Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-05T08:05:11.120Z Has data issue: false hasContentIssue false
  • English
  • Français

Methicillin-Resistant Staphylococcus aureus (MRSA): Risk and Outcome of Colonized vs. Infected Patients

Published online by Cambridge University Press:  02 January 2015

Jenice N. Longfield ,
Timothy R. Townsend ,
David F. Cruess ,
Maureen Stephens ,
Catherine Bishop ,
Elizabeth Bolyard  and
Elsie Hutchinson
Jenice N. Longfield*
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Timothy R. Townsend
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
David F. Cruess
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Maureen Stephens
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Catherine Bishop
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Elizabeth Bolyard
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
Elsie Hutchinson
Affiliation:
Hospital Epidemiology Unit, The Johns Hopkins Hospital, Baltimore, Maryland and the Division of Epidemiology, Department of Preventive Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
*
Department of Preventive Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-4799
Get access Rights & Permissions [Opens in a new window]

Abstract

A retrospective study of 204 patients culture positive for methicillin-resistant Staphylococcus aureus compared infected and colonized patients. Seventy-eight patients were colonized and never developed infection (C), 24 were colonized and subsequently infected (C➧I), and 102 patients had 1 or more nosocomial infections with MRSA at time of first culture (I). The most prevalent sites of infection were wound (26.5%) and bloodstream (20.7%), whereas the respiratory tract and surgical wounds were both frequent sites of colonization. Stepwise discriminant analysis found the most important factors in differentiating likelihood of colonization vs. infection were recent prior hospitalization, history of wound debridement, and number of invasive procedures. Ten percent of (C) died and 25.5% of (I) died. MRSA contributed to death in 57.6% of the (I) deaths (p<.05). These results underscore the importance of differentiating (C) vs. (I) in hospitals where MRSA is endemic so that early specific treatment may be initiated. Risk factors for infection should be discriminated from those for acquisition of the organism.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 6 , Issue 11 , November 1985 , pp. 445 - 450
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1985

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. Kayser, FH, Mak, TM: Methicillin-resistant staphylococci. Am J Med Sci 1972;264:197–205.CrossRefGoogle ScholarPubMed
2. Boyce, JM, Causey, WA: Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control 1982;3:377–383.Google Scholar
3. Thompson, RL, Cabezudo, I, Wenzel, RP: Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med 1982;97:309–317.CrossRefGoogle ScholarPubMed
4. Hughes, JM, Culver, DH, White, JW, et al: Nosocomial infection surveillance, 1980-1982. MMWR 1984;32:1SS–16SS.Google Scholar
5. Haley, RW, Hightower, AW, Khabbaz, RF, et al: The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982;97:297–308.Google Scholar
6. Boyce, JM, White, RL, Spruill, EY: Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis 1983;148:763.Google Scholar
7. Centers for Disease Control: Outline for surveillance and control of nosocomial infections. US Department of Health, Education, and Welfare. Public Health Service, Centers for Disease Control. Atlanta, GA. (Revised) November 1976. November 1976.Google Scholar
8. Snedecor, GW, Cochran, WG: Statistical Methods, ed 9. Ames, Iowa, The Iowa State University Press, 1978; pp 20, 59.Google Scholar
9. Lilienfeld, AM, Lilienfeld, DE: Foundations of Epidemiology, ed 2. New York, Oxford University Press, 1980; p 209.Google Scholar
10. Press, JS, Wilson, S: Choosing between logistic regression and discriminant analysis. Journal of the American Statistical Association 1978;73:699–705.Google Scholar
11. Barrett, FF, McGehee, RF Jr Finland, M: Methicillin-resistant Staphylococcus aureus at Boston City Hospital: Bacteriologic and epidemiologic observations. N Engl J Med 1968;279:441–448.CrossRefGoogle ScholarPubMed
12. Ward, TT, Winn, RE, Hartstein, AI, et al: Observations relating to an inter-hospital outbreak of methicillin-resistant Staphylococcus aureus: Role of anti-microbial therapy in infection control. Infect Control 1981;2:453–459.Google Scholar
13. Myers, JP, Linnemann, CC Jr: Bacteremia due to methicillin-resistant Staphylococcus aureus . J Infect Dis 1982;145:532–536.CrossRefGoogle ScholarPubMed
14. O'Toole, RD, Drew, WL, Dahlgren, BJ, et al: An outbreak of methicillin-resistant Staphylococcus aureus infection: Observations in hospital and nursing home. JAMA 1970;213:257–263.Google Scholar
15. Klimek, JJ, Marsik, FJ, Bartlett, RC, et al: Clinical, epidemiologic and bacteriologic observations of an outbreak of methicillin-resistant Staphylococcus aureus at a large community hospital. Am J Med 1976;61:340–345.Google Scholar
16. Peacock, JE Jr Marsik, FJ, Wenzel, RP: Methicillin-resistant Staphylococcus aureus: Introduction and spread within a hospital. Ann Intern Med 1980;93:526–532.Google Scholar
17. Boyce, JM, Landry, M, Deetz, TR, et al: Epidemiologic studies of an outbreak of nosocomial methicillin-resistant Staphylococcus aureus infections. Infect Control 1981;2:110–116.Google Scholar
18. Craven, DE, Reed, C, Kollish, N, et al: A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med 1981;71:53–59.Google Scholar
19. Cafferkey, MT, Hone, R, Falkiner, FR, et al: Gentamycin and methicillin resistant Staphylococcus aureus in Dublin hospitals: Clinical and laboratory studies. J Med Microbiol 1983;16:117–127.CrossRefGoogle ScholarPubMed
20. Bock, BV, Pasiecznik, , Meyer, RD: Clinical and laboratory studies of nosocomial Staphylococcus aureus resistant to methicillin and aminoglycosides. Infect Control 1982;3(3):224–229.Google ScholarPubMed
21. Locksley, RM, Cohen, ML, Quinn, TC, et al: Multiply antibiotic-resistant Staphylococcus aureus: Introduction, transmission, and evolution of nosocomial infection. Ann Intern Med 1982;97:317–324.Google Scholar
22. Crossley, K, Loesch, D, Landesman, B, et al: An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies. J Infect Dis 1979;139:273–279.Google Scholar
23. Saraglou, G, Cromer, M, Bisno, AL: Methicillin-resistant Staphylococcus aureus: Interstate spread of nosocomial infections with emergence of gentamycin-methicillin resistant strains. Infect Control 1980;1:81–87.Google Scholar
24. Aeilts, GD, Sapico, FL, Canawati, HN, et al: Methicillin-resistant Staphylococcus aureus colonization and infection in a rehabilitation facility. J Clin Microbiol 1982;16:218–223.CrossRefGoogle Scholar
25. Linnemann, CC, Mason, M, Moore, P, et al: Methicillin-resistant Staphylococcus aureus: Experience in a general hospital over four years. Am J Epidemiol 1982;115:941–950.Google Scholar
26. Rutala, WA, Katz, EB, Sherertz, RJ, et al: Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit. J Clin Microbiol 1983;18:683–688.Google Scholar
27. Crossley, K, Landesman, B, Zaske, D: An outbreak of infections caused by strains of S. aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies. J Infect Dis 1979;139:280–287.Google Scholar
28. Finland, M: Changing patterns of susceptibility of common bacterial pathogens to antimicrobial agents. Ann Intern Med 1972;76:1009.Google Scholar
29. Bennett, JV, Brachman, PS: Hospital Infections. Boston, Little, Brown and Company, 1979; p 196.Google Scholar
30. Benner, JE, Kayser, FH: Growing clinical significance of methicillin-resistant Staphylococcus aureus . Lancet 1968;2:741–744.Google Scholar