Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-12-01T02:13:51.513Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Methicillin-Resistant Staphylococcus aureus (MRSA) Acquisition in Roommate Contacts of Patients Colonized or Infected With MRSA in an Acute-Care Hospital

Published online by Cambridge University Press:  02 January 2015

Christine Moore ,
Jastej Dhaliwal ,
Agnes Tong ,
Sarah Eden ,
Cindi Wigston ,
Barbara Willey ,
Allison McGeer  and
Mount Sinai Hospital Infection Control Team
Christine Moore
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada
Jastej Dhaliwal
Affiliation:
Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
Agnes Tong
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada
Sarah Eden
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada
Cindi Wigston
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada
Barbara Willey
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada
Allison McGeer*
Affiliation:
Mt. Sinai Hospital, Toronto, Ontario, Canada Department of Public Health Sciences, University of Toronto, Toronto, Ontario, Canada
*
Room 210, Mount Sinai Hospital, 600 University Avenue, Toronto, Ontario, M5G 1X5, Canada ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To identify risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in patients exposed to an MRSA-colonized roommate.

Design.

Retrospective cohort study.

Setting.

A 472-bed acute-care teaching hospital in Toronto, Canada.

Patients.

Inpatients who shared a room between 1996 and 2004 with a patient who had unrecognized MRSA colonization.

Methods.

Exposed roommates were identified from infection-control logs and from results of screening for MRSA in the microbiology database. Completed follow-up was defined as completion of at least 2 sets of screening cultures (swab samples from the nares, the rectum, and skin lesions), with at least 1 set of samples obtained 7–10 days after the last exposure. Chart reviews were performed to compare those who did and did not become colonized with MRSA.

Results.

Of 326 roommates, 198 (61.7%) had completed follow-up, and 25 (12.6%) acquired MRSA by day 7–10 after exposure was recognized, all with strains indistinguishable by pulsed-field gel electrophoresis from those of their roommate. Two (2%) of 101 patients were not colonized at day 7–10 but, with subsequent testing, were identified as being colonized with the same strain as their roommate (one at day 16 and one at day 18 after exposure). A history of alcohol abuse (odds ratio [OR], 9.8 [95% confidence limits {CLs}, 1.8, 53]), exposure to a patient with nosocomially acquired MRSA (OR, 20 [95% CLs, 2.4,171]), increasing care dependency (OR per activity of daily living, 1.7 [95% CLs, 1.1, 2.7]), and having received levofloxacin (OR, 3.6 [95% CLs, 1.1,12]) were associated with MRSA acquisition.

Conclusions.

Roommates of patients with MRSA are at significant risk for becoming colonized. Further study is needed of the impact of hospital antimicrobial formulary decisions on the risk of acquisition of MRSA.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 7 , July 2008 , pp. 600 - 606
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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.Noskin, GA, Rubin, RJ, Schentag, JJ, et al. National trends in Staphylococcus aureus infection rates: impact on economic burden and mortality over a 6-year period (1998–2003). Clin Infect Dis 2007;45:1132–1140.Google Scholar
2.Fluit, AC, Wielders, CL, Verhoef, J, Schmitz, FJ. Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39:3727–3732.Google Scholar
3.Seal, JB, Moreira, B, Bethel, CD, Daum, RS. Antimicrobial resistance in Staphylococcus aureus at the University of Chicago Hospitals: a 15-year longitudinal assessment in a large university-based hospital. Infect Control Hosp Epidemiol 2003;24:403–408.Google Scholar
4.Shittu, AO, Lin, JAntimicrobial susceptibility patterns and characterization of clinical isolates of Staphylococcus aureus in KwaZulu-Natal province, South Africa. BMC Infect Dis 2006;6:125.Google Scholar
5.Kim, HB, Park, WB, Lee, KD, et al. Nationwide surveillance for Staphylococcus aureus with reduced susceptibility to vancomycin in Korea. J Clin Microbiol 2003;41:2279–2281.Google Scholar
6.Huang, SS, Yokoe, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.Google Scholar
7.Raineri, E, Crema, L, De Silvestri, A, et al. Methicillin-resistant Staphylococcus aureus control in an intensive care unit: a 10 year analysis. J Hosp Infect 2007;67:308–315.Google Scholar
8.Lucet, JC, Paoletti, X, Lolom, I, et al. Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units. Intensive Care Med 2005;31:1051–1057.Google Scholar
9.Safdar, N, Marx, J, Meyer, NA, Maki, DG. Effectiveness of preemptive barrier precautions in controlling nosocomial colonization and infection by methicillin-resistant Staphylococcus aureus in a burn unit. Am J Infect Control 2006;34:476–483.Google Scholar
10.Harbarth, S, Masuet-Aumatell, C, Schrenzel, J, et al. Evaluation of rapid screening and pre-emptive contact isolation for detecting and controlling methicillin-resistant Staphylococcus aureus in critical care: an interventional cohort study. Crit Care 2006;10:R25.CrossRefGoogle ScholarPubMed
11.Stelfox, HT, Bates, DW, Redelmeier, DA. Safety of patients isolated for infection control. JAMA 2003;290:1899–1905.Google Scholar
12.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
13.Weese, JS, Rousseau, J, Traub-Dargatz, JL, Willey, BM, McGeer, AJ, Low, DE. Community-associated methicillin-resistant Staphylococcus aureus in horses and humans who work with horses. J Am Vet Med Assoc 2005;226:580–583.CrossRefGoogle ScholarPubMed
14.Simor, A, Boyd, D, Louie, L, McGeer, A, Mulvey, M, Willey, B. Characterization and proposed nomenclature of epidemic strains of methicillin-resistant Staphylococcus aureus in Canada. Can Commun Dis Rep 1999;25:105–108.Google Scholar
15.Katz, S, Ford, AB, Moskowitz, RW, et al. Studies of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function. JAMA 1963;185:914–919.Google Scholar
16.Pittet, D, Hugonnet, S, Harbarth, S, et al. Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Lancet 2000;356:1307–1312.Google Scholar
17.Dancer, SI. Importance of the environment in methicillin-resistant Staphylococcus aureus acquisition: the case for hospital cleaning. Lancet Infect Dis 2008;8:101–113.CrossRefGoogle ScholarPubMed
18.Ulrich, RS, Quan, X, Choudhary, R, Joseph, A, Zimring, C. The role of the physical environment in the hospital of the 21st century: a once-in-a-lifetime opportunity. The Center for Health Design, 2004. Available at: http://www.healthdesign.org/research/reports/physical_environ.php. Accessed October 20, 2007.Google Scholar
19.Kibbler, CC, Quick, A, O'Neill, AM. The effect of increased bed numbers on MRSA transmission in acute medical wards. Hosp Infect 1998;39:213–219.Google Scholar
20.Gastmeier, P, Schwab, F, Geffers, C, Ruden, H. To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units. Infect Control Hosp Epidemiol 2004;25:109–113.Google Scholar
21.MacKenzie, FM, Bruce, J, Struelens, MJ, Goossens, H, Mollison, J, Gould, IM, ARPAC Steering Group. Antimicrobial drug use and infection control practices associated with the prevalence of methicillin-resistant Staphylococcus aureus in European hospitals. Clin Microbiol Infect 2007;13:269–276.Google Scholar
22.Daeschlein, G, Assadian, O, Rangous, I, Kramer, A. Risk factors for Staphylococcus aureus nasal carriage in residents of three nursing homes in Germany. J Hosp Infect 2006;63:216–212.Google Scholar
23.Miyake, M, Ohbayashi, Y, Iwasaki, A, Ogawa, T, Nagahata, S. Risk factors for methicillin-resistant Staphylococcus aureus (MRSA) and use of a nasal mupirocin ointment in oral cancer inpatients. J Oral Maxillofac Surg 2007;65:2159–2163.Google Scholar
24.Lederer, SR, Riedelsdorf, G, Schiffl, H. Nasal carriage of methicillin resistant Staphylococcus aureus: the prevalence, patients at risk and the effect of elimination on outcomes among outclinic haemodialysis patients. Eur J Med Res 2007;12:284–288.Google Scholar
25.Lucet, JC, Grenet, K, Armand-Lefevre, L, et al. High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005;26:121–126.Google Scholar
26.Eveillard, M, Ernst, C, Cuviller, S, et al. Prevalence of methicillin-resistant Staphylococcus aureus carriage at the time of admission in two acute geriatric wards. J Hosp Infect 2002;50:122–126.Google Scholar
27.Trick, WE, Weinstein, RA, De Marais, PL, et al. Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001;49:270–276.Google Scholar
28.van Werkum, JW, Ten Berg, JM, Thijs Plokker, HW, et al. Staphylococcus aureus infection complicating percutaneous coronary interventions. Int J Cardiol 2007.Google Scholar
29.Fang, A, Hu, SS, Endres, N, Bradford, DS. Risk factors for infection after spinal surgery. Spine 2005;30:1460–1465.Google Scholar
30.Chapoutot, C, Pageaux G-P, Perrigault P-F, et al. Staphylococcus aureus nasal carriage in 104 cirrhotic and control patients: a prospective study. J Hepatol 1999;30:249–253.Google Scholar
31.Schleifer, SJ, Keller, SE, Shiflett, S, Benton, T, Eckholdt, H. Immune changes in alcohol-dependent patients without medical disorders. Alcohol Clin Exp Res 1999;23:1199–1206.Google Scholar
32.Harbarth, S, Sax, H, Fankhauser-Rodriguez, C, Schrenzel, J, Agostinho, A, Pittet, D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med 2006;119:275.Google Scholar
33.Aizen, E, Ljubuncic, Z, Ljubuncic, P, Aizen, I, Potasman, I. Risk factors for methicillin-resistant Staphylococcus aureus colonization in a geriatric rehabilitation hospital. J Gerontol A Biol Sci Med Sci 2007;62:1152–1156.Google Scholar
34.Weber, SG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003;9:1415–1422.Google Scholar
35.MacDougall, C, Harpe, SE, Powel, JP, Johnson, CK, Edmond, MB, Polke, RE. Pseudomonas aeruginosa, Staphylococcus aureus and fluoroquinolone use. Emerg Infect Dis 2005;11:1197–1204.Google Scholar
36.Mahamat, A, MacKenzie, FM, Brooker, K, Monnet, DL, Daures, JP, Gould, IM. Impact of infection control interventions and antibiotic use on hospital MRSA: a multivariate interrupted time-series analysis. Int J Antimi-crob Agents 2007;30:169–176.CrossRefGoogle Scholar
37.Bisognano, C, Vaudaux, P, Rohner, P, Lew, DP, Hooper, DC. Induction of fibronectin-binding proteins and increased adhesion of quinolone-resistant Staphylococcus aureus by subinhibitory levels of ciprofloxacin. Antimicrob Agents Chemother 2000;44:1428–1437.Google Scholar
38.Muto, CA, Pokrywka, M, Shutt, K, et al. A large outbreak of Clostridium difficile-associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol 2005;26:273–280.Google Scholar
39.Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pépin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP 1/027 strain. Clin Infect Dis 2007;45(Suppl 2):S112–S121.Google Scholar
40.MacDougall, C, Polk, RE. Antimicrobial stewardship programs in health care systems. Clin Micro Rev 2005;18:638–656.CrossRefGoogle ScholarPubMed