Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit
- 1 October 2006
- journal article
- Published by Cambridge University Press (CUP) in Infection Control & Hospital Epidemiology
- Vol. 27 (10) , 1032-1040
- https://doi.org/10.1086/507919
Abstract
Background.: Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.Objective.: To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.Design.: Prospective cohort study.Setting.: Surgical ICU at a teaching hospital.Patients.: All patients admitted to the surgical ICU.Results.: Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).Conclusions.: Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.Keywords
This publication has 32 references indexed in Scilit:
- National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004American Journal of Infection Control, 2004
- Do Infection Control Measures Work for Methicillin-ResistantStaphylococcus aureus?Infection Control & Hospital Epidemiology, 2004
- Comparison of Mortality Associated with Methicillin‐Resistant and Methicillin‐SusceptibleStaphylococcus aureusBacteremia: A Meta‐analysisClinical Infectious Diseases, 2003
- Risk Factors for the Transmission of Methicillin‐ResistantStaphylococcus aureusin an Adult Intensive Care Unit: Fitting a Model to the DataThe Journal of Infectious Diseases, 2002
- Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control studyJournal of Hospital Infection, 2000
- Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureusJournal of Hospital Infection, 2000
- Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patientsEuropean Journal of Clinical Microbiology & Infectious Diseases, 1997
- Prospective study of infection, colonization and carriage of methicillin-resistantStaphylococcus aureus in an outbreak affecting 990 patientsEuropean Journal of Clinical Microbiology & Infectious Diseases, 1994
- Enteral hyperalimentation as a source of nosocomial infectionJournal of Hospital Infection, 1990
- CDC definitions for nosocomial infections, 1988American Journal of Infection Control, 1988