Skip to main content Accessibility help
×
Home

The Epidemiology of Methicillin-Resistant Staphylococcus aureus on a Burn Trauma Unit

  • Marin Schweizer (a1) (a2), Melissa Ward (a1), Sandra Cobb (a1), Jennifer McDanel (a2) (a3), Laurie Leder (a1), Lucy Wibbenmeyer (a4), Barbara Latenser (a4), Daniel Diekema (a1) (a3) (a5) and Loreen Herwaldt (a1) (a2) (a5)...

Abstract

Objective.

We assessed the frequency and relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients.

Design.

Prospective cohort study and surveillance for MRSA carriage.

Setting.

BTU of a Midwestern academic medical center.

Patients and Participants.

Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period.

Methods.

Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers' nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis.

Results.

Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25–24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64–35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93–79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment.

Conclusions.

Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.

Copyright

Corresponding author

601 Highway 6 West (152), Iowa City, IA 52246 (marin-schweizer@uiowa.edu)

References

Hide All
1.Barlow, Y. T lymphocytes and immunosuppression in the burned patient: a review. Burns 1994;20(6):487490.
2.Andrade, C, Champagne, S, Caruso, D, Foster, K, Reynolds, K. Methicillin-resistant Staphylococcus aureus: an assessment of environmental contamination in a burn center. Am J Infect Control 2009;37(6):515517.
3.Cook, N. Methicillin-resistant Staphylococcus aureus versus the burn patient. Burns 1998;24(2):9198.
4.Boyce, JM, White, RL, Causey, WA, Lockwood, WR. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA 1983;249(20):28032807.
5.Taylor, GD, Kibsey, P, Kirkland, T, Burroughs, E, Tredget, E. Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit. Burns 1992(4):332335.
6.Appelgren, P, Bjornhagen, V, Bragderyd, K, Jonsson, CE, Ransjo, U. A prospective study of infections in burn patients. Burns 2002;(1):3946.
7.Wibbenmeyer, L, Williams, I, Ward, M, et al.Risk factors for acquiring vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on a burn surgery step-down unit. J Burn Care Res 2010;31(2):269279.
8.Ressner, RA, Murray, CK, Griffith, ME, Rasnake, MS, Hospenthal, DR, Wolf, SE. Outcomes of bacteremia in burn patients involved in combat operations overseas. J Am Coll Surg 2008;206(3):439444.
9.Mayhall, CG. The epidemiology of burn wound infections: then and now. Clin Infect Dis 2003;37(4):543550.
10.Kooistra-Smid, M, Nieuwenhuis, M, van Belkum, A, Verbrugh, H. The role of nasal carriage in Staphylococcus aureus burn wound colonization. FEMS Immunol Med Microbiol 2009;57(1):113.
11.Kooistra-Smid, AM, van Zanten, E, Ott, A, et al.Prevention of Staphylococcus aureus burn wound colonization by nasal mupirocin. Burns 2008;34(6):835839.
12.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362386.
13.Wibbenmeyer, L, Appelgate, D, Williams, I, et al.Effectiveness of universal screening for vancomycin-resistant Enterococcus and methicillin-resistant Staphylococcus aureus on admission to a burn-trauma step-down unit. J Burn Care Res 2009;(4):648656.
14.Dancer, SJ. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8(2):101113.
15.Datta, R, Piatt, R, Yokoe, DS, Huang, SS. Environmental cleaning intervention and risk of acquiring multidrug-resistant organisms from prior room occupants. Arch Intern Med 2011;171(6):491494.
16.Kaiser, ML, Thompson, DJ, Malinoski, D, Lane, C, Cinat, ME. Epidemiology and risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus among burn patients. J Burn Care Res 2011;32(3):429434.
17.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10Suppl 2):S165S193.
18.Sigurdardottir, B, Berg, JV, Hu, J, et al.Descriptive epidemiology and case-control study of patients colonized with vancomycin-resistant enterococcus and methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2006;27(9):913919.
19.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al.Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330338.
20.Wibbenmeyer, L, Danks, R, Faucher, L, et al.Prospective analysis of nosocomial infection rates, antibiotic use, and patterns of resistance in a burn population. J Burn Care Res 2006;27(2):152160.
21.Flayhart, D, Hindler, JF, Bruckner, DA, et al.Multicenter evaluation of BBL CHROMagar MRSA medium for direct detection of methicillin-resistant Staphylococcus aureus from surveillance cultures of the anterior nares. J Clin Microbiol 2005;43(11):55365540.
22.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing—Nineteenth Informational Supplement. Wayne, PA: CLSI; 2008. CLSI document M100-S19.
23.Pfaller, MA, Hollis, RJ, Sader, HS. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Washington, DC: American Society for Microbiology, 1994:10.5.c.110.5.c.12.
24.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41(11):51135120.
25.Wibbenmeyer, LA, Kealey, GP, Latenser, BA, et al.Emergence of the USA300 strain of methicillin-resistant Staphylococcus aureus in a burn-trauma unit. J Burn Care Res 2008;29(5):790797.
26.Dansby, W, Purdue, G, Hunt, J, et al.Aerosolization of methicillin-resistant Staphylococcus aureus during an epidemic in a burn intensive care unit. J Burn Care Res 2008;29(2):331337.
27.Carling, PC, Parry, MF, Bruno-Murtha, LA, Dick, B. Improving environmental hygiene in 27 intensive care units to decrease multidrug-resistant bacterial transmission. Crit Care Med. 2010;38(4):10541059.
28.Kooistra-Smid, M, van Dijk, S, Beerthuizen, G, et al.Molecular epidemiology of Staphylococcus aureus colonization in a burn center. Burns 2004;30(1):2733.
29.Mermel, LA, Cartony, JM, Covington, P, Maxey, G, Morse, D. Methicillin-resistant Staphylococcus aureus colonization at different body sites: a prospective, quantitative analysis. J Clin Microbiol 2011;49(3):11191121.
30.Marshall, C, Spelman, D. Re: is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive care unit? J Clin Microbiol 2007;45(11):3855.
31.Reighard, A, Diekema, D, Wibbenmeyer, L, Ward, M, Herwaldt, L. Staphylococcus aureus nasal colonization and colonization or infection at other body sites in patients on a burn trauma unit. Infect Control Hosp Epidemiol 2009;30(8):721726.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed