Hostname: page-component-848d4c4894-wg55d Total loading time: 0 Render date: 2024-05-17T05:18:47.979Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Transmission of Methicillin-Resistant Staphylococcus aureus: A Blinded Study to Establish Baseline Acquisition Rates

Published online by Cambridge University Press:  02 January 2015

Joel T. Fishbain ,
Joseph C. Lee ,
Honghung D. Nguyen ,
Jeffery A. Mikita ,
Cecilia P. Mikita ,
Catherine F. T. Uyehara  and
Duane R. Hospenthal
Joel T. Fishbain*
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Joseph C. Lee
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Honghung D. Nguyen
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Jeffery A. Mikita
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Cecilia P. Mikita
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Catherine F. T. Uyehara
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
Duane R. Hospenthal
Affiliation:
Departments of Medicine and Clinical Investigation, Tripler Army Medical Center, Honolulu, Hawaii
*
Infectious Disease Service, Ward 63, Bldg 2, 6900 Georgia Ave NW, Washington, DC 20307
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To define the extent of nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to a tertiary-care hospital.

Design:

A blinded, prospective surveillance culture study of patients admitted to the hospital to determine the transmission (acquisition) rate of MRSA Risk factors associated with the likelihood of MRSA colonization on admission were investigated.

Setting:

Tertiary-care military medical facility.

Participants:

All patients admitted to the medicine, surgery, and pediatric wards, and to the medical, surgical, and pediatric intensive care units were eligible for inclusion.

Results:

Five hundred thirty-five admission and 374 discharge samples were collected during the study period. One hundred forty-one patients were colonized with methicillin-susceptible S. aureus (MSSA) and 20 patients (3.7%) were colonized with MRSA on admission. Of the 354 susceptible patients, 6 acquired MRSA during the study for a transmission rate of 1.7%. Patients colonized with MRSA on admission were more likely to be older than non-colonized or MSSA-colonized patients, to have received antibiotics within the past year, to have been hospitalized within the prior 3 years, or to have a known history of MRSA. Patients acquiring MRSA had an average hospital stay of 17.7 days compared with 5.3 days for those who did not acquire MRSA. Pulsed-field gel electrophoresis of the 6 MRSA isolates from patients who acquired MRSA revealed 4 distinct band patterns.

Conclusions:

Most patients colonized with MRSA were identified on admission samples. Surveillance cultures of patients admitted may help to prevent MRSA transmission and infection.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 6 , June 2003 , pp. 415 - 421
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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.Ayliffe, GAJ. The progressive intercontinental spread of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1997;24(suppl 1):S74–S79.Google Scholar
2.U.S. Department of Health and Human Services, Public Health Service. Semiannual Report: Aggregated Data From the National Nosocomial Infections Surveillance (NNIS) System: December 2000. Washington, DC: U.S. Department of Health and Human Services; 2000. Available at www.cdc.gov/ncidod/hip/SURVEILL/NNIS.HTMGoogle Scholar
3.Boetz, MB, Kwok, R, Garcia, JP. Management and epidemiologic analyses of an outbreak due to methicillin-resistant Staphylococcus aureus. Am J Med 1992;92:607–614.Google Scholar
4.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.Google Scholar
5.Hartstein, A, LeMonte, AM, Iwamoto, PKL. DNA typing and control of methicillin-resistant Staphylococcus aureus at two affiliated hospitals. Infect Control Hosp Epidemiol 1997;18:42–48.Google Scholar
6.Jernigan, JA, Clemence, MA, Stott, GA, et al.Control of methicillin-resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686–696.Google Scholar
7.Hartstein, AI, Denny, MA, Morthland, VH, LeMonte, AM, Pfaller, MA. Control of methicillin-resistant Staphylococcus aureus in a hospital and an intensive care unit. Infect Control Hosp Epidemiol 1995;16:405–411.Google Scholar
8.Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S–227S.Google Scholar
9.Haley, RW, Cushion, NB, Tenover, FC, et al.Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614–624.CrossRefGoogle ScholarPubMed
10.Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:46–54.Google Scholar
11.Murray-Leisure, KA, Geib, S, Graceley, D, et al.Control of epidemic methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 1990;11:343–350.Google Scholar
12.Cohen, SH, Morita, MM, Bradford, M. A seven-year experience with methicillin-resistant Staphylococcus aureus. Am J Med 1991;91(suppl 3B):233S–237S.CrossRefGoogle ScholarPubMed
13.Jernigan, JA, Titus, MG, Groschel, DHM, Getchell-White SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496–504.CrossRefGoogle ScholarPubMed
14.Harbarth, S, Pittet, D. Controlling a long-term, hospital-wide epidemic of methicillin-resistant Staphylococcus aureus strains: experiences from the Geneva university hospital. Hygien und Medizin 1997;22:306–313.Google Scholar
15.66 Federal Register 56775 (2001) (codified at 45 CFR §46).Google Scholar
16.Kenner, J, O'Connor, T, Piantanida, N, et al.Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population. Infect Control Hosp Epidemiol 2003;24:439–444.Google Scholar
17.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.Google Scholar
18.Eveillard, M, Eb, F, Tramier, B, et al.Evaluation of the contribution of isolation precautions in prevention and control of multi-resistant bacteria in a teaching hospital. J Hosp Infect 2001;47:116–124.Google Scholar
19.Masaki, H, Watanabe, H, Degawa, S, et al.Significant reduction of methicillin-resistant Staphylococcus aureus bacteremia in geriatric wards after introduction of infection control measures against nosocomial infections. Intern Med 2001;40:214–220.Google Scholar
20.Rao, N, Jacobs, S, Joyce, L. Cost-effective eradication of an outbreak of methicillin-resistant Staphylococcus aureus in a community teaching hospital. Infect Control Hosp Epidemiol 1988;9:255–260.CrossRefGoogle Scholar
21.Papia, G, Louis, M, Tralla, 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 1999;20:473–477.CrossRefGoogle Scholar
22.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.Google Scholar
23.Souweine, B, Traore, O, Aublet-Cuvelier, B, et al.Role of infection control measures in limiting morbidity associated with multi-resistant organisms in critically ill patients. J Hosp Infect 2000;45:107–116.Google Scholar
24.Cosseron-Zerbib, M, Roque Afonso, AM, Naas, T, et al.A control programme for MRSA (methicillin-resistant Staphylococcus aureus) containment in a paediatric intensive care unit: evaluation and impact on infectious caused by other micro-organisms. J Hosp Infect 1998;40:225–235.Google Scholar
25.Kotilainen, P, Routamaa, M, Peltonen, R, et al.Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home. Arch Intern Med 2001;161:859–863.CrossRefGoogle Scholar
26.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
27.Thompson, RL, Cabezudo, I, Wenzel, R. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. Ann Intern Med 1982;97:309–317.Google Scholar
28.Boyce, JM, Jackson, MM, Pugliese, G, et al.Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–113.CrossRefGoogle ScholarPubMed
29.Layton, MC, Hierholzer, WJ, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:12–17.Google Scholar
30.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.Google Scholar
31.Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797–800.CrossRefGoogle ScholarPubMed