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Quantitative Analysis and Molecular Fingerprinting of Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Different Patient Populations: A Prospective, Multicenter Study

Published online by Cambridge University Press:  02 January 2015

L. A. Mermel
Affiliation:
Warren Alpert Medical School of Brown University, Providence, Rhode, Island Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode, Island
S. J. Eells
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
M. K. Acharya
Affiliation:
Outcomes Research International, Hudson, Florida
J. M. Cartony
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
D. Dacus
Affiliation:
Life Care Home Health Services, Delray Beach, Florida
S. Fadem
Affiliation:
Outcomes Research International, Hudson, Florida
E. A. Gay
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
S. Gordon
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
J. R. Lonks
Affiliation:
Warren Alpert Medical School of Brown University, Providence, Rhode, Island Division of Infectious Diseases, Miriam Hospital, Providence, Rhode Island
T. M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
L. K. McDougal
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
J. E. McGowan
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
G. Maxey
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
D. Morse
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
F. C. Tenover
Affiliation:
Cepheid, Sunnyvale, California
Corresponding
E-mail address:

Extract

Objectives.

To better understand the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in different patient populations, to perform quantitative analysis of MRSA in nasal cultures, and to characterize strains using molecular fingerprinting.

Design.

Prospective, multicenter study.

Setting.

Eleven different inpatient and outpatient healthcare facilities.

Participants.

MRSA-positive inpatients identified in an active surveillance program; inpatients and outpatients receiving hemodialysis; inpatients and outpatients with human immunodeficiency virus (HIV) infection; patients requiring cardiac surgery; and elderly patients requiring long-term care.

Methods.

Nasal swab samples were obtained from January 23, 2006, through July 27, 2007; MRSA strains were quantified and characterized by molecular fingerprinting.

Results.

A total of 444 nares swab specimens yielded MRSA (geometric mean quantity, 794 CFU per swab; range, 3-15,000,000 CFU per swab). MRSA prevalence was 20% for elderly residents of long-term care facilities (25 of 125 residents), 16% for HIV-infected outpatients (78 of 494 outpatients), 15% for outpatients receiving hemodialysis (31 of 208 outpatients), 14% for inpatients receiving hemodialysis (86 of 623 inpatients), 3% for HIV-infected inpatients (5 of 161 inpatients), and 3% for inpatients requiring cardiac surgery (6 of 199 inpatients). The highest geometric mean quantity of MRSA was for inpatients requiring cardiac surgery (11,500 CFU per swab). An association was found between HIV infection and colonization with the USA300 or USA500 strain of MRSA (P ≤ .001). The Brazilian clone was found for the first time in the United States. Pulsed-field gel electrophoresis patterns for 11 isolates were not compatible with known USA types or clones.

Conclusion.

Nasal swab specimens positive for MRSA had a geometric mean quantity of 794 CFU per swab, with great diversity in the quantity of MRSA at this anatomic site. Outpatient populations at high risk for MRSA carriage were elderly residents of long-term care facilities, HIV-infected outpatients, and outpatients receiving hemodialysis.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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Quantitative Analysis and Molecular Fingerprinting of Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Different Patient Populations: A Prospective, Multicenter Study
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