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Quantitative Analysis and Molecular Fingerprinting of Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Different Patient Populations: A Prospective, Multicenter Study

Published online by Cambridge University Press:  02 January 2015

L. A. Mermel ,
S. J. Eells ,
M. K. Acharya ,
J. M. Cartony ,
D. Dacus ,
S. Fadem ,
E. A. Gay ,
S. Gordon ,
J. R. Lonks  and
T. M. Perl
...Show all authors
L. A. Mermel*
Affiliation:
Warren Alpert Medical School of Brown University, Providence, Rhode, Island Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode, Island
S. J. Eells
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
M. K. Acharya
Affiliation:
Outcomes Research International, Hudson, Florida
J. M. Cartony
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
D. Dacus
Affiliation:
Life Care Home Health Services, Delray Beach, Florida
S. Fadem
Affiliation:
Outcomes Research International, Hudson, Florida
E. A. Gay
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
S. Gordon
Affiliation:
The Cleveland Clinic Foundation, Cleveland, Ohio
J. R. Lonks
Affiliation:
Warren Alpert Medical School of Brown University, Providence, Rhode, Island Division of Infectious Diseases, Miriam Hospital, Providence, Rhode Island
T. M. Perl
Affiliation:
Johns Hopkins Medical Institutions, Baltimore, Maryland
L. K. McDougal
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
J. E. McGowan
Affiliation:
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
G. Maxey
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
D. Morse
Affiliation:
3M Infection Prevention, St. Paul, Minnesota
F. C. Tenover
Affiliation:
Cepheid, Sunnyvale, California
*
Division of Infectious Diseases, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, ([email protected])
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Extract

Objectives.

To better understand the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection in different patient populations, to perform quantitative analysis of MRSA in nasal cultures, and to characterize strains using molecular fingerprinting.

Design.

Prospective, multicenter study.

Setting.

Eleven different inpatient and outpatient healthcare facilities.

Participants.

MRSA-positive inpatients identified in an active surveillance program; inpatients and outpatients receiving hemodialysis; inpatients and outpatients with human immunodeficiency virus (HIV) infection; patients requiring cardiac surgery; and elderly patients requiring long-term care.

Methods.

Nasal swab samples were obtained from January 23, 2006, through July 27, 2007; MRSA strains were quantified and characterized by molecular fingerprinting.

Results.

A total of 444 nares swab specimens yielded MRSA (geometric mean quantity, 794 CFU per swab; range, 3-15,000,000 CFU per swab). MRSA prevalence was 20% for elderly residents of long-term care facilities (25 of 125 residents), 16% for HIV-infected outpatients (78 of 494 outpatients), 15% for outpatients receiving hemodialysis (31 of 208 outpatients), 14% for inpatients receiving hemodialysis (86 of 623 inpatients), 3% for HIV-infected inpatients (5 of 161 inpatients), and 3% for inpatients requiring cardiac surgery (6 of 199 inpatients). The highest geometric mean quantity of MRSA was for inpatients requiring cardiac surgery (11,500 CFU per swab). An association was found between HIV infection and colonization with the USA300 or USA500 strain of MRSA (P ≤ .001). The Brazilian clone was found for the first time in the United States. Pulsed-field gel electrophoresis patterns for 11 isolates were not compatible with known USA types or clones.

Conclusion.

Nasal swab specimens positive for MRSA had a geometric mean quantity of 794 CFU per swab, with great diversity in the quantity of MRSA at this anatomic site. Outpatient populations at high risk for MRSA carriage were elderly residents of long-term care facilities, HIV-infected outpatients, and outpatients receiving hemodialysis.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 592 - 597
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.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;193:172–179.CrossRefGoogle ScholarPubMed
2.Wertheim, HF, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751–762.CrossRefGoogle ScholarPubMed
3.Hidron, AI, Edwards, JR, Patel, J, et al.NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008;29:996–1011.CrossRefGoogle Scholar
4.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5120.Google Scholar
5.Enright, MC, Day, NP, Davies, CE, Peacock, SJ, Spratt, BG. Multilocus sequence typing for characterization of methicillin-resistant and methicillin-susceptible clones of Staphylococcus aureus. J Clin Microbiol 2000; 38:1008–1015.CrossRefGoogle ScholarPubMed
6.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344: 11–16.CrossRefGoogle ScholarPubMed
7.Wertheim, HF, Vos, MC, Ott, A, et al.Risk and outcome of nosocomial Staphylococcus aureus bacteremia in nasal carriers versus non-carriers. Lancet 2004;364:703–705.Google Scholar
8.Safdar, N, Bradley, EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 2008;121:310–315.CrossRefGoogle ScholarPubMed
9.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
10.Datta, R, Huang, SS. Risk of infection and death due to methicillin-resistant Staphylococcus aureus in long-term carriers. Clin Infect Dis 2008;47:176–181.CrossRefGoogle ScholarPubMed
11.van Belkum, A, Verkaik, NJ, de Vogel, CP, et al.Reclassification of Staphylococcus aureus nasal carriage types. J Infect Dis 2009; 199(12): 1820–1826.CrossRefGoogle ScholarPubMed
12.Nouwen, JL, Ott, A, Kluytmans-Vandenbergh, MF, et al.Predicting the Staphylococcus aureus nasal carrier state: derivation and validation of a culture role. Clin Infect Dis 2004;39:806–811.CrossRefGoogle Scholar
13.Solberg, CO. A study of carriers of Staphylococcus aureus with specific regard to quantitative bacterial estimations. Acta Med Scand Suppl 1965; 436:1–96.Google Scholar
14.White, A. Relation between quantitative nasal cultures and dissemination of staphylococci. J Lab Clin Med 1961;58:273–277.Google ScholarPubMed
15.van Belkum, A, Melles, DC, Nouwen, J, et al.Co-evolutionary aspects of human colonization and infection by Staphylococcus aureus. Infect Genet Evol 2009;9:32–47.CrossRefGoogle ScholarPubMed
16.Ehrenkranz, NJ. Person-to-person transmission of Staphylococcus aureus: quantitative characterization of nasal cariers spreading infection. N Engl J Med 1964;271:225–230.CrossRefGoogle Scholar
17.Bassetti, S, Bischoff, WE, Walter, M, et al.Dispersal of Staphylococcus aureus into the air associated with a rhinovirus infection. Infect Control Hosp Epidemiol 2005;26:196–203.Google Scholar
18.White, A. Increased infection rates in heavy nasal carriers of coagulase-positive staphylococci. Antimicrob Agents Chemother (Bethesda) 1963;161: 667–670.Google ScholarPubMed
19.Kalmeijer, MD, van Nieuwland-Bollen, E, Bogaers-Hofman, D, de Baere, GA, Kluytmans, JAJW. Nasal carriage of Staphylococcus aureus is a major risk factor for surgical-site infections in orthopedic surgery. Infect Control Hosp Epidemiol 2000;21:319–323.Google Scholar
20.Pan, ES, Diep, BA, Charlebois, ED, et al.Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus-and their relation to community-associated disease activity. J Infect Dis 2005;192:811–818.Google Scholar
21.Johnson, LB, Venugopal, AA, Pawlak, J, Saravolatz, LD. Emergence of community-associated methicillin-resistant Staphylococcus aureus infection among patients with end-stage renal disease. Infect Control Hosp Epidemiol 2006;27:1057–1062.CrossRefGoogle ScholarPubMed
22.Johnson, LB, Jose, J, Yousif, F, Pawlak, J, Saravolatz, LD. Prevalence of colonization with community-associated methicillin-resistant Staphylococcus aureus among end-stage renal disease patients and healthcare workers. Infect Control Hosp Epidemiol 2009;30:4–8.Google Scholar
23.Lin, CC, Wang, JL, Lin, CY, et al.Methicillin-resistant Staphylococcus aureus bacteremia in patients with end-stage renal disease in Taiwan: distinguishing between community-associated and healthcare-associated strains. Infect Control Hosp Epidemiol 2009;30:89–92.Google Scholar
24.Wang, CY, Wu, VC, Chen, YM, Su, CT, Wu, KD, Hsueh, PR. Nasal carriage of methicillin-resistant Staphylococcus aureus among patients with end-stage renal disease. Infect Control Hosp Epidemiol 2009;30:93–94.CrossRefGoogle ScholarPubMed