<i>Staphylococcus Aureus</i>Colonization and the Risk of Infection in Critically Ill Patients

Keene, Adam; Vavagiakis, Peter; Lee, Mei-Ho; Finnerty, Kathryn; Nicolls, Deborah; Cespedes, Christian; Quagliarello, Bianca; Chiasson, Mary Ann; Chong, David H.; Lowy, Franklin D.

doi:10.1086/502591

Cited by 33 publications

(29 citation statements)

References 32 publications

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“…Furthermore, in the intervention and postintervention groups respectively, 22.0% and 26.9% of patients were found to have become positive in the first week of admittance to the ICU, which shows the high risk of nasal MRSA acquisition in an endemic situation. MRSA nasal carriers rates rang from 5.6% to 12.9% in ICU patients [5,10,23], such rates being lower than the ones found in our study. As yet, little is known about the MRSA nasal carrier epidemiology in ICU patients or its subsequent clinical consequences, since few in-depth investigations have been made.…”

Section: Discussioncontrasting

confidence: 89%

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

et al. 2007

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Methicillin-resistant Staphylococcus aureus (MRSA) is endemic in most Brazilian Hospitals, and there are few studies which show the efficacy of control measures in such situations. This study evaluated intensive care unit (ICU) patients, in two years divided in control, intervention and post-intervention group. Intervention measures: hands-on educational programs for healthcare workers; early identification of MRSA infected or colonized patients, labeled with a bed-identification tag for contact isolation; nasal carriers, patients, and healthcare professionals treated with topical mupirocin for five days. The hospital infection rates in the control period were compared to the ones in the post-intervention period. Hospital infection rates were found by means of the NNISS methodology The incidence coefficients of MRSA hospital infection (monthly average of 1,000 pts/day) in the control, intervention and post-intervention groups were respectively: 10.2, 5.1 and 2.5/1,000 pts/day (p<0.001) and MRSA-originated bloodstream infections were 3.6, 0.9 and 1.8/1,000 central venous catheter/day (p=0.281). Nasal colonization in both intervention and post-intervention periods was of 30.9% and 22.1% among the hospitalized patients, respectively 54.4% and 46.1% of whom were already MRSA-positive when admitted to the unit. In the intervention period, most of those MRSA infected patients (76.2%) were nasal carrier. Mortality rates were, respectively 26.6%; 27.3% and 21.0% (p<0.001). Nasal carriers, both patients (93.7%) and healthcare professionals (88.2%), were successfully treated with topical mupirocin. Intervention measures for the prevention and control of MRSA infections in ICUs, have been efficient in the reduction of the bloodstream and MRSA-originated hospital infections incidence, and reduced the overall mortality rate significantly.

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Section: Discussioncontrasting

confidence: 89%

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

et al. 2007

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“…5 Consistent with previous reports, colonized patients were far more likely to develop subsequent infection in the 30-day postdischarge period compared with uncolonized patients, and these infections were overwhelmingly identical to the initial colonizing strain. 1113 Importantly, 89% of the colonized patients were detected on admission, with the remaining detected during their ICU stay, presumably after acquisition in the ICU.…”

Section: To Study and When The Occasion Arises To Put What One Has Lsupporting

confidence: 90%

Of Models and Methods: Our Analytic Armamentarium Applied to Methicillin-Resistant Staphylococcus aureus

2005

Infect. Control Hosp. Epidemiol.

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“…Nasal surveillance specimens are components of institutional protocols for the determination of colonization status, and in some cases, for discontinuation of CP; many protocols require such specimens to be obtained in the absence of antibiotic exposure (6). Given the widespread antibiotic use among inpatient populations, the impact of antibiotics on the ability to recover MRSA has important implications for infection control and resource utilization (7)(8)(9). To compare the effect of concurrent administration of antibiotics with activity against MRSA on the detection of MRSA from nasal surveillance swabs, we assessed the concordance of paired samples obtained in a randomized controlled trial, processed using both commercial culture and PCR assays (10).…”

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confidence: 99%

Concordance of PCR and Culture from Nasal Swabs for Detection of Methicillin-Resistant Staphylococcus aureus in a Setting of Concurrent Antistaphylococcal Antibiotics

et al. 2014

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The effect of concurrent administration of antibiotics on the detection of methicillin-resistant Staphylococcus aureus (MRSA) remains unresolved. Here, we assessed the concordance of paired nasal swabs processed using commercial PCR and culture and found high concordance in both the absence and presence of antibiotics with activity against MRSA (93. 7% MHospitals and increasingly, ambulatory settings, are endemic for methicillin-resistant Staphylococcus aureus (MRSA) (1-3). Once patients are found to have had a positive MRSA culture, they require contact precautions (CP) (4, 5). Nasal surveillance specimens are components of institutional protocols for the determination of colonization status, and in some cases, for discontinuation of CP; many protocols require such specimens to be obtained in the absence of antibiotic exposure (6). Given the widespread antibiotic use among inpatient populations, the impact of antibiotics on the ability to recover MRSA has important implications for infection control and resource utilization (7-9). To compare the effect of concurrent administration of antibiotics with activity against MRSA on the detection of MRSA from nasal surveillance swabs, we assessed the concordance of paired samples obtained in a randomized controlled trial, processed using both commercial culture and PCR assays (10). Discordance between PCR and culture results may result from the following: PCR detection of nonviable MRSA organisms, possibly affected by previous antibiotic exposure, in contrast to dependence of culture on bacterial growth; greater sensitivity of PCR than of culture techniques for detection of viable bacteria; or falsepositive PCR results due to the staphylococcal cassette chromosome (SCC) elements present in the absence of the mecA gene.(This study was presented in abstract form at ID Week, San Diego, CA, October 2012.)We performed an analysis of subjects enrolled in an investigator-initiated randomized controlled trial (registered at Clinical Trials.gov under registration no. NCT01234831). Eligible subjects for that trial included those patients admitted to the Massachusetts General Hospital (MGH) between 6 December 2010 and 16 September 2011 with a history of MRSA infection or colonization Ն90 days from the day of admission. The subjects were approached and attempts were made to screen them on days 1, 2, and 3 of hospitalization. Subjects who were enrolled and had at least one set of surveillance screens performed were included in this analysis. The subjects were screened simultaneously by study staff using both the BBL CultureSwab collection and transport system and inoculated onto BBL CHROMagar MRSA medium plates (CA) (Becton, Dickinson and Company) and commercial PCR using the Xpert MRSA real-time PCR assay on the GeneXpert platform (PCR) (Cepheid). The samples obtained within the 48 h after the administration of one or more doses of select antibiotics were considered to be obtained in the presence of "concurrent antibiotics." These antibiotics included trimethoprim-sulfamethoxazole...

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Staphylococcus AureusColonization and the Risk of Infection in Critically Ill Patients

Abstract: The incidence of S. aureus infection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible.

Cited by 33 publications

References 32 publications

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

Efficacy of a program of prevention and control for methicillin-resistant Staphylococcus aureus infections in an intensive-care unit

Of Models and Methods: Our Analytic Armamentarium Applied to Methicillin-Resistant Staphylococcus aureus

Concordance of PCR and Culture from Nasal Swabs for Detection of Methicillin-Resistant Staphylococcus aureus in a Setting of Concurrent Antistaphylococcal Antibiotics

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