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Multiple Site Surveillance Cultures as a Predictor of Methicillin-Resistant Staphylococcus aureus Infections

Published online by Cambridge University Press:  02 January 2015

Benedict Lim Heng Sim ,
Emma McBryde ,
Alan C. Street  and
Caroline Marshall
Benedict Lim Heng Sim
Affiliation:
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
Emma McBryde
Affiliation:
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia Department of Medicine, University of Melbourne, Melbourne, Australia
Alan C. Street
Affiliation:
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia
Caroline Marshall*
Affiliation:
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Australia Department of Medicine, University of Melbourne, Melbourne, Australia
*
Victorian Infectious Diseases Service, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia ([email protected])
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Abstract

Objective.

To determine the relationship between methicillin-resistant Staphylococcus aureus (MRSA) colonization density, colonization site, and probability of infection in a frequently screened cohort of intensive care unit (ICU) patients.

Methods.

Patients had swab samples tested for MRSA at admission to the ICU, discharge from the ICU, and twice weekly during their ICU stay, and they were followed up for development of MRSA infection. Swab test results were analyzed to determine the proportion of patients colonized and the proportion colonized at each screening site. Hazard of MRSA infection (rate of infection per day at risk) was calculated using a Cox proportional hazards analysis, and risk factors for MRSA infection, including presence of MRSA, degree of colonization, and pattern of colonization were determined.

Results.

Among the 4,194 patient episodes, 238 (5.7%) had screening results that were positive for MRSA, and there were 34 cases of MRSA infection. The hazard ratio (HR) for developing an infection increased as more sites were colonized (HR, 3.4 for being colonized at more than 1 site compared with colonization at 1 site [95% confidence interval, 1.2-9.9]). Colonization site was predictive of developing infection (HR for nose or throat colonization compared with no colonization, 168 [95% confidence interval, 69-407]).

Conclusion.

This study demonstrated that the hazard of developing an infection was higher when more sites were colonized and that certain sites were more predictive of infection than others. These results may be useful for predicting infection in ICU patients and may influence treatment.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 8 , August 2013 , pp. 818 - 824
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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References

1.Gordon, RJ, Lowy, FD. Pathogenesis of methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46(suppl 5): S350–S359.CrossRefGoogle ScholarPubMed
2.Wertheim, HFL, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infection. Lancet Inf Dis 2005; 5:751–762.CrossRefGoogle Scholar
3.Ridenour, G, Lampen, R, Federspiel, J, Kritchevsky, S, Wong, E, Climo, M. Selective use of intranasal mupirocin and Chlorhexidine bathing and the incidence of methicillin-resistant Staphylococcus aureus colonization and infection among intensive care unit patients. Infect Control Hosp Epidemiol 2007;28:1155–1161.Google Scholar
4.Climo, MW, Sepkowitz, KA, Zuccotti, G, et al.The effect of daily bathing with Chlorhexidine on the acquisition of methicillin-resistant Staphylococcus aureus, vancomycin-resistant entero-cocci, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009; 37:1858–1865.Google Scholar
5.Milstone, AM, Perl, TM. Fact, fiction, or no data: what does surveillance for methicillin-resistant Staphylococcus aureus prevent in the intensive care unit? Clin Infect Dis 2008;46:1726–1728.Google Scholar
6.van Trijp, MJ, Melles, DC, Hendriks, WD, Parlevliet, GA, Gommane, M, Ott, A. Successful control of widespread methicillin-resistant Staphylococcus aureus colonization and infection in a large teaching hospital in the Netherlands. Infect Control Hosp Epidemiol 2007;28:970–975.Google Scholar
7.Robicsek, A, Suseno, M, Beaumont, JL, Thomson, RB Jr, Peterson, LR. Prediction of methicillin-resistant Staphylococcus aureus involvement in disease sites by concomitant nasal sampling. J Clin Microbiol 2008;46:588–592.Google Scholar
8.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.Google Scholar
9.Keene, A, Vavagiakis, P, Lee, M-H, et al.Staphylococcus aureus colonization and the risk of infection in critically ill patients. Infect Control Hosp Epidemiol 2005;26:622–628.CrossRefGoogle ScholarPubMed
10.Garrouste-Orgeas, M, Timsit, J-F, Kallel, H, et al.Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 2001;22:687–692.Google Scholar
11.Marschall, J, Muhlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006;27:1206–1212.CrossRefGoogle ScholarPubMed
12.Lim, MSC, Marshall, CL, Spelman, D. Carriage of multiple subtypes of methicillin-resistant Staphylococcus aureus (MRSA) by intensive care unit patients. Infect Control Hosp Epidemiol 2006; 27:1063–1067.CrossRefGoogle ScholarPubMed
13.Nouwen, JL, Ott, A, Kluytmans-Vandenbergh, MF, et al.Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a “culture rule”. Clin Infect Dis 2004;39:806–811.CrossRefGoogle ScholarPubMed
14.Marshall, C, Spelman, D. Is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive care unit? J Clin Microbiol 2007;45:1072–1073.Google Scholar
15.Sarda, V, Molloy, A, Kadkol, S, Janda, WM, Hershow, R, McGuinn, M. Active surveillance for methicillin-resistant Staphylococcus aureus in the neonatal intensive care unit. Infect Control Hosp Epidemiol 2009;30:854–860.CrossRefGoogle ScholarPubMed
16.Dias, CG, Ropke, MV, Superti, S, Berquo, L, d'Azevedo, P. Use of a novel selective medium to detect methicillin-resistant Staphylococcus aureus in colonized patients of an intensive care unit. Infect Control Hosp Epidemiol 2004;25:130–132.CrossRefGoogle ScholarPubMed
17.Marshall, C, Richards, M, McBryde, E. Do active surveillance and contact precautions reduce MRSA acquisition? a prospective interrupted time series. PLoS ONE 2013;8(3):e58112.Google Scholar
18.Gardam, M, Brunton, J, Willey, B, McGeer, A, Low, D, Conly, J. A blinded comparison of three laboratory protocols for the identification of patients colonized with methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2001;22:152–156.Google Scholar
19.Ferguson, J. Current approaches to screening for multi-resistant organisms (MRO) in acute care Australian and selected New Zealand hospitals and recommendations for a minimum standard. Aust Inf Control 2002;7:8–12.Google Scholar
20.Pittet, D, Monod, M, Suter, PM, Frenk, E, Auckenthaler, R. Candida colonization and subsequent infections in critically ill surgical patients. Ann Surg 1994;220:751–758.Google Scholar
21.Eggimann, P, Ostrosky-Zeichner, L. Early antifungal intervention strategies in ICU patients. Curr Opin Crit Care 2010;16:465–469.CrossRefGoogle ScholarPubMed
22.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
23.Wertheim, HFL, 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
24.Ringberg, H, Cathrine Petersson, A, Walder, M, Hugo Johansson, PJ. The throat: an important site for MRSA colonization. Scand I Infect Dis 2006;38:888–893.Google Scholar
25.Nilsson, P, Ripa, T. Staphylococcus aureus throat colonization is more frequent than colonization in the anterior nares. J Clin Microbiol 2006;44:3334–3339.Google Scholar
26.Furuno, JP, Harris, AD, Wright, MO, et al. Value of performing active surveillance cultures on intensive care unit discharge for detection of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2007;28:666–670.CrossRefGoogle ScholarPubMed
27.Ridenour, GA, Wong, ES, Call, MA, Climo, MW. Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infect Control Hosp Epidemiol 2006;27:271–278.CrossRefGoogle ScholarPubMed
28.Huang, SS, Diekema, DJ, Warren, DK, et al.Strain-relatedness of methicillin-resistant Staphylococcus aureus isolates recovered from patients with repeated infection. Clin Infect Dis 2008;46: 1241–1247.Google Scholar
29.Reighard, A, Diekema, D, Wibbenmeyer, L, Ward, M, Herwaldt, L. Staphylococcus aureus nasal colonization and colonization or infection at other body sites in patients on a burn trauma unit. Infect Control Hosp Epidemiol 2009;30:721–726.Google Scholar
30.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
31.Yang, ES, Tan, J, Eells, S, Rieg, G, Tagudar, G, Miller, LG. Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections. Clin Microbiol Infect 2009;16:425–431.Google Scholar