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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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