Skip to main content Accessibility help
×
Home
Hostname: page-component-6c8bd87754-827q6 Total loading time: 0.236 Render date: 2022-01-19T06:12:21.089Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Patient-Associated Risk Factors for Acquisition of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital

Published online by Cambridge University Press:  02 January 2015

Jo-anne M. Salangsang*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Pittsburgh, Pennsylvania University of Pittsburgh Medical Center, the Infectious Diseases Epidemiology Research Unit, Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania
Lee H. Harrison
Affiliation:
University of Pittsburgh Medical Center, the Infectious Diseases Epidemiology Research Unit, Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania
Maria M. Brooks
Affiliation:
Department of Epidemiology, Graduate School of Public Health, Pittsburgh, Pennsylvania
Kathleen A. Shutt
Affiliation:
University of Pittsburgh Medical Center, the Infectious Diseases Epidemiology Research Unit, Graduate School of Public Health and School of Medicine, Pittsburgh, Pennsylvania
Melissa I. Saul
Affiliation:
Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Carlene A. Muto
Affiliation:
Division of Infectious Diseases, Department of Medicine, Pittsburgh, Pennsylvania Department of Infection Control, Pittsburgh, Pennsylvania
*
3601 Fifth Avenue, Falk Medical Building, Suite 3A, Pittsburgh, PA 15213 (salangsangjs@upmc.edu)

Extract

Background.

Determining risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals is important for defining infection-control measures that may lead to fewer hospital-acquired infections.

Objective.

To determine patient-associated risk factors for acquisition of MRSA in a tertiary care hospital with the goal of identifying modifiable risk factors.

Methods.

A retrospective matched case-control study was performed. Case patients who acquired MRSA during hospitalization and 2 matched control patients were selected among inpatients admitted to target units during the period from 2001 through 2008. The odds of exposure to potential risk factors were compared between case patients and control patients, using matched univariate conditional logistic regression. A single multivariate conditional logistic regression model identifying independent patient-specific risk factors was generated.

Results.

A total of 451 case patients and 866 control patients were analyzed. Factors positively associated with MRSA acquisition were as follows: target unit stay before index culture; primary diagnosis of respiratory disease, digestive tract disease, injury or trauma, or other diagnosis compared with cardiocirculatory disease; peripheral vascular disease; mechanical ventilation with pneumonia; ventricular shunting or ventriculostomy; and ciprofloxacin use. Factors associated with decreased risk were receipt of a solid-organ transplant and use of penicillins, cephalosporins, rifamycins, daptomycin or linezolid, and proton pump inhibitors.

Conclusion.

Among the factors associated with increased risk, few are modifiable. Patients with at-risk conditions could be targeted for intensive surveillance to detect acquisition sooner. The association of MRSA acquisition with target unit exposure argues for rigorous application of hand hygiene, appropriate barriers, environmental control, and strict aseptic technique for all procedures performed on such Patients. Our findings support focusing efforts to prevent MRSA transmission and restriction of ciprofloxacin use.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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.Boyce, JM. Methicillin-resistant Staphylococcus aureus: a continuing infection control challenge. Eur J Clin Microbiol Infect Dis 1994;13(1):4549.CrossRefGoogle ScholarPubMed
2.Klevens, RM, Edwards, JR, Tenover, FC, McDonald, LC, Horan, T, Gaynes, R. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006;42(3):389391.CrossRefGoogle ScholarPubMed
3.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):17631771.CrossRefGoogle ScholarPubMed
4.Boyce, JM. Understanding and controlling methicillin-resistant Staphylococcus aureus infections. Infect Control Hosp Epidemiol 2002;23(9):485487.CrossRefGoogle Scholar
5.Boyce, JM. Increasing prevalence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1990;11(12):639642.CrossRefGoogle ScholarPubMed
6.Blot, SI, Vandewoude, KH, Hoste, EA, Colardyn, FA. Outcome and attributable mortality in critically ill patients with bacteremia involving methicilhn-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162(19):22292235.CrossRefGoogle ScholarPubMed
7.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a metaanalysis. Clin Infect Dis 2003;36(1):5359.CrossRefGoogle Scholar
8.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26(2):166174.CrossRefGoogle Scholar
9.Davis, KA, Stewart, II, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39(6):776782.CrossRefGoogle ScholarPubMed
10.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344(1):1116.CrossRefGoogle ScholarPubMed
11.Muller, A, Mauny, F, Talon, D, Donnan, PT, Harbarth, S, Bertrand, X. Effect of individual- and group-level antibiotic exposure on MRSA isolation: a multilevel analysis. J Antimicrob Chemother 2006;58(4):878881.CrossRefGoogle ScholarPubMed
12.Warren, DK, Guth, RM, Coopersmith, CM, Merz, LR, Zack, JE, Fraser, VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006;27(10): 10321040.CrossRefGoogle Scholar
13.Fishbain, JT, Lee, JC, Nguyen, HD, et al.Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003;24(6):415421.CrossRefGoogle ScholarPubMed
14.Marshall, C, Wolfe, R, Kossmann, T, Wesselingh, S, Harrington, G, Spelman, D. Risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) by trauma patients in the intensive care unit. J Hosp Infect 2004;57(3):245252.CrossRefGoogle ScholarPubMed
15.Hashimoto, M, Sugawara, Y, Tamura, S, et al.Acquisition of methicillin-resistant Staphylococcus aureus after living donor liver transplantation: a retrospective cohort study. BMC Infect Dis 2008;8:155.CrossRefGoogle ScholarPubMed
16.Moore, C, Dhaliwal, J, Tong, A, et al.Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in roommate contacts of patients colonized or infected with MRSA in an acute-care hospital. Infect Control Hosp Epidemiol 2008;29(7):600606.CrossRefGoogle ScholarPubMed
17.Ibelings, MM, Bruining, HA. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998;164(6):411418.CrossRefGoogle ScholarPubMed
18.Rioux, C, Armand-Lefevre, L, Guerinot, W, Andremont, A, Lucet, JC. Acquisition of methicillin-resistant Staphylococcus aureus in the acute care setting: incidence and risk factors. Infect Control Hosp Epidemiol 20O7;27(6): 733736.CrossRefGoogle Scholar
19.Yount, RJ, Vries, JK, Councill, CD. The Medical Archival System: an information retrieval system based on distributed parallel processing. Inf Process Manag 1991;27:379389.CrossRefGoogle Scholar
20.Cook, DJ, Kollef, MH. Risk factors for ICU-acquired pneumonia. JAMA 1998;279(20):16051606.CrossRefGoogle Scholar
21.Rubinstein, E, Kollef, MH, Nathwani, D. Pneumonia caused by methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008;46(suppl 5):S378S385.CrossRefGoogle Scholar
22.Weber, SG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003;9(11):14151422.CrossRefGoogle Scholar
23.LeBlanc, L, Pepin, J, Toulouse, K, et al.Fluoroquinolones and risk for methicillin-resistant Staphylococcus aureus, Canada. Emerg Infect Dis 2006;12(9):13981405.CrossRefGoogle ScholarPubMed
24.Tacconelli, E, De Angelis, G, Cataldo, MA, Pozzi, E, Cauda, R. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? A systematic review and meta-analysis. J An-timicrob Chemother 2008;61(1):2638.CrossRefGoogle ScholarPubMed
25.Laheij, RJ, Sturkenboom, MC, Hassing, RJ, Dieleman, J, Strieker, BH, Jansen, JB. Risk of community-acquired pneumonia and use of gastric acid-suppressive drugs. JAMA 2004;292(16):19551960.CrossRefGoogle ScholarPubMed
26.Aseeri, M, Schroeder, T, Kramer, J, Zackula, R. Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol 2008;103(9):23082313.CrossRefGoogle ScholarPubMed
27.Cordonnier, C, Buzyn, A, Leverger, G, et al.Epidemiology and risk factors for gram-positive coccal infections in neutropenia: toward a more targeted antibiotic strategy. Clin Infect Dis 2003;36(2):149158.CrossRefGoogle Scholar
28.Owens, RC Jr, Donskey, CJ, Gaynes, RP, Loo, VG, Muto, CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis 2008;46(suppl 1):S19S31.CrossRefGoogle ScholarPubMed
29.Merrer, J, Santoli, F, Appere 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):718723.CrossRefGoogle Scholar
27
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.

Patient-Associated Risk Factors for Acquisition of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital
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.

Patient-Associated Risk Factors for Acquisition of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital
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.

Patient-Associated Risk Factors for Acquisition of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital
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? *