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Extranasal Methicillin-Resistant Staphylococcus aureus Colonization at Admission to an Acute Care Veterans Affairs Hospital

Published online by Cambridge University Press:  02 January 2015

Stacey E. Baker ,
Stephen M. Brecher ,
Ernest Robillard ,
Judith Strymish ,
Elizabeth Lawler  and
Kalpana Gupta
Stacey E. Baker
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Stephen M. Brecher
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Ernest Robillard
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Judith Strymish
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Elizabeth Lawler
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
Kalpana Gupta*
Affiliation:
Veterans Affairs Boston Health Care System, Boston, Massachusetts
*
Veterans Affairs Boston Health Care System, 150 South Huntington Avenue, 151 MAV, Boston, MA 02130 ([email protected])
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Extract

Objective.

To evaluate the prevalence of and risk factors for extranasal methicillin-resistant Staphylococcus aureus (MRSA) colonization and its relationship to nasal colonization among veterans hospitalized for acute care.

Design.

Prospective observational study.

Setting.

Veterans Affairs (VA) acute care hospital in Boston, Massachusetts.

Patients.

Convenience sample of 150 patients hospitalized within the previous 36 hours and screened for nasal MRSA who were not known to have an active MRSA infection or MRSA isolates recovered from a wound during the past 12 months.

Methods.

Potential risk factors for MRSA colonization were assessed, and oropharynx, axilla, hand, perirectal, wound, and catheter insertion site samples were obtained for culture. MRSA was identified in chromogenic agar and confirmed by use of routine culture techniques. Nasal MRSA colonization was detected by means of polymerase chain reaction (PCR).

Results.

Nasal swab samples analyzed by use of PCR yielded results positive for MRSA in 16 (11%) of 150 patients. Extranasal cultures yielded positive results for 3 (2%) of 134 patients who tested negative for nasal MRSA colonization and for 9 (56%) of 16 patients who tested positive for nasal MRSA colonization (odds ratio [OR], 56.1 [95% confidence interval {CI}, 12.4-254.6]; P <.001). The oropharynx was the most commonly colonized extranasal site (10 patients [7%]). Independent risk factors for extranasal MRSA colonization included nasal MRSA colonization (OR, 66.9 [95% CI, 11.8-379.7]; P <.001) and end-stage hepatic disease (OR, 98.5 [95% CI, 3.1-3,112.4]; P = .01).

Conclusions.

Extranasal MRSA colonization is infrequent among veterans admitted for acute care to VA Boston Healthcare System. Extranasal MRSA colonization was strongly associated with nasal MRSA colonization, which suggests that the VA MRSA Prevention Initiative is not missing a large number of MRSA-colonized patients by focusing on nasal-only screening.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 1 , January 2010 , pp. 42 - 46
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Müder, RR, Cunningham, C, McCray, E, et al. Implementation of at industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphybcoccus aureus infection. Infect Control Hosp Epidemiol 2008;29:702–708.Google Scholar
2.Chang, S, Sethi, A, Eckstein, B, Stiefel, U, Cadnum, J, Donskey, C. Skin and environmental contamination with methicillin-resistant Staphylococcus aureus among carriers identified clinically versus through active surveillance. Clin Infect Dis 2009;48:1423–1428.CrossRefGoogle ScholarPubMed
3.Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.CrossRefGoogle ScholarPubMed
4.Rohr, U, Wilhelm, M, Muhr, G, Gatermann, S. Qualitative and (semiquantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients. Int J Hyg Environ Health 2004;207:51–55.Google Scholar
5.Ringberg, H, Cathrine Petersson, A, Walder, M, Hugo Johansson, PJ. The throat: an important site for MRSA colonization. Scand J Infect Dis 2006;38:888–893.CrossRefGoogle ScholarPubMed
6.Kerttula, AM, Lyytikainen, O, Virolainen, A, Finne-Soveri, H, Agthe, N, Vuo-pio-Varkila, J. Staphylococcus aureus colonization among nursing home residents in a large Finnish nursing home. Scand J Infect Dis 2007;39:996–1001.CrossRefGoogle Scholar
7.Roghmann, MC, Gorman, PH, Wallin, MT, Kreisel, K, Shurland, S, Johnson, JA. Staphylococcus aureus colonization in community-dwelling people with spinal cord dysfunction. Arch Phys Med Rehabil 2007;88:979–983.Google Scholar
8.Aizen, E, Ljubuncic, Z, Ljubuncic, P, Aizen, I, Potasman, I. Risk factors for methicillin-resistant Staphylococcus aureus colonization in a geriatric rehabilitation hospital. J Gerontol A Biol Sci Med Sci 2007;62:1152–1156.CrossRefGoogle Scholar
9.Eveillard, M, de Lassence, A, Landen, E, Barnaud, G, Ricard, JD, Joly-Guillou, ML. Evaluation of a strategy of screening multiple anatomical sites for methicillin-resistant Staphylococcus aureus at admission to a teaching hospital. Infect Control Hosp Epidemiol 2006;27:181–184.Google Scholar
10.Shurland, SM, Stine, OC, Venezia, RA, et al. Colonization sites of USA300 methicillin-resistant Staphylococcus aureus in residents of extended care facilities. Infect Control Hosp Epidemiol 2009;30:313–318.CrossRefGoogle ScholarPubMed
11.Marschall, J, Muhlemann, K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006;27:1206–1212.Google Scholar
12.Mertz, D, Frei, R, Jaussi, B, et al. Throat swabs are necessary to reliably detect carriers of Staphylococcus aureus. Clin Infect Dis 2007;45:475–477.Google Scholar
13.Mertz, D, Frei, R, Periat, N, et al. Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 2009;169:172–178.Google Scholar
14.Nilsson, P, Ripa, T. Staphylococcus aureus throat colonization in more frequent than colonization in the anterior nares. J Clin Microbiol 2006;44:3334–3339.CrossRefGoogle ScholarPubMed
15.Marshall, C, Spelman, D. Is throat screening necessary to detect methicillin-resistant Staphylococcus aureus colonization in patients upon admission to an intensive care unit? J Clin Microbiol 2007;45:3855.Google Scholar
16.Miller, LG, Diep, BA. Clinical practice: colonization, fomites, and virulence: rethinking the pathogenesis of community-associated methicillin-resistant Staphylococcus aureus infection. Clin Infect Dis 2008;46:752–760.Google Scholar