Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T16:37:13.721Z Has data issue: false hasContentIssue false
  • English
  • Français

A Systematic Literature Review and Meta-Analysis of Factors Associated with Methicillin-Resistant Staphylococcus aureus Colonization at Time of Hospital or Intensive Care Unit Admission

Published online by Cambridge University Press:  02 January 2015

James A. McKinnell ,
Loren G. Miller ,
Samantha J. Eells ,
Eric Cui  and
Susan S. Huang
James A. McKinnell*
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute at , Harbor-University of California, –Los Angeles Medical Center, Torrance, California David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California Department of Health Policy and Management, University of California, –Los Angeles Fielding School of Public Health, Los Angeles, California
Loren G. Miller
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute at , Harbor-University of California, –Los Angeles Medical Center, Torrance, California David Geffen School of Medicine, University of California–Los Angeles, Los Angeles, California
Samantha J. Eells
Affiliation:
Infectious Disease Clinical Outcomes Research Unit, Division of Infectious Disease, Los Angeles Biomedical Research Institute at , Harbor-University of California, –Los Angeles Medical Center, Torrance, California Department of Epidemiology, University of California, –Los Angeles Fielding School of Public Health, Los Angeles, California
Eric Cui
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California–Irvine School of Medicine, Irvine, California
Susan S. Huang
Affiliation:
Division of Infectious Diseases and Health Policy Research Institute, University of California–Irvine School of Medicine, Irvine, California
*
1124 West Carson Street, Box 466, Torrance, CA 90502 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Screening for methicillin-resistant Staphylococcus aureus (MRSA) in high-risk patients is a legislative mandate in 9 US states and has been adopted by many hospitals. Definitions of high risk differ among hospitals and state laws. A systematic evaluation of factors associated with colonization is lacking. We performed a systematic review of the literature to assess factors associated with MRSA colonization at hospital admission.

Design.

We searched MEDLINE from 1966 to 2012 for articles comparing MRSA colonized and noncolonized patients on hospital or intensive care unit (ICU) admission. Data were extracted using a standardized instrument. Meta-analyses were performed to identify factors associated with MRSA colonization.

Results.

We reviewed 4,381 abstracts; 29 articles met inclusion criteria (n = 76,913 patients). MRSA colonization at hospital admission was associated with recent prior hospitalization (odds ratio [OR], 2.4 [95% confidence interval (CI), 1.3–4.7]; P<.01), nursing home exposure (OR, 3.8 [95% CI, 2.3–6.3]; P< .01), and history of exposure to healthcare-associated pathogens (MRSA carriage: OR, 8.0 [95% CI, 4.2–15.1]; Clostridium difficile infection: OR, 3.4 [95% CI, 2.2–5.3]; vancomycin-resistant Enterococci carriage: OR, 3.1 [95% CI, 2.5–4.0]; P< .01 for all). Select comorbidities were associated with MRSA colonization (congestive heart failure, diabetes, pulmonary disease, immunosuppression, and renal failure; P< .01 for all), while others were not (human immunodeficiency virus, cirrhosis, and malignancy). ICU admission was not associated with an increased risk of MRSA colonization (OR, 1.1 [95% CI, 0.6–1.8]; P = .87).

Conclusions.

MRSA colonization on hospital admission was associated with healthcare contact, previous healthcare-associated pathogens, and select comorbid conditions. ICU admission was not associated with MRSA colonization, although this is commonly used in state mandates for MRSA screening. Infection prevention programs utilizing targeted MRSA screening may consider our results to define patients likely to have MRSA colonization.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 10 , October 2013 , pp. 1077 - 1086
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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.Hidron, AI, Edwards, IR, Patel, J, et al.NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006–2007. Infect Control Hosp Epidemiol 2008;29(11):996–1011.CrossRefGoogle Scholar
2.Sader, HS, Streit, IM, Fritsche, TR, Jones, RN. Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002–2004). Clin Microbiol Infect 2006;12(9):844–852.CrossRefGoogle ScholarPubMed
3.Voss, A, Milatovic, D, Wallrauch-Schwarz, C, Rosdahl, VT, Braveny, I. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994;13(1):50–55.CrossRefGoogle ScholarPubMed
4.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(10):3727–3732.CrossRefGoogle Scholar
5.Jain, R, Kralovic, SM, Evans, ME, et al.Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364(15):1419–1430.CrossRefGoogle ScholarPubMed
6.Robicsek, A, Beaumont, JL, Paule, SM, et al.Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med 2008;148(6):409–418.CrossRefGoogle ScholarPubMed
7.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24(5):362–386.CrossRefGoogle ScholarPubMed
8.Coia, JE, Duckworth, GJ, Edwards, DI, et al.Guidelines for the control and prevention of meticillin-resistant Staphylococcus aureus (MRSA) in healthcare facilities. J Hosp Infect 2006;63(suppl 1):S1–S44.CrossRefGoogle ScholarPubMed
9.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10 suppl 2):S165–S193.CrossRefGoogle ScholarPubMed
10.Bode, LG, Kluytmans, JA, Wertheim, HF, et al.Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362(1):9–17.CrossRefGoogle ScholarPubMed
11.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(8):971–978.CrossRefGoogle ScholarPubMed
12.West, TE, Guerry, C, Hiott, M, Morrow, N, Ward, K, Salgado, CD. Effect of targeted surveillance for control of methicillin-resistant Staphylococcus aureus in a community hospital system. Infect Control Hosp Epidemiol 2006;27(3):233–238.CrossRefGoogle Scholar
13.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(8):476–483.CrossRefGoogle Scholar
14.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(8):1051–1057.CrossRefGoogle ScholarPubMed
15.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 Enterococcus, and healthcare-associated bloodstream infections: results of a quasi-experimental multicenter trial. Crit Care Med 2009;37(6):1858–1865.CrossRefGoogle ScholarPubMed
16.Lee, BY, Bailey, RR, Smith, KJ, et al.Universal methicillin-resistant Staphylococcus aureus (MRSA) surveillance for adults at hospital admission: an economic model and analysis. Infect Control Hosp Epidemiol 2010;31(6):598–606.CrossRefGoogle ScholarPubMed
17.Hacek, DM, Paule, SM, Thomson, RB JrRobicsek, A, Peterson, LR. Implementation of a universal admission surveillance and decolonization program for methicillin-resistant Staphylococcus aureus (MRSA) reduces the number of MRSA and total number of S. aureus isolates reported by the clinical laboratory. J Clin Microbiol 2009;47(11):3749–3752.CrossRefGoogle ScholarPubMed
18.Dancer, SJ. Considering the introduction of universal MRSA screening. J Hosp Infect 2008;69(4):315–320.CrossRefGoogle ScholarPubMed
19.Parvez, N, Jinadatha, C, Fader, R, et al.Universal MRSA nasal surveillance: characterization of outcomes at a tertiary care center and implications for infection control. South Med J 2010;103(11):1084–1091.CrossRefGoogle Scholar
20.Association for Professionals in Infection Control and Epidemiology (APIC). MRSA Laws. Washington, DC: APIC, 2011. http://www.apic.org/Resource_/TinyMceFileManager/Advocacy-PDFs/MRSA_map.gif. Accessed March 2, 2012.Google Scholar
21. California Health and Safety Code Section 1255.8. September 25, 2008.Google Scholar
22. Illinois Compiled Statutes 210 ILCS 83, MRSA Screening and Reporting Act, Section 5. August 20, 2007.Google Scholar
23.Zaccai, JH. How to assess epidemiological studies. Postgrad Med J 2004;80(941):140–147.CrossRefGoogle ScholarPubMed
24.Friedenreich, CM. Methods for pooled analysis of epidemiologic studies. Epidemiology 1993;4(4):295–302.CrossRefGoogle ScholarPubMed
25.Bickel, PJ, Hammel, EA, O'Connell, JW. Sex bias in graduate admissions: data from Berkeley. Science 1975;187(4175):398–404.CrossRefGoogle ScholarPubMed
26.Pearl, J. Causality: Models, Reasoning, and Inference. Cambridge: Cambridge University Press, 2000.Google Scholar
27.Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994;78(4):644–650.CrossRefGoogle Scholar
28.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19(3):181–185.CrossRefGoogle ScholarPubMed
29.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(3):443–450.CrossRefGoogle ScholarPubMed
30.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(2):122–126.CrossRefGoogle ScholarPubMed
31.Samad, A, Banerjee, D, Carbarns, N, Ghosh, S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect 2002;51(1):43–46.CrossRefGoogle ScholarPubMed
32.Corea, E, de Silva, T, Perera, J. Methicillin-resistant Staphylococcus aureus: prevalence, incidence and risk factors associated with colonization in Sri Lanka. J Hosp Infect 2003;55(2):145–148.CrossRefGoogle ScholarPubMed
33.Ho, PL. Carriage of methicillin-resistant Staphylococcus aureus, ceftazidime-resistant gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Crit Care Med 2003;31(4):1175–1182.CrossRefGoogle ScholarPubMed
34.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163(2):181–188.CrossRefGoogle Scholar
35.Marshall, C, Harrington, G, Wolfe, R, Fairley, CK, Wesselingh, S, Spelman, D. Acquisition of methicillin-resistant Staphylococcus aureus in a large intensive care unit. Infect Control Hosp Epidemiol 2003;24(5):322–326.CrossRefGoogle Scholar
36.Fukuda, M, Tanaka, H, Kajiwara, Y, et al.High-risk populations for nasal carriage of methicillin-resistant Staphylococcus aureus. J Infect Chemother 2004;10(3):189–191.CrossRefGoogle ScholarPubMed
37.Merrer, J, Pisica-Donose, G, Leneveu, M, Pauthier, F. Prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among patients with femoral neck fractures: implication for antibiotic prophylaxis. Infect Control Hosp Epidemiol 2004;25(6):515–517.CrossRefGoogle ScholarPubMed
38.Hidron, Al, Kourbatova, EV, Halvosa, JS, et al.Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005;41(2):159–166.CrossRefGoogle Scholar
39.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(2):121–126.CrossRefGoogle ScholarPubMed
40.Sax, H, Harbarth, S, Gavazzi, G, et al.Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital. Age Ageing 2005;34(5):456–462.CrossRefGoogle ScholarPubMed
41.Dupeyron, C, Campillo, B, Richardet, JP, Soussy, CJ. Long-term efficacy of mupirocin in the prevention of infections with meticillin-resistant Staphylococcus aureus in a gastroenterology unit. J Hosp Infect 2006;63(4):385–392.CrossRefGoogle Scholar
42.Warren, DK, Guth, RM, Coopersmith, CM, Merz, LR, Zack, JE, Fraser, VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol 2006;27(10):1032–1040.CrossRefGoogle Scholar
43.Casas, I, Sopena, N, Esteve, M, et al.Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus carriage at hospital admission. Infect Control Hosp Epidemiol 2007;28(11):1314–1317.CrossRefGoogle ScholarPubMed
44.Chaberny, IF, Bindseil, A, Sohr, D, Gastmeier, P. A point-prevalence study for MRSA in a German university hospital to identify patients at risk and to evaluate an established admission screening procedure. Infection 2008;36(6):526–532.CrossRefGoogle Scholar
45.Riedel, S, Von Stein, D, Richardson, K, et al.Development of a prediction rule for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus carriage in a Veterans Affairs Medical Center population. Infect Control Hosp Epidemiol 2008;29(10):969–971.CrossRefGoogle Scholar
46.Russell, DL, Flood, A, Zaroda, TE, et al.Outcomes of colonization with MRSA and VRE among liver transplant candidates and recipients. Am J Transplant 2008;8(8):1737–1743.CrossRefGoogle ScholarPubMed
47.Baykam, N, Esener, H, Ergonul, O, et al.Methicillin-resistant Staphylococcus aureus on hospital admission in Turkey. Am J Infect Control 2009;37(3):247–249.CrossRefGoogle ScholarPubMed
48.Kock, R, Brakensiek, L, Mellmann, A, et al.Cross-border comparison of the admission prevalence and clonal structure of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2009;71(4):320–326.CrossRefGoogle ScholarPubMed
49.Nishikawa, M, Tanaka, T, Nakashima, K, et al.Screening for methicillin-resistant Staphylococcus aureus (MRSA) carriage on admission to a geriatric hospital. Arch Gerontol Geriatr 2009;49(2):242–245.CrossRefGoogle ScholarPubMed
50.Niven, DJ, Laupland, KB, Gregson, DB, Church, DL. Epidemiology of Staphylococcus aureus nasal colonization and influence on outcome in the critically ill. J Crit Care 2009;24(4):583–589.CrossRefGoogle ScholarPubMed
51.Creamer, E, Dolan, A, Sherlock, O, et al.The effect of rapid screening for methicillin-resistant Staphylococcus aureus (MRSA) on the identification and earlier isolation of MRSA-positive patients. Infect Control Hosp Epidemiol 2010;31(4):374–381.CrossRefGoogle ScholarPubMed
52.Honda, H, Krauss, MJ, Coopersmith, CM, et al.Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol 2010;31(6):584–591.CrossRefGoogle ScholarPubMed
53.Keene, A, Lemos-Filho, L, Levi, M, et al.The use of a critical care consult team to identify risk for methicillin-resistant Staphylococcus aureus infection and the potential for early intervention: a pilot study. Crit Care Med 2010;38(1):109–113.CrossRefGoogle Scholar
54.Wright, MO, Kharasch, M, Beaumont, JL, Peterson, LR, Robicsek, A. Reporting catheter-associated urinary tract infections: denominator matters. Infect Control Hosp Epidemiol 2011;32(7):635–640.CrossRefGoogle ScholarPubMed
55.Robicsek, A, Beaumont, JL, Wright, MO, Thomson, RB JrKaul, KL, Peterson, LR. Electronic prediction rules for methicillin-resistant Staphylococcus aureus colonization. Infect Control Hosp Epidemiol 2011;32(1):9–19.CrossRefGoogle ScholarPubMed
56.University of California San Francisco (UCSF) Department of Hospital Epidemiology and Infection Control. Active Surveillance Testing (AST) for Methicillin-Resistant Staphylococcus aureus (MRSA). Policy 4.6. San Francisco: UCSF, 2011.Google Scholar
57.Tacconelli, E, De Angelis, G, Cataldo, MA, Pozzi, E, Cauda, R. Does antibiotic exposure increase the risk of methicillin-resistant Staphylococcus aureus (MRSA) isolation? a systematic review and meta-analysis. J Antimicrob Chemother 2008;61(1):26–38.CrossRefGoogle ScholarPubMed
58.Paterson, DL. “Collateral damage” from cephalosporin or quinolone antibiotic therapy. Clin Infect Dis 2004;38(suppl 4):S341–S345.CrossRefGoogle ScholarPubMed
59.Robicsek, A, Beaumont, JL, Peterson, LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2009;48(7):910–913.CrossRefGoogle ScholarPubMed
60.Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32(10):1393–1398.CrossRefGoogle ScholarPubMed
61.Larsson, AK, Gustafsson, E, Nilsson, AC, Odenholt, I, Ringberg, H, Melander, E. Duration of methicillin-resistant Staphylococcus aureus colonization after diagnosis: a four-year experience from southern Sweden. Scand J Infect Dis 2011;43(6/7):456–462.CrossRefGoogle ScholarPubMed
62.Popovich, KJ, Hota, B, Aroutcheva, A, et al.Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients. Clin Infect Dis 2013;56(8):1067–1074.CrossRefGoogle ScholarPubMed
63.Shet, A, Mathema, B, Mediavilla, JR, et al.Colonization and subsequent skin and soft tissue infection due to methicillin-resistant Staphylococcus aureus in a cohort of otherwise healthy adults infected with HIV type 1. J Infect Dis 2009;200(1):88–93.CrossRefGoogle Scholar
64.Miller, M, Cespedes, C, Bhat, M, Vavagiakis, P, Klein, RS, Lowy, FD. Incidence and persistence of Staphylococcus aureus nasal colonization in a community sample of HIV-infected and -uninfected drug users. Clin Infect Dis 2007;45(3):343–346.CrossRefGoogle Scholar
65.El-Sharif, A, Ashour, HM. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) colonization and infection in intravenous and inhalational opiate drug abusers. Exp Biol Med (Maywood) 2008;233(7):874–880.CrossRefGoogle ScholarPubMed
66.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(5):328–332.CrossRefGoogle ScholarPubMed
67.Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, et al.Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001–2002. J Infect Dis 2006;193(2):172–179.CrossRefGoogle ScholarPubMed
68.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al.Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001–2004. J Infect Dis 2008;197(9):1226–1234.CrossRefGoogle ScholarPubMed
69.McKinnell, JA, Huang, SS, Eells, SJ, Cui, E, Miller, LG. Quantifying the impact of extranasal testing of body sites for mefhicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013;34(2)161–170.CrossRefGoogle ScholarPubMed
70.Matheson, A, Christie, P, Stari, T, et al.Nasal swab screening for methicillin-resistant Staphylococcus aureus—how well does it perform? a cross-sectional study. Infect Control Hosp Epidemiol 2012;33(8):803–808.CrossRefGoogle ScholarPubMed
71.Morgan, DJ, Day, HR, Furuno, JP, et al.Improving efficiency in active surveillance for methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus at hospital admission. Infect Control Hosp Epidemiol 2010;31(12):1230–1235.CrossRefGoogle ScholarPubMed