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Active Surveillance to Determine the Impact of Methicillin-Resistant Staphylococcus aureus Colonization on Patients in Intensive Care Units of a Veterans Affairs Medical Center

Published online by Cambridge University Press:  02 January 2015

Mukesh Patel ,
Jeffrey D. Weinheimer ,
Ken B. Waites  and
John W. Baddley
Mukesh Patel*
Affiliation:
Birmingham Veterans Affairs Medical Center, University of Alabama at Birmingham, Birmingham, Alabama Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
Jeffrey D. Weinheimer
Affiliation:
School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama
Ken B. Waites
Affiliation:
Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
John W. Baddley
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
*
Division of Infectious Diseases, Department of Medicine, University of Alabama at Birmingham, 1900 University Boulevard, 229 Tinsley Harrison Tower, Birmingham, AL 35294–0006 ([email protected])
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Abstract

Objective.

The impact of methicillin-resistant Staphylococcus aureus (MRSA) colonization on mortality has not been well characterized. We sought to describe the impact of MRSA colonization on patients admitted to intensive care units (ICUs) in the Birmingham Veterans Affairs Medical Center (VAMC).

Methods.

We conducted a retrospective cohort study of ICU patients at the Birmingham VAMC during 2005 to evaluate the predictors of MRSA colonization and determine its effect on clinical outcomes. Surveillance cultures for MRSA were performed on admission to the ICU and weekly thereafter. Clinical findings, the incidence of MRSA infection, and mortality within 3 months after ICU admission were recorded. Predictors of mortality and S. aureus colonization were determined using multivariable models.

Results.

S. aureus colonization was present in 97 (23.3%) of 416 patients screened, of whom 67 (16.1%) were colonized with methicillin-susceptible S. aureus (MSSA) and 30 (7.2%) with MRSA. All-cause mortality at 3 months among MRSA-colonized patients was significantly greater than that among MSSA-colonized patients (46.7% vs 19.4%; P = .009). MRSA colonization was an independent predictor of death (adjusted odds ratio [OR] ,3.7 [95% confidence interval {CI}, 1.5–8.9]; P = .003) and onset of MRSA infection after hospital discharge (adjusted OR, 7.6 [95% CI, 2.48–23.2]; P < .001). Risk factors for MRSA colonization included recent antibiotic use (adjusted OR, 4.8 [95% CI, 1.9–12.2]; P = .001) and dialysis (adjusted OR, 18.9 [95% CI, 2.1–167.8]; P = .008).

Conclusions.

Among ICU patients, MRSA colonization is associated with subsequent MRSA infection and an all-cause mortality that is greater than that for MSSA colonization. Active surveillance for MRSA colonization may identify individuals at risk for these adverse outcomes. Prospective studies of outcomes in MRSA-colonized patients may better define the role of programs for active MRSA surveillance.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 6 , June 2008 , pp. 503 - 509
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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References

1.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 metaanalysis. Clin Infect Dis 2003;36:53–59.Google Scholar
2.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;36:592–598.CrossRefGoogle ScholarPubMed
3.Coello, R, Glynn, JR, Gaspar, C, Picazo, JJ, Fereres, J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized MRSA. J Hosp Infect 1997;37:39–46.CrossRefGoogle Scholar
4.Roghmann, MC, Siddiqui, A, Plaisance, K, Standiford, H. MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers. JHosp Infect 2001;47:98–103.Google ScholarPubMed
5.Davis, KA, Stewart, JJ, Crouch, HK, Florez, CE, Hospenthal, DR. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004;39:776–782.Google Scholar
6.Huang, SS, Piatt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.Google Scholar
7.Weber, SG, Huang, SS, Oriola, S, et al. Legislative mandates for use of active surveillance cultures to screen for methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci: position statement from the joint SHEA and APIC task force. Am J Infect Control 2007;35:73–85.CrossRefGoogle ScholarPubMed
8.Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.CrossRefGoogle ScholarPubMed
9.Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994;78:644–650.Google Scholar
10.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195:330–338.Google Scholar
11.Huang, SS, Yokoc, DS, Hinrichsen, VL, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis 2006;43:971–978.Google Scholar
12.Clinical and Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Susceptibility Testing; Seventeenth Informational Supplement. Wayne, PA: CLSI; 2007:M100–S16.Google Scholar
13.Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.Google Scholar
14.Kuehnert, MJ, Kruszon-Moran, D, Hill, HA, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001–2002. J Infect Dis 2006;193:172–129.Google Scholar
15.Hidron, AI, Kourbatova, EV, Halvosa, JS, et al. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005;41:159–166.Google Scholar
16.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24:409–414.CrossRefGoogle ScholarPubMed
17.Graham, P, Lin, SX, Larson, EL. U.S.A population-based survey of Staphylococcus aureus colonization. Ann Intern Med 2006;144:318–325.CrossRefGoogle ScholarPubMed
18.Saiman, L, Crorquist, A, Wu, F, et al. An outbreak of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit. Infect Control Hosp Epidemiol 2003;24:317–321.Google Scholar
19.Khoury, J, Jones, M, Grim, A, Dunne, WM Jr, Fraser, V. Eradication of methicillin-resistant Staphylococcus aureus from a neonatal intensive care unit by active surveillance and aggressive infection control measures. Infect Control Hosp Epidemiol 2005;26:616–621.CrossRefGoogle ScholarPubMed
20.Back, NA, Linnemann, CC Jr, Staneck, JL, Kotagal, UR. Control of methicillin-resistant Staphylococcus aureus in a neonatal intensive care unit: use of intensive microbiologic surveillance and mupirocin. Infect Control Hosp Epidemiol 1996;17:227–231.Google Scholar
21.Suetens, C, Niclaes, L, Jans, B, et al. Methicillin-resistant Staphylococcus aureus colonization is associated with higher mortality in nursing home residents with impaired cognitive status. J Am Geriatr Soc 2006;54:1854–1860.CrossRefGoogle ScholarPubMed
22.Ridenour, GA, Wong, ES, Call, MA, Climo, MW. Duration of colonization with methicillin-resistant Staphylococcus aureus among patients in the intensive care unit: implications for intervention. Infect Control Hosp Epidemiol 2006;27:271–278.CrossRefGoogle ScholarPubMed