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Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

Published online by Cambridge University Press:  02 January 2015

Pritish K. Tosh ,
Simon Agolory ,
Bethany L. Strong ,
Kerrie VerLee ,
Jennie Finks ,
Kayoko Hayakawa ,
Teena Chopra ,
Keith S. Kaye ,
Nicholas Gilpin  and
Christopher F. Carpenter
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Pritish K. Tosh*
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Simon Agolory
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Global AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Bethany L. Strong
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Harvard Medical School, Boston, Massachusetts
Kerrie VerLee
Affiliation:
Michigan Department of Community Health, Lansing, Michigan Council of State and Territorial Epidemiologists, Atlanta, Georgia
Jennie Finks
Affiliation:
Michigan Department of Community Health, Lansing, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Teena Chopra
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Nicholas Gilpin
Affiliation:
Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, Michigan
Christopher F. Carpenter
Affiliation:
Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, Michigan
Nadia Z. Haque
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Lois E. Lamarato
Affiliation:
Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
Marcus J. Zervos
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Valerie S. Albrecht
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sigrid K. McAllister
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Brandi Limbago
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Duncan R. MacCannell
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Linda K. McDougal
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alexander J. Kallen
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alice Y. Guh
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55901 ([email protected])
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Abstract

Background.

Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.

Objective.

Identify the prevalence of VRSA precursor organisms.

Design.

Prospective cohort with embedded case-control study.

Participants.

Southeastern Michigan adults with chronic lower-extremity wounds.

Methods.

Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).

Results.

Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.

Conclusions.

Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 954 - 960
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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