Skip to main content Accessibility help
×
Home

Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

  • Pritish K. Tosh (a1) (a2) (a3), Simon Agolory (a1) (a4), Bethany L. Strong (a2) (a5), Kerrie VerLee (a6) (a7), Jennie Finks (a6), Kayoko Hayakawa (a8), Teena Chopra (a8), Keith S. Kaye (a8), Nicholas Gilpin (a9), Christopher F. Carpenter (a9), Nadia Z. Haque (a10), Lois E. Lamarato (a11), Marcus J. Zervos (a10), Valerie S. Albrecht (a2), Sigrid K. McAllister (a2), Brandi Limbago (a2), Duncan R. MacCannell (a2), Linda K. McDougal (a2), Alexander J. Kallen (a2) and Alice Y. Guh (a2)...

Abstract

Background.

Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.

Objective.

Identify the prevalence of VRSA precursor organisms.

Design.

Prospective cohort with embedded case-control study.

Participants.

Southeastern Michigan adults with chronic lower-extremity wounds.

Methods.

Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).

Results.

Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.

Conclusions.

Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.

Copyright

Corresponding author

Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55901 (tosh.pritish@mayo.edu)

References

Hide All
1.Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin-United States, 2002. MMWR Morb Mortal Wkly Rep 2002;51:565567.
2.Sievert, DM, Rudrik, JT, Patel, JB, McDonald, LC, Wilkins, MJ, Hageman, JC. Vancomycin-resistant Staphylococcus aureus in the United States, 2002-2006. Clin Infect Dis 2008;46:668674.
3.Centers for Disease Control and Prevention. CDC reminds clinical laboratories and healthcare infection preventionists of their role in the search and containment of vancomycin-resistant Staphylococcus aureus (VRSA). http://www.cdc.gov/HAI/settings/lab/vrsa_lab_search_containment.html. Accessed June 21, 2012.
4.de Niederhausern, S, Bondi, M, Messi, P, et al. Vancomycin-resistance transferability from VanA enterococci to Staphylococcus aureus. Curr Microbiol 2011;62:13631367.
5.Zhu, W, Murray, PR, Huskins, WC, et al.Dissemination of an enterococcus Incl8-like van A plasmid associated with vancomycin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2010;54:43144320.
6.McDougal, LK, Fosheim, GE, Nicholson, A, et al.Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus isolates causing invasive disease in the United States. Antimicrob Agents Chemother 2010;54:38043811.
7.Zhu, W, Clark, NC, McDougal, LK, Hageman, J, McDonald, LC, Patel, JB. Vancomycin-resistant Staphylococcus aureus isolates associated with Incl8-like vanA plasmids in Michigan. Antimicrob Agents Chemother 2008;52:452457.
8.Zhu, W, Clark, NC, Patel, JB. pSK41-like plasmid is necessary for Incl8-like vanA plasmid transfer from Enterococcus faecalis to Staphylococcus aureus in vitro. Antimicrob Agents Chemother 2012;57:212219.
9.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus-Pennsylvania, 2002. MMWR Morb Mortal Wkiy Rep 2002;51:902.
10.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus-New York, 2004. MMWR Morb Mortal Wkly Rep 2004;53:322323.
11.Finks, J, Wells, E, Dyke, TL, et al.Vancomycin-resistant Staphylococcus aureus, Michigan, USA, 2007. Emerg Infect Dis 2009;15: 943945.
12.Tenover, FC, Weigel, LM, Appelbaum, PC, et al.Vancomycinresistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob Agents Chemother 2004;48:275280.
13.Harmsen, D, Claus, H, Witte, W, Rothganger, J, Turnwald, D, Vogel, U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003; 41:54425448.
14.Limbago, B, Fosheim, GE, Schoonover, V, et al.Characterization of methicillin-resistant Staphylococcus aureus isolates collected in 2005 and 2006 from patients with invasive disease: a population-based analysis. J Clin Microbiol 2009;47:13441351.
15.Katz, S, Downs, TD, Cash, HR, Grotz, RC. Progress in development of the index of ADL. Gerontologist 1970;10:2030.
16.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.
17.Flannery, EL, Wang, L, Zollner, S, Foxman, B, Mobley, HL, Mody, L. Wounds, functional disability, and indwelling devices are associated with cocolonization by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in southeast Michigan. Clin Infect Dis 2011;53:12151222.
18.Mermel, LA, Eells, SJ, Acharya, MK, et al.Quantitative analysis and molecular fingerprinting of methicillin-resistant Staphylococcus aureus nasal colonization in different patient populations: a prospective, multicenter study. Infect Control Hosp Epidemiol 2010;31:592597.
19.Scanvic, A, Denk, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:13931398.
20.Weigel, LM, Donlan, RM, Shin, DH, et al.High-level vancomycin-resistant Staphylococcus aureus isolates associated with a polymicrobial biofilm. Antimicrob Agents Chemother 2007;51:231238.

Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

  • Pritish K. Tosh (a1) (a2) (a3), Simon Agolory (a1) (a4), Bethany L. Strong (a2) (a5), Kerrie VerLee (a6) (a7), Jennie Finks (a6), Kayoko Hayakawa (a8), Teena Chopra (a8), Keith S. Kaye (a8), Nicholas Gilpin (a9), Christopher F. Carpenter (a9), Nadia Z. Haque (a10), Lois E. Lamarato (a11), Marcus J. Zervos (a10), Valerie S. Albrecht (a2), Sigrid K. McAllister (a2), Brandi Limbago (a2), Duncan R. MacCannell (a2), Linda K. McDougal (a2), Alexander J. Kallen (a2) and Alice Y. Guh (a2)...

Metrics

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