Hostname: page-component-8448b6f56d-c47g7 Total loading time: 0 Render date: 2024-04-16T20:56:45.360Z Has data issue: false hasContentIssue false
  • English
  • Français

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 ,
Anthony D. Harris ,
Mary-Claire Roghmann ,
J. Kristie Johnson ,
Min Zhan ,
Jessina C. McGregor  and
Jon P. Furuno
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)
Get access Rights & Permissions [Opens in a new window]

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
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 5 , May 2011 , pp. 481 - 489
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Bonten, MJ, Gaillard, CA, Johanson, WG Jr, et al. Colonization in patients receiving and not receiving topical antimicrobial prophylaxis. Am J Respir Crit Care Med 1994;150(5):1332–1340.CrossRefGoogle Scholar
2. Bonten, MJM, Slaughter, S, Ambergen, AW, et al. The role of “colonization pressure” in the spread of vancomycin-resistant enterococci: an important infection control variable. Arch Intern Med 1998;158(10):1127–1132.CrossRefGoogle ScholarPubMed
3. 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):362–386.CrossRefGoogle ScholarPubMed
4. McFarland, LV, Mulligan, ME, Kwok, RY, Stamm, WE. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 1989; 320(4):204–210.CrossRefGoogle ScholarPubMed
5. Bloemendaal, AL, Fluit, AC, Jansen, WMT, et al. Acquisition and cross-transmission of Staphylococcus aureus in European intensive care units. Infect Control Hosp Epidemiol 2009;30(2):117–124.CrossRefGoogle ScholarPubMed
6. Williams, VR, Callery, S, Vearncombe, M, Simor, AE. The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus . Am J Infect Control 2009;37(2): 106–110.CrossRefGoogle ScholarPubMed
7. Drees, M, Snydman, DR, Schmid, CH, et al. Prior environmental contamination increases the risk of acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2008;46(5):678–685.CrossRefGoogle ScholarPubMed
8. Dubberke, ER, Reske, KA, Yan, Y, Olsen, MA, McDonald, LC, Fraser, VJ. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis 2007;45(12):1543–1549.CrossRefGoogle Scholar
9. Dubberke, ER, Reske, KA, Olsen, MA, et al. Evaluation of Clostridium difficile-associated disease pressure as a risk factor for C. difficile–associated disease. Arch Intern Med 2007;167(10): 1092–1097.CrossRefGoogle ScholarPubMed
10. Lawrence, SJ, Puzniak, LA, Shadel, BN, Gillespie, KN, Kollef, MH, Mundy, LM. Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure. Infect Control Hosp Epidemiol 2007;28(2):123–130.CrossRefGoogle ScholarPubMed
11. Dancer, SJ, Coyne, M, Speekenbrink, A, Samavedam, S, Kennedy, J, Wallace, PG. MRSA acquisition in an intensive care unit. Am J Infect Control 2006;34(1):10–17.CrossRefGoogle Scholar
12. Cepeda, JA, Whitehouse, T, Cooper, B, et al. Isolation of patients in single rooms or cohorts to reduce spread of MRSA in intensive-care units: prospective two-centre study. Lancet 2005;365: 295–304.CrossRefGoogle ScholarPubMed
13. Lucet, J-C, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31(8):1051–1057.CrossRefGoogle ScholarPubMed
14. Winston, LG, Charlebois, ED, Pang, S, Bangsberg, DR, Perdreau-Remington, F, Chambers, HF III. Impact of a formulary switch from ticarcillin-clavulanate to piperacillin-tazobactam on colonization with vancomycin-resistant enterococci. Am J Infect Control 2004;32(8):462–469.CrossRefGoogle ScholarPubMed
15. Martinez, JA, Ruthazer, R, Hansjosten, K, Barefoot, L, Snydman, DR. Role of environmental contamination as a risk factor for acquisition of vancomycin-resistant enterococci in patients treated in a medical intensive care unit. Arch Intern Med 2003; 163(16):1905–1912.CrossRefGoogle Scholar
16. Ho, P-L, Hong Kong intensive care unit antimicrobial resistance study (HK-ICARE) Group. Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Crit Care Med 2003;31(4):1175–1182.CrossRefGoogle ScholarPubMed
17. Muller, AA, Mauny, F, Bertin, M, et al. Relationship between spread of methicillin-resistant Staphylococcus aureus and antimicrobial use in a French university hospital. Clin Infect Dis 2003;36(8):971–978.CrossRefGoogle Scholar
18. Srinivasan, A, Song, X, Ross, T, Merz, W, Brower, R, Perl, TM. A prospective study to determine whether cover gowns in addition to gloves decrease nosocomial transmission of vancomycin-resistant enterococci in an intensive care unit. Infect Control Hosp Epidemiol 2002;23(8):424–428.CrossRefGoogle Scholar
19. Puzniak, LA, Leet, T, Mayfield, J, Kollef, M, Mundy, LM. To gown or not to gown: the effect on acquisition of vancomycin-resistant enterococci. Clin Infect Dis 2002;35(1):18–25.CrossRefGoogle ScholarPubMed
20. Puzniak, LA, Mayfield, J, Leet, T, Kollef, M, Mundy, LM. Acquisition of vancomycin-resistant enterococci during scheduled antimicrobial rotation in an intensive care unit. Clin Infect Dis 2001;33(2):151–157.CrossRefGoogle Scholar
21. Merrer, J, Santoli, F, Appéré-De Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21 (11):718–723.CrossRefGoogle Scholar
22. Harris, AD, Kotetishvili, M, Shurland, S, et al. How important is patient-to-patient transmission in extended-spectrum ß-lacta-mase Escherichia coli acquisition. Am J Infect Control 2007;35(2): 97–101.CrossRefGoogle ScholarPubMed
23. Harris, AD, Perencevich, EN, Johnson, JK, et al. Patient-to-patient transmission is important in extended-spectrum β-lactamase-producing Klebsiella pneumoniae acquisition. Clin Infect Dis 2007;45(10):1347–1350.CrossRefGoogle ScholarPubMed
24. Cohen, AL, Calfee, D, Fridkin, SK, et al. Recommendations for metrics for multidrug-resistant organisms in healthcare settings: SHEA/HICPAC position paper. Infect Control Hosp Epidemiol 2008;29(10):901–913.CrossRefGoogle ScholarPubMed
25. McBryde, ES, Pettitt, AN, McElwain, DLS. A stochastic mathematical model of methicillin resistant Staphylococcus aureus transmission in an intensive care unit: predicting the impact of interventions. J Theor Biol 2007;245(3):470–481.CrossRefGoogle Scholar
26. Raboud, J, Saskin, R, Simor, A, et al. Modeling transmission of methicillin-resistant Staphylococcus aureus among patients admitted to a hospital. Infect Control Hosp Epidemiol 2005;26(7): 607–615.CrossRefGoogle ScholarPubMed
27. Forrester, M, Pettitt, AN. Use of stochastic epidemic modeling to quantify transmission rates of colonization with methicillin-resistant Staphylococcus aureus in an intensive care unit. Infect Control Hosp Epidemiol 2005;26(7):598–606.CrossRefGoogle Scholar