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Carriage of Methicillin-Resistant Staphylococcus Aureus at Hospital Admission

Published online by Cambridge University Press:  31 March 2016

Nicolas Troillet ,
Yehuda Carmeli ,
Matthew H. Samore ,
Joanna Dakos ,
Karen Eichelberger ,
Paola C. DeGirolami  and
Adolf W. Karchmer
Nicolas Troillet*
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Yehuda Carmeli
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Matthew H. Samore
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Joanna Dakos
Affiliation:
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Karen Eichelberger
Affiliation:
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Paola C. DeGirolami
Affiliation:
Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
Adolf W. Karchmer
Affiliation:
Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
*
Division of Infectious Diseases, Central Institute of the Valais Hospitals, 86 Avenue Grand-Champsec, CH-1951 Sion, Switzerland
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Abstract

Objectives:

To measure the prevalence of, and to establish predictors for, the nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission. To evaluate mannitol-salt agar with oxacillin for the simultaneous detection and identification of MRSA from nasal swabs.

Design:

Three-month prospective case-control survey, with data collected from interviews and computerized databases. The criterion standard for MRSA detection was culture on Mueller-Hinton agar with oxacillin 6 μg/mL (National Committee for Clinical Laboratory Standards method).

Setting:

320-bed tertiary-care hospital.

Patients:

387 patients screened within 24 hours after admission, including 10 MRSA carriers (cases), 291 patients with no S aureus, and 86 patients with methicillin-susceptible S aureus.

Results:

The prevalence of MRSA nasal carriage was 2.6%, whereas the prevalence of carriage was 3.1% when both nasal and wound cultures were performed. The significant predictors of carriage were a prior detection of MRSA, open wounds, diabetes mellitus, treatments by injection, prior nursing home stays, visits at home by a nurse, and prior antibiotic treatments. Cases had stayed for longer periods in hospitals and had received longer antibiotic treatments within a year. Eighty patients (including the 10 cases) had diabetes, had been exposed to healthcare facilities within a year, and had antibiotics within 6 months. The sensitivity and negative predictive value of nasal swabs on mannitol-salt agar with oxacillin were 60% and 71%, respectively.

Conclusion:

MRSA carriage on admission to the hospital may be an increasing and underestimated problem. Further studies are needed to develop and validate a sensitive and specific prediction rule.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 3 , March 1998 , pp. 180 - 185
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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