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Methicillin-Resistant Staphylococcus Aureus Carriage Among Patients After Hospital Discharge

Published online by Cambridge University Press:  21 June 2016

Menno R. Vriens
Affiliation:
University Medical Center Utrecht, Department of Surgery, Utrecht, the Netherlands University Medical Center Utrecht, Eijkman-Winkler Center for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene and Infection Prevention, Utrecht, the Netherlands
Hetty E. M. Blok*
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Center for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene and Infection Prevention, Utrecht, the Netherlands
Ada C. M. Gigengack-Baars
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Center for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene and Infection Prevention, Utrecht, the Netherlands
Ellen M. Mascini
Affiliation:
Microbiological and Immunological Laboratory, Rijnstate Hospital, Arnhem, the Netherlands
Chris van der Werken
Affiliation:
University Medical Center Utrecht, Department of Surgery, Utrecht, the Netherlands
Jan Verhoef
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Center for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene and Infection Prevention, Utrecht, the Netherlands
Annet Troelstra
Affiliation:
University Medical Center Utrecht, Eijkman-Winkler Center for Microbiology, Infectious Diseases and Inflammation, Department of Hospital Hygiene and Infection Prevention, Utrecht, the Netherlands
*
University Medical Center Utrecht, ZHIP, HP G 04.614, P.O. Box 85500, 3508 GA Utrecht, the Netherlands.H.E.M.Blok@lab.azu.nl

Abstract

Background and Objective:

At the University Medical Center Utrecht (UMCU), follow-up implies an inventory of risk factors and screening for MRSA colonization among all MRSA-positive patients for at least 6 months. If risk factors or positive cultures persist or re-emerge, longer follow-up is indicated and isolation at readmission. This study investigated how long MRSA-positive patients remained colonized after hospital discharge and which risk factors were important. Furthermore, the results of eradication therapy were evaluated.

Design:

All patients who were positive for MRSA at the UMCU between January 1991 and January 2001 were analyzed regarding carriage state, presence of risk factors for prolonged carriage of Staphylococcus aureus, and eradication treatment.

Results:

A total of 135 patients were included in the study. The median follow-up time was 1.2 years. Eighteen percent of the patients were dismissed from follow-up 1 year after discharge. Only 5 patients were dismissed after 6 months. Among patients with no risk factors, eradication treatment was effective for 95% within 1 year. Among patients with persistent risk factors, treatment was effective for 89% within 2 years.

Conclusions:

Based on these findings, eradication therapy should be prescribed for all MRSA carriers, independent of the presence of risk factors. MRSA-positive patients should be evaluated for 6 months for the presence of risk factors and MRSA carriage. Screening for risk factors is important because intermittent MRSA carriage was found in a significant number of our patients. Patients with negative MRSA cultures and without risk factors for 12 months can be safely dismissed from follow-up. (Infect Control Hosp Epidemiol 2005;26:629-633)

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Engemann, JJ, Carmeji, Y, Cosgrove SE, et al.Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36:592598.CrossRefGoogle ScholarPubMed
2.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karch-mer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36:5359.CrossRefGoogle ScholarPubMed
3.Vriens, MR, Blok, HEM, Fluit, AC, Troelstra, A, Verhoef, J, van der Werken, C. Ten years of strict MRSA-policy in a Dutch University Medical Center: what price are we paying? Eur J Clin Microbiol Infect Dis 2002;21:782786.CrossRefGoogle Scholar
4.Abrahamson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what cost? Infect Control Hosp Epidemiol 1999;20:408411.CrossRefGoogle Scholar
5.Papia, G, Louie, M, Traila, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 2001;20:473477.CrossRefGoogle Scholar
6.Kim, T, Oh, PI, Simor, AE. The economic impact of methicillin-resistant Staphylococcus aureus in Canadian hospitals. Infect Control Hosp Epidemiol 2001;22:99104.CrossRefGoogle Scholar
7.Karchmer, TB, Durbin, LJ, Simonton, BM, Farr, BM. Cost-effectiveness of active surveillance cultures and contact/droplet precautions for control of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2002;51:126132.CrossRefGoogle Scholar
8.Rubinovitch, B, Pittet, D. Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned? J Hosp Infect 2001;47:918.CrossRefGoogle ScholarPubMed
9.Chaix, C, Durand-Zaleski, I, Albert, C, Brun-Buisson, C.Control of epidemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999;282:17451751.CrossRefGoogle Scholar
10.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;24:362386.Google ScholarPubMed
11.Pearman, JW, Grubb, WB. Preventing the importation and establishment of methicillin-resistant Staphylococcus aureus in hospitals in Western Australia. APUA Newsletter 1993;11:18.Google Scholar
12.Vandenbroucke-Grauls, CMJE.Methicillin-resistant Staphylococcus aureus control in hospitals: the Dutch experience. Infect Control Hosp Epidemiol 1996;17:512513.CrossRefGoogle ScholarPubMed
13.Neeling, AI, van Leeuwen, WJ, Schouls, LM, et al.Resistance of staphylococci in the Netherlands: surveillance by an electronic network during 1989-1995. J Antimicrob Chemother 1998;41:93101.CrossRefGoogle ScholarPubMed
14.Andersen, BM, Bergh, K, Steinbakk, M, et al.A Norwegian nosocomial outbreak of methicillin-resistant Staphylococcus aureus resistant to fusidic acid and susceptible to other antistaphylococcal agents. J Hosp Infect 1999;41:123132.CrossRefGoogle ScholarPubMed
15.Dutch Working Party for Infection Prevention. Management Policy for Methicillin Resistant Staphylococcus aureus. Leiden, the Netherlands: Dutch Working Party for Infection Prevention; 1995:35a. Available at www.WIP.nl.Google ScholarPubMed
16.Verhoef, J, Beaujean, D, Blok, H, et al.A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461466.CrossRefGoogle ScholarPubMed
17.Morgan, MG, Jackson, B, Anderson, D. Long-term methicillin-resistant Staphylococcus aureus (MRSA) carriage and tagging of patient records. J Hosp Infect 1997;36:7879.CrossRefGoogle ScholarPubMed
18.Bradley, SF, Terpennings, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417422.CrossRefGoogle Scholar
19.Hancox, R, Cummins, A, Kelsey, MC. An outbreak of MRSA associated with long-term colonization of medical staff. J Hosp Infect 1992;22:170172.CrossRefGoogle Scholar
20.Shimada, M, Kamakura, T, Itasaka, H, Matsumata, T, Hashizume, M, Sugimachi, K.The significance of methicillin-resistant Staphylococcus aureus infection in general surgery: a multivariate analysis of risk factors and preventive approaches. Surgery Today 1993;23:880884.CrossRefGoogle Scholar
21.Frénay, HME, Vandenbroucke-Grauls, CMJE, Molkenboer, MJCH, Verhoef, J. Long-term carriage of methicillin-resistant Staphylococcus aureus after discharge from hospital. J Hosp Infect 1992;22:207215.CrossRefGoogle ScholarPubMed
22.Beaujean, DJMA, Weersink, AJL, Blok, HEM, Frénay, HME, Verhoef, J. Determining risk factors for methicillin-resistant Staphylococcus aureus carriage after discharge from hospital. J Hosp Infect 1999;42: 213218.CrossRefGoogle ScholarPubMed
23.Blok, HEM, Vriens, MR, Weersink, AJL, Troelstra, A. Carriage of methicillin-resistant Staphylococcus aureus (MRSA) after discharge from hospital: follow-up for how long? A Dutch multi-center study. J Hosp Infect 2001;48:325327.CrossRefGoogle Scholar
24.Hicks, NR, Moore, EP, Williams, EW. Carriage and community treatment of methicillin-resistant Staphylococcus aureus: what happens to colonized patients after discharge? J Hosp Infect 1991;19:1724.CrossRefGoogle ScholarPubMed
25.MacKinnon, MM, Allen, KD. Long-term MRSA carriage in hospital patients. J Hosp Infect 2000;46:216221.CrossRefGoogle ScholarPubMed
26.Scanvic, A, Denie, 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.CrossRefGoogle ScholarPubMed
27.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:11231128.CrossRefGoogle ScholarPubMed
28.Wertheim, H, Verbrugh, HA, van Pelt, C, de Man, P, van Belkum, A, Vos, MC. Improved detection of methicillin-resistant Staphylococcus aureus using phenyl mannitol broth containing aztreonam and ceftizoxime. J Clin Microbiol 2001;39:26602662.CrossRefGoogle ScholarPubMed
29.Fluit, AC, Wielders, CLC, Verhoef, J, Schmitz, F-J.Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39:37273732.CrossRefGoogle ScholarPubMed
30.Boxerbaum, B, Jacobs, MR, Cechner, RL. Prevalence and significance of methicillin-resistant Staphylococcus aureus in patients with cystic fibrosis. Pediatr Pulmonol 1988;4:159163.CrossRefGoogle Scholar
31
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