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Staphylococcus Aureus Colonization and the Risk of Infection in Critically Ill Patients

Published online by Cambridge University Press:  21 June 2016

Adam Keene ,
Peter Vavagiakis ,
Mei-Ho Lee ,
Kathryn Finnerty ,
Deborah Nicolls ,
Christian Cespedes ,
Bianca Quagliarello ,
Mary Ann Chiasson ,
David Chong  and
Franklin D. Lowy
Adam Keene*
Affiliation:
Division of Infectious Diseases, New York, New York
Peter Vavagiakis
Affiliation:
Panna Technologies, Inc., New York, New York
Mei-Ho Lee
Affiliation:
Division of Infectious Diseases, New York, New York
Kathryn Finnerty
Affiliation:
Department of Medicine, New York, New York
Christian Cespedes
Affiliation:
Division of Infectious Diseases, New York, New York
Bianca Quagliarello
Affiliation:
Division of Infectious Diseases, New York, New York
Mary Ann Chiasson
Affiliation:
Medical & Health Research Association of NYC, Inc., New York, New York
David Chong
Affiliation:
Division of Pulmonary and Critical Care Medicine, Columbia University College of Physicians & Surgeons, New York, New York
Franklin D. Lowy
Affiliation:
Division of Infectious Diseases, New York, New York Department of Pathology, New York, New York
*
Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467-2490.[email protected]
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Abstract

Objective:

To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients.

Design:

Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates.

Results:

Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of noncolonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%.

Conclusions:

The incidence of S. aureusinfection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible. (Infect Control Hosp Epidemiol 2005;26:622-628)

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 7 , July 2005 , pp. 622 - 628
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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