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The Epidemiology of Methicillin-Resistant Staphylococcus aureus on a Burn Trauma Unit

Published online by Cambridge University Press:  02 January 2015

Marin Schweizer ,
Melissa Ward ,
Sandra Cobb ,
Jennifer McDanel ,
Laurie Leder ,
Lucy Wibbenmeyer ,
Barbara Latenser ,
Daniel Diekema  and
Loreen Herwaldt
Marin Schweizer*
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa
Melissa Ward
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa
Sandra Cobb
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa
Jennifer McDanel
Affiliation:
University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa University of Iowa Carver College of Medicine, Department of Pathology, Iowa City, Iowa
Laurie Leder
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa
Lucy Wibbenmeyer
Affiliation:
University of Iowa Carver College of Medicine, Department of Surgery, Iowa City, Iowa
Barbara Latenser
Affiliation:
University of Iowa Carver College of Medicine, Department of Surgery, Iowa City, Iowa
Daniel Diekema
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa University of Iowa Carver College of Medicine, Department of Pathology, Iowa City, Iowa University of Iowa Hospitals and Clinics, Program of Hospital Epidemiology, Iowa City, Iowa
Loreen Herwaldt
Affiliation:
University of Iowa Carver College of Medicine, Department of Internal Medicine, Iowa City, Iowa University of Iowa College of Public Health, Department of Epidemiology, Iowa City, Iowa University of Iowa Hospitals and Clinics, Program of Hospital Epidemiology, Iowa City, Iowa
*
601 Highway 6 West (152), Iowa City, IA 52246 (marin-schweizer@uiowa.edu)
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Abstract

Objective.

We assessed the frequency and relatedness of methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine whether healthcare workers, the environment, or admitted patients could be a reservoir for MRSA on a burn trauma unit (BTU). We also assessed risk factors for MRSA colonization among BTU patients.

Design.

Prospective cohort study and surveillance for MRSA carriage.

Setting.

BTU of a Midwestern academic medical center.

Patients and Participants.

Patients admitted to a BTU from February 2009 through January 2010 and healthcare workers on this unit during the same time period.

Methods.

Samples for MRSA culture were collected on admission from the nares and wounds of all BTU patients. We also had collected culture samples from the throat, axilla, antecubital fossa, groin, and perianal area of 12 patients per month. Samples collected from healthcare workers' nares and from environmental sites were cultured quarterly. MRSA isolates were typed by pulsed-field gel electrophoresis.

Results.

Of 144 patients, 24 (17%) carried MRSA in their nares on admission. Male sex (odds ratio [OR], 5.51; 95% confidence interval [95% CI], 1.25–24.30), admission for necrotizing fasciitis (OR, 7.66; 95% CI, 1.64–35.81), and MRSA colonization of a site other than the nares (OR, 23.40; 95% CI, 6.93–79.01) were independent predictors of MRSA nasal carriage. Cultures of samples collected from 4 healthcare workers and 4 environmental cultures had positive results. Two patients were colonized with strains that were indistinguishable from strains collected from a healthcare worker or the environment.

Conclusions.

Patients were a major reservoir for MRSA. Infection control efforts should focus on preventing transmission of MRSA from patients who are MRSA carriers to other patients on the unit.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 11 , November 2012 , pp. 1118 - 1125
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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