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Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Published online by Cambridge University Press:  10 May 2016

Caroline Landelle ,
Anne Iten ,
Ilker Uçkay ,
Hugo Sax ,
Véronique Camus ,
Gilles Cohen ,
Gesuele Renzi ,
Jacques Schrenzel ,
Didier Pittet  and
Arnaud Perrier
...Show all authors
Caroline Landelle
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Anne Iten
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland Division of General Internal Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Ilker Uçkay
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Hugo Sax
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Véronique Camus
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Gilles Cohen
Affiliation:
Division of Medico-Economic Analysis, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Gesuele Renzi
Affiliation:
Clinical Microbiology Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Jacques Schrenzel
Affiliation:
Clinical Microbiology Laboratory, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Didier Pittet
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Arnaud Perrier
Affiliation:
Division of General Internal Medicine, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
Stephan Harbarth*
Affiliation:
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
*
Infection Control Program, University of Geneva Hospitals and Medical School, 4 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland (stephan.harbarth@hcuge.ch)
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Abstract

Objective.

To test the hypothesis that methicillin-susceptible Staphylococcus aureus (MSSA) carriage may protect against nosocomial methicillin-resistant S. aureus (MRSA) acquisition by competing for colonization of the anterior nares.

Design.

Prospective cohort and nested case-control study.

Setting.

Swiss university hospital.

Patients.

All adult patients admitted to 14 wards of the general medicine division between April 1 and October 31, 2007.

Methods.

Patients were screened for MRSA and MSSA carriage at admission to and discharge from the division. Associations between nosocomial MRSA acquisition and MSSA colonization at admission and other confounders were analyzed by univariable and multivariable analysis.

Results.

Of 898 patients included, 183 (20%) were treated with antibiotics. Nosocomial MRSA acquisition occurred in 70 (8%) of the patients (case patients); 828 (92%) of the patients (control subjects) were free of MRSA colonization at discharge. MSSA carriage at admission was 20% and 21% for case patients and control subjects, respectively. After adjustment by multivariate logistic regression, no association was observed between MSSA colonization at admission and nosocomial MRSA acquisition (adjusted odds ratio [aOR], 1.2 [95% confidence interval (CI), 0.6–2.3]). By contrast, 4 independent predictors of nosocomial MRSA acquisition were identified: older age (aOR per 1-year increment, 1.05 [95% CI, 1.02–1.08]); increased length of stay (aOR per 1-day increment, 1.05 [95% CI, 1.02–1.09]); increased nursing workload index (aOR per 1-point increment, 1.02 [95% CI, 1.01–1.04]); and previous treatment with macrolides (aOR, 5.6 [95% CI, 1.8–17.7]).

Conclusions.

Endogenous MSSA colonization does not appear to protect against nosocomial MRSA acquisition in a population of medical patients without frequent antibiotic exposure.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 5 , May 2014 , pp. 527 - 533
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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Footnotes

a.

C.L. and A.I. contributed equally to this study.

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