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Staphylococcus aureus Nasal Colonization in Patients with Cirrhosis: Prospective Assessment of Association with Infection

Published online by Cambridge University Press:  02 January 2015

Feng Yee Chang ,
Nina Singh ,
Timothy Gayowski ,
Marilyn M. Wagener  and
Ignazio R. Marino
Feng Yee Chang
Affiliation:
Veterans' Affairs Medical Center, Pittsburgh, Pennsylvania
Nina Singh*
Affiliation:
Veterans' Affairs Medical Center, Pittsburgh, Pennsylvania
Timothy Gayowski
Affiliation:
Veterans' Affairs Medical Center, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Veterans' Affairs Medical Center, Pittsburgh, Pennsylvania
Ignazio R. Marino
Affiliation:
Veterans' Affairs Medical Center, Pittsburgh, Pennsylvania
*
Infectious Disease Section, VA Medical Center, University Dr C, Pittsburgh, PA 15240
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Abstract

OBJECTIVE: To determine if Staphylococcus aureus colonization of the anterior nares was a risk factor for S aureus infection in patients with cirrhosis and to determine the predictors of S aureus infection in colonized patients.

DESIGN: Prospective cohort study.

PATIENTS:84 consecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center.

RESULTS: Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MRSA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSSA). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carriers within 1 month, and 7 acquired MRSA carriage more than a month later. Higher Child-Pugh score was independently associated with MRSA carriage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3). S aureus nasal carriers (9 [23%] of 39) were significantly more likely to develop S aureus infections than noncarriers (2 [4%] of 45; P=.02). Central venous catheter use was associated independently with S aureus infections in the carriers (OR, 4.1; CI95, 2.8-6.1). Mortality was significantly higher in carriers who developed S aureus infections as compared to those who did not (57% vs 13%; P=.022); S aureus infection was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8).

CONCLUSIONS:Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhosis

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 5 , May 1998 , pp. 328 - 332
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

REFERENCES

1. McCashland, TM, Sorrell, MF, Zetterman, RK. Bacterial endocarditis in patients with chronic liver disease. Am J Gastroen-terology 1994;89:924–927.Google Scholar
2. Singh, N, Yu, VL, Wagener, MM, Gayowski, T. Fever in cirrhosis in the 1990s: a prospective study with clinical implications. Clin Infect Dis 1997;24:1135–1138. Abstract.Google Scholar
3. Weinkle, T, Schiller, R, Fehrenbach, FJ, Pohle, HD. Association between Staphylococcus aureus nasopharyngeal colonization and septicemia in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 1992;11:985–989.Google Scholar
4. Ganesh, R, Castle, D, McGibbon, D, Phillips, I, Bradbeer, C. Staphylococcal carriage and HIV infection. Lancet 1989;2:558.Google Scholar
5. Pujol, M, Pena, C, Pallares, R, Ariza, J, Ayats, J, Dominguez, MA, Gudiol, F. Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-suscepti- ble strains. Am J Med 1996;100:509–516.Google Scholar
6. Muder, RR, Brennen, C, Wagener, MM, Vickers, RM, Rihs, JD, Hancock, GA, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
7. Kirmani, N, Tuazon, CU, Murray, HW, Parrish, AE, Sheagren, JN. Staphylococcus aureus carriage rate of patients receiving longterm hemodialysis. Arch Intern Med 1978;138:1657–1659.Google Scholar
8. Nguyen, MH, Kauffman, C, Arbeit, R, Goodman, R, Squier, C, Singh, N. Staphylococcus aureus nasal carriage and infection in HIV-infected patients. In: Programs and abstracts of the 35th Interscience Conference on Antimicrobial Agents and Chemotherapy; 09 1995; San Francisco, CA. Abstract.Google Scholar
9. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, Standiford, HC, John, JF, Korvick, JA, Kauffman, CA, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.Google Scholar
10. Chow, JW, Yu, VL. Staphylococcus aureus nasal carriage in hemodialysis patients; its role in infection and approaches to prophylaxis. Arch Intern Med 1989;149:1258–1262.Google Scholar
11. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
12. Sherlock, S, Dooley, J. Hepatic cirrhosis. In: Sherlock, S, Dooley, J, eds. Diseases of the Liver and Biliary System. Oxford, England: Blackwell Scientific; 1992:357–369.Google Scholar
13. Yu, VL, Goetz, A, Wagener, M, Smith, PB, Ribs, JD, Hanchett, J, et al. Staphylococcus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. N Engl J Med 1986;315:91–96.Google Scholar
14. Densen, P, Clark, RA, Nauseef, WM. Grandcytic phagocytes. In: Mandell, GL, Benett, JE, Dolin, R, eds. Principles and Practices of Infectious Diseases. New York, NY: Churchill Livingstone; 1995:78–101.Google Scholar
15. Bailey, RJ, Woolf, IL, Cullens, H, et al. Metabolic inhibition of polymorphonuclear leukocytes in fulminant hepatic failure. Lancet 1976;1:1162–1163.Google Scholar
16. Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infections. J Infect Dis 1983;148:763.Google Scholar