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Carriage of Methicillin-Resistant Staphylococcus Aureus at Hospital Admission

  • Nicolas Troillet (a1), Yehuda Carmeli (a1), Matthew H. Samore (a1), Joanna Dakos (a2), Karen Eichelberger (a2), Paola C. DeGirolami (a2) and Adolf W. Karchmer (a1)...

Abstract

Objectives:

To measure the prevalence of, and to establish predictors for, the nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission. To evaluate mannitol-salt agar with oxacillin for the simultaneous detection and identification of MRSA from nasal swabs.

Design:

Three-month prospective case-control survey, with data collected from interviews and computerized databases. The criterion standard for MRSA detection was culture on Mueller-Hinton agar with oxacillin 6 μg/mL (National Committee for Clinical Laboratory Standards method).

Setting:

320-bed tertiary-care hospital.

Patients:

387 patients screened within 24 hours after admission, including 10 MRSA carriers (cases), 291 patients with no S aureus, and 86 patients with methicillin-susceptible S aureus.

Results:

The prevalence of MRSA nasal carriage was 2.6%, whereas the prevalence of carriage was 3.1% when both nasal and wound cultures were performed. The significant predictors of carriage were a prior detection of MRSA, open wounds, diabetes mellitus, treatments by injection, prior nursing home stays, visits at home by a nurse, and prior antibiotic treatments. Cases had stayed for longer periods in hospitals and had received longer antibiotic treatments within a year. Eighty patients (including the 10 cases) had diabetes, had been exposed to healthcare facilities within a year, and had antibiotics within 6 months. The sensitivity and negative predictive value of nasal swabs on mannitol-salt agar with oxacillin were 60% and 71%, respectively.

Conclusion:

MRSA carriage on admission to the hospital may be an increasing and underestimated problem. Further studies are needed to develop and validate a sensitive and specific prediction rule.

Copyright

Corresponding author

Division of Infectious Diseases, Central Institute of the Valais Hospitals, 86 Avenue Grand-Champsec, CH-1951 Sion, Switzerland

References

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1.Benner, EJ, Kayser, FH. Growing clinical significance of methi-cillin-resistant Staphylococcus aureus. Lancet 1968;ii:741ߝ744.
2.Barret, FE, McGehe, RF Jr, Finland, M. Methicillin-resistant Staphylococcus aureus at Boston City Hospital: bacteriologic and epidemiologic observations. N Engl J Med 1968;279:441ߝ448.
3.Panlilio, AL, Culver, DH, Gaynes, RP, Banerjee, S, Henderson, TS, Tolson, JS, et al. Methicillin-resistant Staphylococcus aureus in US hospitals, 1975-1991. Infect Control Hosp Epidemiol 1992;13:582ߝ586.
4.Voss, A, Milatovic, D, Wallrauch-Schwartz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13:50ߝ55.
5.Riley, TV, Pearman, JW, Rouse, IL. Changing epidemiology of methicillin-resistant Staphylococcus aureus in Western Australia. Med J Aust 1995;163:412ߝ414.
6.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313ߝ328.
7.Saravolatz, LD, Markowitz, N, Arking, L, Pohold, D, Fisher, E. Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:11ߝ16.
8.Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309ߝ317.
9.Rosenberg, J. Methicillin-resistant Staphylococcus aureus (MRSA) in the community: who's watching? Lancet 1995;346:132ߝ133.
10.Embil, J, Ramotar, K, Romance, L, Alfa, M, Conly, J, Cronk, S, et al. Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies, 1990-1992. Infect Control Hosp Epidemiol 1994;15:646ߝ651.
11.Lugeon, C, Blanc, DS, Wenger, A, Francioli, P. Molecular epidemioloy of methicillin-resistant Staphylococcus aureus at a low-incidence hospital over a four-year period. Infect Control Hosp Epidemiol 1995;16:220ߝ267.
12.Layton, MC, Hierholzer, WJ, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:12ߝ17.
13.Lally, RT, Ederer, MN, Woolfrey, BF. Evaluation of mannitol salt agar with oxacillin as a screening medium for methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1985;22:501ߝ504.
14.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. 2nd ed. Approved standard M7-A2. Villanova, PA: National Committee for Clinical Laboratory Standards; 1990.
15.Charlson, ME, Pompei, P, Ales, KL, McKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373ߝ383.
16.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistance Staphylococcus aureus. Clin Infect Dis 1994;19:1123ߝ1128.
17.Cookson, B, Peters, B, Webster, M, Phillips, I, Rahman, M, Noble, W. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1989;27:1471ߝ1476.
18.Maslow, JN, Brecher, S, Gunn, J, Durbin, A, Barlow, MA, Arbeit, RD. Variation and persistence of methicillin-resistant Staphylococcus aureus strains among individual patients over extended periods of time. Eur J Clin Microbiol Infect Dis 1995;14:282ߝ290.
19.Walsh, TJ, Vlahov, D, Hansen, SL, Sonnenberg, E, Khabbaz, R, Gadacz, T, et al. Prospective microbiologic surveillance in control of nosocomial methicillin-resistant Staphylococcus aureus. Infect Control 1987;8:7ߝ14.
20.Decker, MD, Schaffner, W. The relationship between the hospital and the community. In: Bennett, JV, Brackman, PS, eds. Hospital Infections. 3rd ed. Boston, MA: Little, Brown and Co; 1992:221ߝ230.
21.Berman, DS, Eisner, W, Kreiswirth, B. Community-acquired methicillin-resistant Staphylococcus aureus infection. New Engl J Med 1993;329:1896.
22.Hollis, RJ, Barr, JL, Doebbeling, BN, Pfaller, MA, Wenzel, RP. Familial carriage of methicillin-resistant Staphylococcus aureus and subsequent infection in a premature neonate. Clin Infect Dis 1995;21:328ߝ332.

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