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Systematic Review of Measurement and Adjustment for Colonization Pressure in Studies of Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci, and Clostridium difficile Acquisition

Published online by Cambridge University Press:  02 January 2015

Adebola O. Ajao*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Veterans' Affairs Maryland Health Care System, Baltimore, Maryland
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland Veterans' Affairs Maryland Health Care System, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Min Zhan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Jessina C. McGregor
Affiliation:
College of Pharmacy, Oregon State University/Oregon Health Sciences University, Portland, Oregon
Jon P. Furuno
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
*
University of Maryland School of Medicine, Department of Epidemiology and Public Health, 685 West Baltimore Street, MSTF Room 360 Baltimore, MD, 21201 (aajao@epi.umaryland.edu)

Abstract

Objective.

Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile.

Methods.

We performed a computerized search of studies of nosocomial MRSA, VRE, and C. difficile acquisition published before July 1, 2009, through MEDLINE. Studies were included if a study outcome was MRSA, VRE, or C. difficile acquisition; the authors identified risk factors associated with MRSA, VRE, or C. difficile acquisition; and the study measured colonization pressure.

Results.

The initial MEDLINE search yielded 505 articles. Sixty-six of these were identified as studies of nosocomial MRSA, VRE, or C. difficile acquisition; of these, 18 (27%) measured colonization pressure and were included in the final review. The definition of colonization pressure varied considerably between studies: the proportion of MRSA- or VRE-positive patients (5 studies), the proportion of MRSA- or VRE-positive patient-days (6 studies), or the total or mean number of MRSA-, VRE-, or C. difficile-positive patients or patient-days (7 studies) in the unit over periods of varying length. In 10 of 13 studies, colonization pressure was independently associated with MRSA, VRE, or C. difficile acquisition.

Conclusion.

There is a need for a simple and consistent method to quantify colonization pressure in both research and routine clinical care to accurately assess the effect of colonization pressure on cross-transmission of antibiotic-resistant bacteria.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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Systematic Review of Measurement and Adjustment for Colonization Pressure in Studies of Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci, and Clostridium difficile Acquisition
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