Hostname: page-component-8448b6f56d-jr42d Total loading time: 0 Render date: 2024-04-24T22:30:52.143Z Has data issue: false hasContentIssue false
  • English
  • Français

Staphylococcus aureus Colonization before Infection Is Not Associated with Mortality among S. aureus-infected Patients: A Meta-analysis

Published online by Cambridge University Press:  02 January 2015

Marin L. Schweizer ,
Ann Bossen ,
Jennifer S. McDanel  and
Leslie K. Dennis
Marin L. Schweizer*
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
Ann Bossen
Affiliation:
College of Nursing, University of Iowa, Iowa City, Iowa
Jennifer S. McDanel
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
Leslie K. Dennis
Affiliation:
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa
*
Iowa City Veterans Affairs Medical Center (152), 601 Highway 6 West, Iowa City, IA 52246 (marin-schweizer@uiowa.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background and Objective.

The literature is conflicted as to whether people colonized with Staphylococcus aureus are at an increased risk of mortality. The aim of this meta-analysis was to review and analyze the current literature to determine whether prior history of S. aureus colonization is associated with mortality among S. aureus-infected patients.

Methods.

The PUBMED databases were searched with keywords related to S. aureus colonization and mortality. After reviewing 380 article abstracts and 59 articles in detail, only 7 studies had data on the association between S. aureus colonization and mortality among S. aureus-infected patients. Crude estimates of study odds ratios (ORs) were calculated on the basis of data from subset analyses. We pooled crude ORs from the 7 studies using a random-effects model. Woolf's test for heterogeneity was assessed.

Results.

When all studies were pooled in a random-effects model, no association between S. aureus colonization and mortality among S. aureus-infected patients was seen (pooled OR, 1.08 [95% confidence interval (CI), 0.32–3.66]; n = 7; heterogeneity P = .05). When the analyses were restricted to infection-attributable mortality, the association between colonization and mortality among S. aureus-infected patients was not statistically significant (pooled OR, 0.42 [95% CI, 0.15–1.21]; n = 4; heterogeneity P = .28).

Conclusions.

S. aureus colonization was not associated with mortality among patients who developed an S. aureus infection. Interventions to decolonize S. aureus carriers may prevent S. aureus infections but may not be sufficient to prevent mortality.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 8 , August 2012 , pp. 796 - 802
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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.Graham, PL III, Lin, SX, Larson, EL. A U.S. population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006;144:318–325.CrossRefGoogle Scholar
2.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998;339:520–532.CrossRefGoogle ScholarPubMed
3.Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed
4.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;344:11–16.Google Scholar
5.Aires de Sousa, M, de Lencastre, H. Bridges from hospitals to the laboratory: genetic portraits of methicillin-resistant Staphylococcus aureus clones. FEMS Immunol Med Microbiol 2004;40:101–111.Google Scholar
6.Woeste, G, Zapletal, C, Wullstein, C, Golling, M, Bechstein, WO. Influence of methicillin-resistant Staphylococcus aureus carrier status in liver transplant recipients. Transplant Proc 2005;37: 1710–1712.Google Scholar
7.Porter, R, Subramani, K, Thomas, AN, Chadwick, P. Nasal carriage of Staphylococcus aureus on admission to intensive care: incidence and prognostic significance. Intensive Care Med 2003;29: 655–658.Google Scholar
8.Campillo, B, Dupeyron, C, Richardet, JP. Epidemiology of hospital-acquired infections in cirrhotic patients: effect of carriage of methicillin-resistant Staphylococcus aureus and influence of previous antibiotic therapy and norfloxacin prophylaxis. Epidemiol Infect 2001;127:443–450.CrossRefGoogle ScholarPubMed
9.Fortaleza, CR, Melo, EC, Fortaleza, CM. Nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus and mortality among patients in an intensive care unit. Rev hat Am Enfermagem 2009;17:677–682.CrossRefGoogle Scholar
10.Wertheim, HF, Vos, MC, Ott, A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet 2004;364:703–705.CrossRefGoogle ScholarPubMed
11.Woolf, B. On estimating the relation between blood group and disease. Ann Hum Genet 1955;19:251–253.Google Scholar
12.DerSimonian, R, Laird, N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177–188.Google Scholar
13.Petitti, DB. Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis. 2nd ed. New York: Oxford University Press, 2000.Google Scholar
14.Lai, CF, Liao, CH, Pai, MF, et al. Nasal carriage of methicillin-resistant Staphylococcus aureus is associated with higher all cause mortality in hemodialysis patients. Clin J Am Soc Nephrol 2011; 6:167–174.CrossRefGoogle ScholarPubMed
15.Nguyen, MH, Kauffman, CA, Goodman, RP, et al. Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients. Ann Intern Med 1999;130:221–225.CrossRefGoogle ScholarPubMed
16.Niclaes, L, Buntinx, F, Banuro, F, Lesaffre, E, Heyrman, J. Consequences of MRSA carriage in nursing home residents. Epidemiol Infect 1999;122:235–239.Google Scholar
17.Chang, FY, Singh, N, Gayowski, T, Wagener, MM, Marino, IR. Staphylococcus aureus nasal colonization in patients with cirrhosis: prospective assessment of association with infection. Infect Control Hosp Epidemiol 1998;19:328–332.Google Scholar
18.Patel, M, Weinheimer, JD, Waites, KB, Baddley, JW. Active surveillance to determine the impact of methicillin-resistant Staphylococcus aureus colonization on patients in intensive care units of a Veterans Affairs medical center. Infect Control Hosp Epidemiol 2008;29:503–509.Google Scholar
19.Maraqa, NF, Aigbivbalu, L, Masnita-Iusan, C, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization and infection among infants at a level III neonatal intensive care unit. Am J Infect Control 2011;39:35–41.CrossRefGoogle Scholar
20.Konvalinka, A, Errett, L, Fong, IW. Impact of treating Staphylococcus aureus nasal carriers on wound infections in cardiac surgery. J Hosp Infect 2006;64:162–168.CrossRefGoogle ScholarPubMed
21.Kalmeijer, MD, Coertjens, H, van Nieuwland-Bollen, PM, et al. Surgical site infections in orthopedic surgery: the effect of mu-pirocin nasal ointment in a double-blind, randomized, placebo-controlled study. Clin Infect Dis 2002;35:353–358.Google Scholar
22.Cimochowski, GE, Harostock, MD, Brown, R, Bernardi, M, Alonzo, N, Coyle, K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg 2001;71:1572–1579.CrossRefGoogle ScholarPubMed
23.Tacconelli, E, Carmeli, Y, Aizer, A, Ferreira, G, Foreman, MG, D'Agata, EM. Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: a meta-analysis. Clin Infect Dis 2003;37:1629–1638.Google Scholar
24.Bode, LG, Kluytmans, JA, Wertheim, HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:9–17.Google Scholar
25.Nicholson, MR, Huesman, LA. Controlling the usage of intranasal mupirocin does impact the rate of Staphylococcus aureus deep sternal wound infections in cardiac surgery patients. Am J Infect Control 2006;34:44–48.Google Scholar
26.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karch-mer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36: 53–59.Google Scholar
27.Blaine, KP, Tuohy, MJ, Wilson, D, et al. Progression to bacteremia in critical care patients colonized with methicillin-resistant Staphylococcus aureus expressing Panton-Valentine leukocidin. Diagn Microbiol Infect Dis 2010;68:28–33.Google Scholar
28.Grundmeier, M, Tuchscherr, L, Bruck, M, et al. Staphylococcal strains vary greatly in their ability to induce an inflammatory response in endothelial cells. / Infect Dis 2010;201:871–880.Google Scholar