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Colonization by Staphylococcus Aureus Resistant to Methicillin and Ciprofloxacin During 20 Months' Surveillance in a Private Skilled Nursing Facility

Published online by Cambridge University Press:  02 January 2015

Yee-Lean Lee ,
Geeta Gupta ,
Thomas Cesario ,
Richard Lee ,
Sandra Nothvogel ,
James Nassar ,
Leo Flionis  and
Lauri Thrupp
Yee-Lean Lee
Affiliation:
Academic Geriatric Resources Program, Department of Medicine, University of California, Irvine, Orange, California
Geeta Gupta
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
Thomas Cesario
Affiliation:
Academic Geriatric Resources Program, Department of Medicine, University of California, Irvine, Orange, California
Richard Lee
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
Sandra Nothvogel
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
James Nassar
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
Leo Flionis
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
Lauri Thrupp*
Affiliation:
Infectious Disease Division, Department of Medicine, University of California, Irvine, Orange, California
*
Professor of Medicine, University of California, Irvine, University of California Irvine Medical Center, 101 City Dr S, Orange, CA 92668
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Abstract

Objective:

To evaluate endemic colonization with Staphylococcus aureus resistant to methicillin, ciprofloxacin, or both among patients of a private skilled nursing facility, with regard to colonization rate and site, and relation to infection and prior antibiotic use.

Design:

Prospective quarterly culture surveillance of nares and rectal specimens over 20 months' observation.

Results:

The mean prevalence was 3.8% in new admissions and 5.4% for in-house patients; cumulatively, 7.5% of the patients were colonized during the study period. The colonization rate remained stable during the study period. Screening of rectal, as well as nares, specimens detected substantially more colonized patients than would have been detected by nasal cultures alone. Five to seven percent of the colonized patients developed later infection with methicillin-ciprofloxacin-resistant S aureus. Colonized patients did not differ significantly from the noncolonized group in prior use of quinolones, but the colonized group was exposed significantly more frequently to other antibiotics than the noncolonized group. Eighty-three percent of methicillin-resistant S aureus (MRSA) isolated from infections and 89% from colonization were also ciprofloxacin resistant.

Conclusion:

Although all infecting and most colonizing isolates of MRSA were resistant to quinolones, the overall rate of colonization remained low and stable despite the continued use of quinolones. The findings suggest that good infection control practice has prevented broader spread of such strains in this facility.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 10 , October 1996 , pp. 649 - 653
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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