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Staphylococcus Aureus Rectal Carriage and its Association with Infections in Patients in a Surgical Intensive Care Unit and a Liver Transplant Unit

Published online by Cambridge University Press:  02 January 2015

Cheryl Squier ,
John D. Rihs ,
Kathleen J. Risa ,
Asia Sagnimeni ,
Marilyn M. Wagener ,
Janet Stout ,
Robert R. Muder  and
Nina Singh
Cheryl Squier
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
John D. Rihs
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Kathleen J. Risa
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Asia Sagnimeni
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Janet Stout
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Nina Singh*
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
*
VA Medical Center, Infectious Disease Section, University Drive C, Pittsburgh, PA 15240
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Abstract

Background:

The role of rectal carriage of Staphylococcus aureus as a risk factor for nosocomial S. aureus infections in critically ill patients has not been fully discerned.

Methods:

Nasal and rectal swabs for S. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit.

Results:

Overall, 49.5% (101 of 204) of the patients never harbored S. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due to S. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P = .001). Patients with both rectal and nasal carriage were significantly more likely to develop S. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85; P = .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients with S. aureus infections.

Conclusions:

Rectal carriage represents an underappreciated reservoir for S. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk for S. aureus infections in these patients than currently realized.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 9 , September 2002 , pp. 495 - 501
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Pujol, M, Pena, C, Pallares, R, et al. Nosocomial S. aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996;100:509–516.Google Scholar
2.Ibelings, MS, Bruining, HA. Methicillin-resistant Staphylococcus aureus: acquisition and risk of death in patients in the intensive care unit. Eur J Surg 1998;164:411–418.Google Scholar
3.Wade, JJ, Rolando, N, Hayllar, K, Philpott-Howard, J, Casewell, MW, Williams, R. Bacterial and fungal infections after liver transplantation: an analysis of 284 patients. Hepatology 1995;21:1328–1366.Google Scholar
4.Singh, N, Paterson, D, Chang, FY, et al. Methicillin-resistant Staphylococcus aureus: the other emerging resistant gram-positive coccus among liver transplant recipients. Clin Infect Dis 2000;30:322–327.Google Scholar
5.Bert, F, Galdbart, JO, Zarrouk, V, et al. Association between nasal carriage of Staphylococcus aureus and infection in liver transplant recipients. Clin Infect Dis 2000;31:1295–1299.CrossRefGoogle ScholarPubMed
6.Westphal, K, Wichelhaus, TA, Strouhal, U, Kessler, P, Brade, V. Incidence and risk factors of methicillin-resistant Staphylococcus aureus colonisation/infection in an intensive care unit. Infection 1997;25:323–324.CrossRefGoogle Scholar
7.Torre-Cisneros, J, Herrero, C, Canas, E, Reguera, JM, de la Mata, M, Gomez-Bravo, MA. High mortality related with Staphylococcus aureus bacteremia after liver transplantation. Eur J Clin Microbiol Infect Dis 2002;21:385–388.Google Scholar
8.Chang, FY, Singh, N, Gayowski, T, Drenning, SD, Wagener, MM, Marino, IR. Staphylococcus aureus nasal colonization and association with infections in liver transplant recipients. Transplantation 1998;65:1169–1172.CrossRefGoogle ScholarPubMed
9.Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994;78:644–650.Google Scholar
10.Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505–520.CrossRefGoogle ScholarPubMed
11.Laterre, PF, Vandenberghe, A, Gigi, J, DelMee, M. Failure of mupirocin and Chlorhexidine to eradicate methicillin-resistant Staphylococcus aureus carriage in an intensive care unit (ICU). Presented at the Interscience Conference of Antimicrobial Agents and Chemotherapy; September 26-29, 1999; San Diego, CA Abstract #1702.Google Scholar
12.Paterson, DL, Singh, N, Gayowski, T, Marino, IR, Wagener, MM. Lack of clinical efficacy of nasal mupirocin in preventing S. aureus infections in liver transplant recipients. Presented at the 40th Interscience Conference on Antimicrobial Agents and Chemotherapy; September 1720, 2000; Toronto, Ontario, Canada. Abstract 487.Google Scholar
13.Rimland, D, Roberson, B. Gastrointestinal carriage of methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1986;24:137–138.Google Scholar
14.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions of nosocomial infections, 1998. Am J Infect Control 1988;16:128–140.Google Scholar
15.Tenover, FC, Arbeit, R, Archer, G, et al. Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus. J Clin Microbiol 1994;32:407–415.Google Scholar
16.Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
17.Harbarth, S, Liassine, N, Dharan, S, Herrault, P, Auckenthaler, R, Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:1380–1385.Google Scholar
18.Dupeyron, C, Campillo, B, Mangeney, N, Richardet, JP, Leluan, G. Carriage of Staphylococcus aureus and of gram-negative bacilli resistant to third-generation cephalosporins in cirrhotic patients: a prospective assessment of hospital-acquired infections. Infect Control Hosp Epidemiol 2001;22:427–432.Google Scholar
19.A'Court, C, Garrard, CS. Nosocomial pneumonia in the intensive care unit: mechanisms and significance. Thorax 1992;47:465–473.Google Scholar
20.Montecalvo, MA, Horowitz, H, Gedris, C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994; 38:1363–1367.Google Scholar
21.Bonten, MJM, Hayden, MK, Nathan, C, et al. Epidemiology of colonisation of patients and environment with vancomycin-resistant enterococci. Lancet 1996;348:1615–1619.CrossRefGoogle ScholarPubMed
22.Donskey, CJ, Hanrahan, JA, Hutton, RA, Rice, LB. Effect of parenteral antibiotic administration on persistence of vancomycin-resistant Enterococcus faecium in the mouse gastrointestinal tract. J Infect Dis 1999;180:384–390.Google Scholar
23.Craven, DE, Steger, KA. Nosocomial pneumonia in mechanically ventilated adult patients: epidemiology and prevention in 1996. Semin Respir Infect 1996;11:32–53.Google ScholarPubMed
24.Mouton, RP, Hermans, J, Simoons-Smit, AM, Hoogkamp-Korstanje, JA, Degener, JE, van Klingeren, B. Correlations between consumption of antibiotics and methicillin resistance in coagulase-negative staphylococci. J Antimicrob Chemother 1990;26:573–583.Google Scholar