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Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Admitted to Adult Intensive Care Units: The STAR*ICU Trial

Published online by Cambridge University Press:  02 January 2015

Nisha Nair ,
Ekaterina Kourbatova ,
Katharine Poole ,
Charmaine M. Huckabee ,
Patrick Murray ,
W. Charles Huskins  and
Henry M. Blumberg
Nisha Nair
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
Ekaterina Kourbatova
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Katharine Poole
Affiliation:
Rho Federal Systems Division, Chapel Hill, North Carolina
Charmaine M. Huckabee
Affiliation:
Rho Federal Systems Division, Chapel Hill, North Carolina
Patrick Murray
Affiliation:
National Institutes of Health Clinical Center, Bethesda, Maryland
W. Charles Huskins
Affiliation:
College of Medicine, Mayo Clinic, Rochester, Minnesota
Henry M. Blumberg*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
*
Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA30303 ([email protected])
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Abstract

Background.

The multicenter, cluster-randomized Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) trial was performed in 18 U.S. adult intensive care units (ICUs). It evaluated the effectiveness of infection control strategies to reduce the transmission of methicillin-resistant Staphylococcus aureus (MRSA) colonization and/or infection. Our study objective was to examine the molecular epidemiology of MRSA and assess the prevalence and risk factors for community acquired (CA)-MRSA genotype nasal carriage at the time of ICU admission.

Methods.

Selected MRSA isolates were subjected to molecular typing using pulsed-field gel electrophoresis.

Results.

Of 5,512 ICU patient admissions in the STAR*ICU trial during the intervention period, 626 (11%) had a nares sample culture result that was positive for MRSA. A total of 210 (34%) of 626 available isolates were selected for molecular typing by weighted random sampling. Of 210 patients, 123 (59%) were male; mean age was 63 years. Molecular typing revealed that 147 isolates (70%) were the USAIOO clone, 26 (12%) were USA300, 12 (6%) were USA500, 8 (4%) were USA800, and 17 (8%) were other MRSA genotypes. In a multivariate analysis, patients who were colonized with a CA-MRSA genotype (USA300, USA400, or USA1000) were less likely to have been hospitalized during the previous 12 months (PR [prevalence ratio], 0.39 [95% confidence interval (CI), 0.21-0.73]) and were less likely to be older (PR, 0.97 [95% CI, 0.95-0.98] per year) compared with patients who were colonized with a healthcare-associated (HA)-MRSA genotype.

Conclusion.

CA-MRSA genotypes have emerged as a cause of MRSA nares colonization among patients admitted to adult ICUs in the United States. During the study period (2006), the predominant site of CA-MRSA genotype acquisition appeared to be in the community.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1057 - 1063
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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References

1.Boucher, HW, Corey, GR. Epidemiology of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2008;46(suppl 5): S344–S349.CrossRefGoogle ScholarPubMed
2.National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) system report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32(8):470–485.CrossRefGoogle Scholar
3.Lowy, FD. Staphylococcus aureus infections. N Engl J Med 1998; 339(8):520–532.CrossRefGoogle ScholarPubMed
4.Cosgrove, SE, Sakoulas, G, Perencevich, EN, Schwaber, MJ, Karchmer, AW, Carmeli, Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003;36(1): 53–59.Google Scholar
5.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26(2): 166–174.CrossRefGoogle ScholarPubMed
6.Engemann, JJ, Carmeli, Y, Cosgrove, SE, et al. Adverse clinical and economic outcomes attributable to methicillin resistance among patients with Staphylococcus aureus surgical site infection. Clin Infect Dis 2003;36(5):592–598.Google Scholar
7.King, MD, Humphrey, BJ, Wang, YF, Kourbatova, EV, Ray, SM, Blumberg, HM. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006;144(5):309–317.CrossRefGoogle ScholarPubMed
8.Klevens, RM, Morrison, MA, Nadle, J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007;298(15):1763–1771.Google Scholar
9.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355(7):666–674.Google Scholar
10.Methicillin-resistant Staphylococcus aureus infections among competitive sports participants: Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morb Mortal Wkly Rep 2003;52(33):793–795.Google Scholar
11.Begier, EM, Frenette, K, Barrett, NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004;39(10):1446–1453.CrossRefGoogle ScholarPubMed
12.Outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections: Los Angeles County, California, 2002-2003. MMWR Morb Mortal Wkly Rep 2003;52(5):88.Google Scholar
13.Diep, BA, Chambers, HF, Graber, CJ, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med 2008;148(4):249–257.CrossRefGoogle ScholarPubMed
14.Adcock, PM, Pastor, P, Medley, F, Patterson, JE, Murphy, TV. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998;178(2):577–580.CrossRefGoogle ScholarPubMed
15.Herold, BC, Immergluck, LC, Maranan, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279(8): 593–598.Google Scholar
16.Deurenberg, RH, Stobberingh, EE. The evolution of Staphylococcus aureus. Infect Genet Evol 2008;8(6):747–763.CrossRefGoogle ScholarPubMed
17.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41 (11):5113–5120.CrossRefGoogle ScholarPubMed
18.Boyle-Vavra, S, Ereshefsky, B, Wang, CC, Daum, RS. Successful multiresistant community-associated methicillin-resistant Staphylococcus aureus lineage from Taipei, Taiwan, that carries either the novel staphylococcal chromosome cassette mec (SCCmec) type VT or SCCmec type IV. J Clin Microbiol 2005; 43(9):4719–4730.CrossRefGoogle ScholarPubMed
19.Johnson, AP, Aucken, HM, Cavendish, S, et al. Dominance of EMRSA-15 and -16 among MRSA causing nosocomial bacteraemia in the UK: analysis of isolates from the European Antimicrobial Resistance Surveillance System (EARSS). J Antimicrob Chemother 2001;48(1):143–144.Google Scholar
20.Vandenesch, F, Naimi, T, Enright, MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis 2003;9(8):978–984.CrossRefGoogle ScholarPubMed
21.Huskins, WC, Huckabee, CM, O'Grady, NP, et al. Intervention to reduce transmission of resistant bacteria in intensive care. N Engl J Med 2011;364:1407–1418.Google Scholar
22.Seybold, U, Kourbatova, EV, Johnson, JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006;42(5):647–656.CrossRefGoogle Scholar
23.Zetola, N, Francis, JS, Nuermberger, EL, Bishai, WR. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2005;5(5):275–286.CrossRefGoogle ScholarPubMed
24.Kourbatova, EV, Halvosa, JS, King, MD, Ray, SM, White, N, Blumberg, HM. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA 300 clone as a cause of health care-associated infections among patients with prosthetic joint infections. Am J Infect Control 2005;33(7):385–391.CrossRefGoogle ScholarPubMed
25.Otter, JA, French, GL. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2006;6(12):753–755.CrossRefGoogle ScholarPubMed
26.Patel, M, Kumar, RA, Stamm, AM, Hoesley, CJ, Moser, SA, Waites, KB. USA300 genotype community-associated methicillin-resistant Staphylococcus aureus as a cause of surgical site infections. J Clin Microbiol 2007;45(10):3431–3433.CrossRefGoogle ScholarPubMed
27.Said-Salim, B, Mathema, B, Kreiswirth, BN. Community-acquired methicillin-resistant Staphylococcus aureus: an emerging pathogen. Infect Control Hosp Epidemiol 2003;24(6):451–455.CrossRefGoogle ScholarPubMed
28.Corbella, X, Dominguez, MA, Pujol, M, et al. Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16(5):351–357.CrossRefGoogle ScholarPubMed
29.Seybold, U, Halvosa, JS, White, N, Voris, V, Ray, SM, Blumberg, HM. Emergence of and risk factors for methicillin-resistant Staphylococcus aureus of community origin in intensive care nurseries. Pediatrics 2008;122(5):1039–1046.Google Scholar
30.Bleasdale, SC, Trick, WE, Gonzalez, IM, Lyles, RD, Hayden, MK, Weinstein, RA. Effectiveness of Chlorhexidine bathing to reduce catheter-associated bloodstream infections in medical intensive care unit patients. Arch Intern Med 2007;167(19):2073–2079.Google Scholar
31.Como-Sabetti, K, Harriman, KH, Buck, JM, Glennen, A, Boxrud, DJ, Lynfield, R. Community-associated methicillin-resistant Staphylococcus aureus: trends in case and isolate characteristics from six years of prospective surveillance. Public Health Rep 2009;124(3):427–435.CrossRefGoogle ScholarPubMed
32.Johnson, AP, Pearson, A, Duckworth, G. Surveillance and epidemiology of MRSA bacteraemia in the UK. J Antimicrob Chemother 2005;56(3):455–462.CrossRefGoogle ScholarPubMed
33.Da Silva Coimbra, MV, Teixeira, LA, Ramos, RL, et al. Spread of the Brazilian epidemic clone of a multiresistant MRSA in two cities in Argentina. J Med Microbiol 2000;49(2):187–192.Google Scholar