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Acquisition and Cross-Transmission of Staphylococcus aureus in European Intensive Care Units

Published online by Cambridge University Press:  02 January 2015

Alexander L. A. Bloemendaal ,
Ad C. Fluit ,
Wouter M. T. Jansen ,
Menno R. Vriens ,
Tristan Ferry ,
Laurent Argaud ,
Jose M. Amorim ,
A. C. Resende ,
Alvaro Pascual  and
Lorena López-Cerero
...Show all authors
Alexander L. A. Bloemendaal*
Affiliation:
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
Ad C. Fluit
Affiliation:
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
Wouter M. T. Jansen
Affiliation:
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
Menno R. Vriens
Affiliation:
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
Tristan Ferry
Affiliation:
Université Lyon 1, Centre National de Référence des Staphylocoques, Faculté Laennec, Lyon, France
Laurent Argaud
Affiliation:
Service de Réanimation Médicale Pôle d'Activité d'Urgences et de Réanimation Médicales Groupement Hospitalier Edouard Herriot Hospices Civils de Lyon, Lyon, France
Jose M. Amorim
Affiliation:
Department of Microbiology, Hospital Geral de Santo Antonio, Porto, Portugal
A. C. Resende
Affiliation:
Service de Réanimation Médicale Pôle d'Activité d'Urgences et de Réanimation Médicales Groupement Hospitalier Edouard Herriot Hospices Civils de Lyon, Lyon, France
Alvaro Pascual
Affiliation:
Department of Microbiology, Hospital Virgen Macarena, Seville, Spain
Lorena López-Cerero
Affiliation:
Department of Microbiology, Hospital Virgen Macarena, Seville, Spain
Stefania Stefani
Affiliation:
Department of Microbiology, Catania, Italy
Giacomo Castiglione
Affiliation:
Intensive Care Unit Ward, Vittorio Emanuele Hospital, Catania, Italy
Penelope Evangelopoulou
Affiliation:
Athens University School of Nursing, Intensive Care Unit, Athens, Greece
Sophia Tsiplakou
Affiliation:
Microbiology and Immunology Department, KAT Hospital, Athens, Greece
Inne H. M. Borel Rinkes
Affiliation:
Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
Jan Verhoef
Affiliation:
Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
*
Department of Surgery, Room G04.228, University Medical Center Utrecht, Heidelberglaan 100, P.O. Box 85500, 3508 GA Utrecht, The Netherlands (a.l.a.bloemendaal@umcutrecht.nl)
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Abstract

Objective.

To study the acquisition and cross-transmission of Staphylococcus aureus in different intensive care units (ICUs).

Methods.

We performed a multicenter cohort study. Six ICUs in 6 countries participated. During a 3-month period at each ICU, all patients had nasal and perineal swab specimens obtained at ICU admission and during their stay. All S. aureus isolates that were collected were genotyped by spa typing and multilocus variable-number tandem-repeat analysis typing for cross-transmission analysis. A total of 629 patients were admitted to ICUs, and 224 of these patients were found to be colonized with S. aureus at least once during ICU stay (22% were found to be colonized with methicillin-resistant S. aureus [MRSA]). A total of 316 patients who had test results negative for S. aureus at ICU admission and had at least 1 follow-up swab sample obtained for culture were eligible for acquisition analysis.

Results.

A total of 45 patients acquired S. aureus during ICU stay (31 acquired methicillin-susceptible S. aureus [MSSA], and 14 acquired MRSA). Several factors that were believed to affect the rate of acquisition of S. aureus were analyzed in univariate and multivariate analyses, including the amount of hand disinfectant used, colonization pressure, number of beds per nurse, antibiotic use, length of stay, and ICU setting (private room versus open ICU treatment). Greater colonization pressure and a greater number of beds per nurse correlated with a higher rate of acquisition for both MSSA and MRSA. The type of ICU setting was related to MRSA acquisition only, and the amount of hand disinfectant used was related to MSSA acquisition only. In 18 (40%) of the cases of S. aureus acquisition, cross-transmission from another patient was possible.

Conclusions.

Colonization pressure, the number of beds per nurse, and the treatment of all patients in private rooms correlated with the number of S. aureus acquisitions on an ICU. The amount of hand disinfectant used was correlated with the number of cases of MSSA acquisition but not with the number of cases of MRSA acquisition. The number of cases of patient-to-patient cross-transmission was comparable for MSSA and MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 2 , February 2009 , pp. 117 - 124
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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