Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-p4zth Total loading time: 0.228 Render date: 2021-07-28T01:09:31.217Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients

Published online by Cambridge University Press:  21 June 2016

Nina Singh
Affiliation:
Division of Infectious Diseases, Department of Medicine, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Cheryl Squier
Affiliation:
Division of Infectious Diseases, Department of Medicine, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Cheryl Wannstedt
Affiliation:
Division of Transplant Surgery, Department of Surgery, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Lois Keyes
Affiliation:
Division of Transplant Surgery, Department of Surgery, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Division of Infectious Diseases, Department of Medicine, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Thomas V. Cacciarelli
Affiliation:
Division of Transplant Surgery, Department of Surgery, Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
Corresponding
E-mail address:

Abstract

Background.

Methicillin-resistant Staphylococcus aureus has emerged as a leading pathogen in transplant recipients and has become endemic in many institutions where transplantation is performed. The role of active surveillance programs based on the detection of colonization in the prevention of S. aureus infection in liver transplant recipients has not been defined.

Methods.

A total of 47 consecutive patients who underwent liver transplantation during 1996-1999 were compared with 97 patients who received a liver transplant during 2000-2004 after implementation of an intensive intervention program that included use of surveillance cultures to detect nasal and rectal colonization, use of cohorting and contact isolation precautions, and decolonization with intranasal mupirocin therapy.

Results.

The rate of new acquisition of S. aureus colonization of nares after transplantation decreased from 45.6% (21 of 46 patients) during the preintervention period to 9.9% (9 of 91 patients) during the postintervention period (P< .001). An increased length of hospital stay (odds ratio, 1.03; 95% confidence interval, 1.01-1.05; P < .002) was associated with new carriage acquisition, and transplantation during the postintervention period (odds ratio, 0.21; 95% confidence interval, 0.08-0.51; P<.001) was independently protective against new carriage. The rate of infection due to S. aureus decreased from 40.4% (19 of 47 patients) during the preintervention period to 4.1% (4 of 97 patients) during the postintervention period (P<.001), and the rate of bacteremia decreased from 25.5% (12 of 47 patients) to 4.1% (4 of 97 patients), respectively (P< .001). Overall, S. aureus infections occurred more frequently among patients with new carriage than among patients who were carriers at the time of transplantation (P< .001) or patients who were noncarriers (P< .001).

Conclusions.

Use of active surveillance cultures to detect colonization and implementation of targeted infection control interventions proved to be effective in curtailing new acquisition of S. aureus colonization and in decreasing the rate of S. aureus infection that was endemic in our population of liver transplant recipients.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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.Desai, D, Desai, N, Nightingale, P, Elliott, T, Neuberger, J. Carriage of methicillin-resistant Staphylococcus aureus is associated with an increased risk of infection after liver transplantation. Liver Transpl 2003; 9:754759.CrossRefGoogle ScholarPubMed
2.Bert, F, Galdbart, JO, Zarrouk, V, et al. Staphylococcus aureus nasal colonization and infection in liver transplant recipients. Clin Infect Dis 2000; 31:12951299.CrossRefGoogle Scholar
3.Singh, N, Gayowski, T, Wagener, M, Yu, VL. Infectious complications in liver recipients on tacrolimus: prospective analysis of 88 consecutive liver transplants. Transplantation 1994; 58:774778.CrossRefGoogle ScholarPubMed
4.Torre-Cisneros, J, Herrero, C, Canas, E, Reguera, JM, De La Mata, M, Gomez-Bravo, MA. High mortality related with Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 2002; 21:385388.Google ScholarPubMed
5.Merrer, J, Santoli, F, Apéré-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; 21:718723.CrossRefGoogle Scholar
6.Tomic, V, Sventina, P, Trinkaus, D, Sorli, J, Widmer, AF, Trampuz, A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004; 164:20382043.CrossRefGoogle Scholar
7.Farr, BM, Jarvis, WR. Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? Infect Control Hosp Epidemiol 2002; 23:6575.CrossRefGoogle ScholarPubMed
8.Haley, RW, Cushion, NR, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995; 171:614624.CrossRefGoogle ScholarPubMed
9.Carrier, M, Marchand, R, Auger, P, et al. Methicillin-resistant Staphylococcus aureus infection in a cardiac surgical unit. J Thorac Cardiovasc Surg 2002; 123:4044.CrossRefGoogle Scholar
10.Barrett, SP, Mummery, RF, Chattopadhyay, B. Trying to control MRSA causes more problems than it solves. J Hosp Infect 1998; 39:8593.CrossRefGoogle ScholarPubMed
11.Green, M, Avery, RK, Preiksaitis, J. Guidelines for the prevention and management of infectious complications of solid organ transplantation: multiply resistant gram-positive bacteria. Am J Transplantation 2004; 4: 3136.Google Scholar
12.Singh, N, Paterson, DL, Chang, FY, Gayowski, T, Squier, C, Wagener, MM, Marino, IR. Methicillin-resistant Staphlococcus aureus: the other emerging resistant gram-positive coccus among liver transplant recipients. Clin Infect Dis 2000; 30:322327.CrossRefGoogle Scholar
13.Paterson, DL, Rihs, JD, Squier, C, Gayowski, T, Sagnimeni, A, Singh, N. Lack of efficacy of mupirocin in the prevention of infections with Staphylococcus aureus in liver transplant recipients and candidates. Transplantation 2003; 75:194198.CrossRefGoogle ScholarPubMed
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions of nosocomial infections. Am J Infect Control 1988; 16:128140.CrossRefGoogle ScholarPubMed
15.Boyce, JM, Havill, NL, Kohan, C, Dumigan, DG, Ligi, CE. Do infection control measures work for methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 2004; 25:395401.CrossRefGoogle ScholarPubMed
16.Ray, AJ, Pultz, NJ, Bhalla, A, Aran, DC, Donskey, CJ. Coexistence of vancomycin-resistant enterococci and Staphylococcus aureus in the intestinal tracts of hospitalized patients. Clin Infect Dis 2003; 37:875881.CrossRefGoogle Scholar
17.Donskey, CR, Ray, AJ, Hoyen, CK, et al. Colonization and infection with multiple nosocomial pathogens among patients colonized with vancomycin-resistant enterococcus. Infect Control Hosp Epidemiol 2003; 24: 242245.CrossRefGoogle Scholar
18.Dupeyron, C, Campillo, B, Mangeney, N, Bordes, M, Richardet, JP. Carriage of Staphylococcus aureus and of gram-negative bacilli resistant to third-generation cephalosporins in cirrhotic patients: a prospective assessment of hospital-acquired infections. Infect Control Hosp Epidemiol 2001; 22: 427432.CrossRefGoogle ScholarPubMed
19.Squier, C, Rihs, J, Risa, K, et al. S. aureus nasal carriage and association with infections in intensive care unit and liver transplant unit patients. Infect Control Hosp Epidemiol 2002; 23:495501.Google Scholar
55
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Impact of an Aggressive Infection Control Strategy on Endemic Staphylococcus aureus Infection in Liver Transplant Recipients
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *