacity to labour and physically participate in economic activity is privileged (indicatively, Campbell and Oliver, 1996; Phillipson, 1982).
Postdischarge Decolonization of Patients Harboring MRSA USA300 Strains: Secondary Analysis of the CLEAR Trial
- Gabrielle M. Gussin, Lauren Heim, Thomas Tjoa, Loren Miller, Daniel L. Gillen, Mohamad Sater, Yonatan H. Grad, Raveena D. Singh, Susan Huang
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s75-s76
- Print publication:
- October 2020
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Background: The Changing Lives by Eradicating Antibiotic Resistance (CLEAR) Trial was a trial of 2,121 recently discharged methicillin-resistant Staphylococcus aureus (MRSA) carriers randomized to MRSA education plus a 5-day decolonization regimen repeated twice monthly for the 6 months following discharge versus MRSA education alone. Decolonization resulted in a 30% reduction in MRSA infection and a 17% reduction in all-cause infection (Huang SS et al, NEJM, 2019) in the year following discharge. We pursued an evaluation of USA300 carriers to determine whether the decolonization benefit differed for this strain type. Methods: A secondary analysis of the CLEAR randomized controlled trial (RCT) was performed, limiting the cohort to participants known to harbor USA300 at or within 30 days of enrollment and who attended all follow-up visits in the year following discharge. Within this subset, we conducted a time-to-event analysis using unadjusted and adjusted Cox proportional-hazard models. Variables in adjusted analyses included demographic data, insurance type, presence of coexisting conditions or medical devices at enrollment, hospitalization or residence in a nursing home in the year before enrollment, receipt of anti-MRSA antibiotics, protocol adherence, and randomization strata. Results: USA300 was identified in 420 of the 783 participants who attended all visits and had strains genetically tested. MRSA infections occurred in 27 of 207 education group participants (0.149 per person year) and in 19 of 213 decolonization group participants (0.099 per-person year). Point estimates from the unadjusted hazard ratios of infection reduction were similar (0.59; 95% CI, 0.32–1.09) to the full trial population (0.61; 95% CI, 0.44–0.85), suggesting nondifferential benefit for the USA300 strain type. Adjusted models were highly similar. Conclusions: The reduction in MRSA infection associated with postdischarge decolonization in the subgroup of participants who harbored the USA300 strain-type was consistent with overall trial findings. Although the original trial was not powered for the evaluation of a USA300 subset, this RCT provides a valuable design for assessing the magnitude of strain-specific responsiveness to decolonization during a time when national rates of MRSA invasive disease have plateaued and USA300 is responsible for an increasing proportion of infections. These data suggest that postdischarge decolonization should be similarly effective in carriers of either USA300 or healthcare-associated MRSA strains.
Funding: None
Disclosure: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which antiseptic product is provided to participating hospitals and nursing homes. Mohamad Sater, Salary-Day Zero Diagnostics.