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Colonization and Infection With Methicillin-Resistant Staphylococcus aureus: Associated Factors and Eradication

Published online by Cambridge University Press:  02 January 2015

Angel Asensio ,
Antonio Guerrero ,
Carmen Quereda ,
Maxima Lizán  and
Manuel Martinez-Ferrer
Angel Asensio*
Affiliation:
Servicio de Medicina Preventiva, Madrid, Spain
Antonio Guerrero
Affiliation:
Unidad de Enfermedades Infecciosas, Madrid, Spain
Carmen Quereda
Affiliation:
Unidad de Enfermedades Infecciosas, Madrid, Spain
Maxima Lizán
Affiliation:
Servicio de Medicina Preventiva, Madrid, Spain
Manuel Martinez-Ferrer
Affiliation:
Servicio de Microbiología, Hospital Ramon y Cajal, Universidad de Alcala de Henares, Madrid, Spain
*
Servicio de Medicina Preventive Hospital Ramon y Cajal, Ctra de Colmenar Km 9, 1, 28034 Madrid, Spain
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Abstract

Objectives:

To identify characteristics associated with methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection, and to evaluate the efficacy of systemic and topical antimicrobials in the eradication of MRSA carriage among hospitalized patients.

Design:

A case-control study was done to identify associations. Odds ratios were estimated by unconditional multiple logistic regression. Cohort study was done to evaluate MRSA decolonization efficacy by an oral regimen. Patients infected or colonized with MRSA received a 5-day course of oral (166 mg/800 mg) trimethoprim-sulfametroxazole twice daily and 600 mg of rifampin once daily as decolonization treatment. The proportion of MRSA-free patients after decolonization treatment was determined. Persistence of clearing was estimated by the Kaplan-Meier method.

Setting:

Ramón y Cajal Hospital, a 1,249-bed, tertiary-care teaching hospital in Madrid, Spain.

Patients:

One hundred ninety-two patients with hospital-acquired MRSA infection/colonization and 195 MRSA-free random controls.

Results:

Six factors were associated independently with MRSA infection/colonization: age (every 10 years of age, odds ratio [OR]=1.3); ward (surgical, OR=1; medical, OR=3.1; intensive care unit, OR=60); previous hospitalization (OR=6.9); coma (OR=25.3); invasive procedures (each, OR=1.7); 3 or more weeks of hospitalization (OR=3.8). We failed to show antibiotic therapy to be an independent risk factor for MRSA hospital infection/colonization. Overall, MRSA eradication was 64.2% by day 2 to 9 after completion of treatment. Kaplan-Meier product limit survival analysis showed that the probability of remaining MRSA-free was 65.3% (SE=0.09) at 32 days after completion of treatment.

Conclusions:

The results offer a rationale for reduction of MRSA infection/colonization in the hospital by interventions aimed at early identification of patients at higher risk, at prompt discharge of patients, and at preventing dissemination while performing invasive procedures. They also provide estimates of antibiotic treatment efficacy to reduce the reservoir of MRSA in the hospital.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 1 , January 1996 , pp. 20 - 28
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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References

1. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis 1979;139:273–279.10.1093/infdis/139.3.273CrossRefGoogle ScholarPubMed
2. Crossley, K, Landesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: epidemiologic studies. J Infect Dis 1979;139:273–279.10.1093/infdis/139.3.273CrossRefGoogle Scholar
3. Peacock, JE, Moorman, DR, Wenzel, RP, Mandell, GL. Methicillin-resistant Staphylococcus aureus: microbiologic characteristics, antimicrobial susceptibilities, and assessment of virulence of an epidemic strain. J Infect Dis 1981;144:575–582.10.1093/infdis/144.6.575Google Scholar
4. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosecomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.10.7326/0003-4819-97-3-309CrossRefGoogle ScholarPubMed
5. Boyce, JM. Methicillin-resistant Staphylococcus aureus; detection, epidemiology, and control measures. Infect Dis Clin North Am 1989;3:901–913.10.1016/S0891-5520(20)30313-5Google Scholar
6. Boyce, JM, Landry, M, Deetz, TR, DuPont, HL. Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981;2:110–116.10.1017/S0195941700053881CrossRefGoogle ScholarPubMed
7. Peacock, JE, Marsik, FJ, Wenzel, RP. Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.10.7326/0003-4819-93-4-526CrossRefGoogle ScholarPubMed
8. Law, MR, Gill, ON. Hospital-acquired infection with methicillin-resistant and methicillin-sensitive staphylococci. Epidemiol Infect 1988;101:623–629.10.1017/S0950268800029496CrossRefGoogle ScholarPubMed
9. Hershow, RC, Khayr, WF, Smith, NL. A comparison of clinical virulence of nosocomially acquired methicillin-resistant and methicillin-sensitive Staphylococcus aurens infections in a university hospital. Infect Control Hosp Epidemiol 1992;13:587–593.Google Scholar
10. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981;71:53–58.10.1016/0002-9343(81)90258-8Google Scholar
11. Ward, TT, Winn, RE, Hartstein, AL, et al. Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: role of antimicrobial therapy in infection control. Infect Control 1981;2:453–459.10.1017/S0195941700055715CrossRefGoogle Scholar
12. Bartzokas, CA, Paton, JH, Gionson, FM, Graham, R, McLaughlin, GA, Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med 1984;311:1422–1425.10.1056/NEJM198411293112207CrossRefGoogle ScholarPubMed
13. Walsh, TJ, Standiford, HC, Reboli, AC, et al. Randomized double-blinded trial of rifampin with either novobiocin or trimethoprim-sulfamethoxazole against methicillin-resistant Staphylococcus aureus colonization: prevention of antimicrobial resistance and effect of host factors on outcome. Antimicrob Agents Chemother 1993;37:1334–1342.10.1128/AAC.37.6.1334CrossRefGoogle ScholarPubMed
14. Muder, RR, Brennen, MM, Wagener, RM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term-care facility. Ann Intern Med 1991;114:107–112.10.7326/0003-4819-114-2-1-107CrossRefGoogle ScholarPubMed
15. Boyce, JM. Should we vigorously try to contain and control methicillin-resistant Staphylococcus aureus? Infect Control Hosp Epidemiol 1991;12:46–54.10.2307/30147088Google Scholar
16. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3CrossRefGoogle ScholarPubMed
17. National Committee on Clinical Laboratory Standards. Methods for dilution antimicrobial susceptibility tests for bacteria that grow aerobically. Document M7A2. Villanova, PA: NCCLS, 1990.Google Scholar
18. Hennekens, CH, Buring, JE. Case-control studies. Selection of controls. In: Mayrent, SL, ed. Epidemiology in Medicine. Boston, MA: Little, Brown and Co; 1987:137.Google Scholar
19. McCabe, WR, Jackson, GJ. Gram-negative bacteremial I: etiology and ecology . Arch Intern Med 1962;11:884–885.Google Scholar
20. McCabe, WR, Jackson, GJ. Gram-negative bacteremia, III: clinical laboratory and therapeutic observations. Arch Intern Meed 1962;110:858–864.Google Scholar
21. Statistix 3.1. An Interactive Statistical Analysis Program for Microcomputers. Analytical Software. St. Paul, MN: Statistix; 1990.Google Scholar
22. Dean, AG, Dean, JA, Burton, AH, Dicker, RC. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Stone Mountain, GA: USD, Inc; 1990.Google Scholar
23. Hosmer, DV, Lemeshow, S. Model-building strategies and methods for logistic regression. In: Hosmer, DV, ed. Applied Logistic Regression. New York, NY: Wiley and Sons; 1989:82–89.Google Scholar
24. Lacksley, RM, Cohen, ML, Quinn, TC, et al. Multiply antibioticresistant Staphylococcus aureus: introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317–324.10.7326/0003-4819-97-3-317Google Scholar
25. McNeil, JJ, Proudfoot, AD, Tosolini, FA, et al. Methicillin-resistant Staphylococcus aureus in an Australian teaching hospital. J Hosp Infect 1984;5:1824.10.1016/0195-6701(84)90097-5CrossRefGoogle Scholar
26. Ellison, RT, Judson, FN, Peterson, LC, et al. Oral rifampin and trimethoprim-sulfametoxazole therapy in asymptomatic carriers of methicillin-resistant Staphylococcus aureus infections. West J Med 1984;140:735–740.Google Scholar
27. Roccaforte, JS, Bittner, MJ, Stumpf, CA, Preheim, LC. Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with the use of trimethoprim-sulfametoxazole, rifampin, and bacitracin. Am J Infect Control 1988:141–146.10.1016/0196-6553(88)90024-7CrossRefGoogle Scholar
28. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.10.1016/0002-9343(93)90063-UGoogle Scholar
29. Bennet, ME, Thurn, JR, Klicker, R, Williams, CO, Weiler, M. Recommendations from a Minnesota task force for the management of persons with methicillin-resistant Staphylococcus aureus . Am J Infect Control 1992;20:42–48.10.1016/S0196-6553(05)80127-0CrossRefGoogle Scholar
30. Hospital Infection Society and British Society for Antimicrobial Chemotherapy. Revised Guidelines for the Control of Epidemic Methicillin-Resistant Staphylococcus aureus. J Hosp Infect 1990;16:351–377.10.1016/0195-6701(90)90008-CGoogle Scholar
31. Wenzel, RP, Nettleman, MD, Jones, RN. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl3B):221S–227S.10.1016/0002-9343(91)90372-5Google Scholar
32. Cookson, BD. MRSA major problem or minor threat? J Med Microbiol 1993;38:309–310.10.1099/00222615-38-5-309CrossRefGoogle ScholarPubMed