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Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

David K. Warren ,
Rebecca M. Guth ,
Craig M. Coopersmith ,
Liana R. Merz ,
Jeanne E. Zack  and
Victoria J. Fraser
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri Barnes lewish Hospital, Saint Louis, Missouri
Rebecca M. Guth
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Craig M. Coopersmith
Affiliation:
Departments of Surgery and Anesthesiology, Washington University School of Medicine, Saint Louis, Missouri
Liana R. Merz
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Jeanne E. Zack
Affiliation:
Missouri Baptist Medical Center, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri Barnes lewish Hospital, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8051, Saint Louis, MO 63110, (dwarren@im.wustl.edu)
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Extract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.

Objective.

To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.

Design.

Prospective cohort study.

Setting.

Surgical ICU at a teaching hospital.

Patients.

All patients admitted to the surgical ICU.

Results.

Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).

Conclusions.

Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1032 - 1040
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Ibelings, MM, Bruining, HA. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998; 164:411–418.CrossRefGoogle ScholarPubMed
2. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470–485.CrossRefGoogle Scholar
3. Tiemersma, EW, Bronzwaer, SL, Lyytikainen, O, et al. Methicillin-resistant Staphylococcus aureus in Europe, 1999-2002. Emerg Infect Dis 2004; 10:1627–1634.CrossRefGoogle ScholarPubMed
4. Corbella, X, Dominguez, MA, Pujol, M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997; 16:351–357.CrossRefGoogle ScholarPubMed
5. Davis, KA, Stewart, JJ, 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; 39:776–782.CrossRefGoogle ScholarPubMed
6. Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994; 78:644–650.CrossRefGoogle Scholar
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; 36:53–59.CrossRefGoogle ScholarPubMed
8. Blot, S, Vandewoude, K, Hoste, E, Colardyn, F. Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus . Arch Intern Med 2002; 162:2229–2235.CrossRefGoogle ScholarPubMed
9. Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgicalsite infection. Clin Infect Dis 2003; 36:592–598.CrossRefGoogle Scholar
10. Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, S, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus . Am J Epidemiol 1996; 143:496–504.CrossRefGoogle ScholarPubMed
11. Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus . J Hosp Infect 2000; 46:43–49.CrossRefGoogle ScholarPubMed
12. Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998; 27:543–550.CrossRefGoogle ScholarPubMed
13. 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; 21:718–723.CrossRefGoogle Scholar
14. Marshall, C, Harrington, G, Wolfe, R, Fairley, C. Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit. Infect Control Hosp Epidemiol 2003; 24:322–326.CrossRefGoogle Scholar
15. Chaix, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost-benefit analysis in an intensive care unit. JAMA 1999; 282:1745–1751.CrossRefGoogle Scholar
16. Girou, E, Azar, J, Wolkenstein, P, Cizeau, F, Brun-Buisson, C, Roujeau, JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000; 21:583–587.CrossRefGoogle Scholar
17. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988; 16:128–140.CrossRefGoogle ScholarPubMed
18. Hennekens, CH, Buring, JE. Screening. In: Mayrent, SL, ed. Epidemiology in Medicine. 1st ed. Boston: Little, Brown and Company; 1987:327–347.Google Scholar
19. Lucet, J, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit. Arch Intern Med 2003; 163:181–188.CrossRefGoogle ScholarPubMed
20. Jernigan, J, Pullen, A, Flowers, L, Bell, M, Jarvis, W. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003; 24:409–414.CrossRefGoogle ScholarPubMed
21. Coello, R, Jimenez, J, Garcia, M, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994; 13:74–81.CrossRefGoogle Scholar
22. Boyce, J, Havill, N, Kohan, C, Dumigan, D, Ligi, C. Do infection control measures work for methicillin-resistant Staphylococcus aureus . Infect Control Hosp Epidemiol 2004; 25:395–401.CrossRefGoogle ScholarPubMed
23. Scanvic, A, Denic, 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;32:1393–1398.CrossRefGoogle ScholarPubMed
24. 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; 19:1123–1128.CrossRefGoogle ScholarPubMed
25. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991; 115:417–422.CrossRefGoogle ScholarPubMed
26. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991; 114:107–112.CrossRefGoogle ScholarPubMed
27. Boyce, JM. MRSA patients: proven methods to treat colonization and infection. J Hosp Infect 2001; 48(Suppl A):S9–S14.CrossRefGoogle ScholarPubMed
28. Ma, XX, Ito, T, Tiensasitorn, C, et al. Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002; 46:1147–1152.CrossRefGoogle ScholarPubMed
29. Troillet, N, Carmeli, Y, Samore, MH, et al. Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998; 19:181–185.CrossRefGoogle ScholarPubMed
30. Wilson, R. Bacteria, antibiotics and COPD. Eur Respir J 2001; 17:995–1007.CrossRefGoogle ScholarPubMed
31. Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005; 31:1051–1057.CrossRefGoogle ScholarPubMed
32. Grundmann, H, Hori, S, Winter, B, Tami, A, Austin, DJ. Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: fitting a model to the data. J Infect Dis 2002; 185:481–488.CrossRefGoogle Scholar
33. Roghmann, MC, Siddiqui, A, Plaisance, K, Standiford, H. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. J Hosp Infect 2001; 47:98–103.CrossRefGoogle ScholarPubMed
34. Thurn, J, Crossley, K, Gerdts, A, Maki, M, Johnson, J. Enteral hyperalimentation as a source of nosocomial infection. J Hosp Infect 1990; 15:203–217.CrossRefGoogle ScholarPubMed
35. Dziekan, G, Hahn, A, Thune, K, et al. Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study. J Hosp Infect 2000; 46:263–270.CrossRefGoogle Scholar