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Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

David K. Warren ,
Rebecca M. Guth ,
Craig M. Coopersmith ,
Liana R. Merz ,
Jeanne E. Zack  and
Victoria J. Fraser
David K. Warren*
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri Barnes lewish Hospital, Saint Louis, Missouri
Rebecca M. Guth
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Craig M. Coopersmith
Affiliation:
Departments of Surgery and Anesthesiology, Washington University School of Medicine, Saint Louis, Missouri
Liana R. Merz
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri
Jeanne E. Zack
Affiliation:
Missouri Baptist Medical Center, Saint Louis, Missouri
Victoria J. Fraser
Affiliation:
Division of Infectious Diseases, Washington University School of Medicine, Saint Louis, Missouri Barnes lewish Hospital, Saint Louis, Missouri
*
Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8051, Saint Louis, MO 63110, (dwarren@im.wustl.edu)
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Extract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) is a cause of healthcare-associated infections among surgical intensive care unit (ICU) patients, though transmission dynamics are unclear.

Objective.

To determine the prevalence of MRSA nasal colonization at ICU admission, to identify associated independent risk factors, to determine the value of these factors in active surveillance, and to determine the incidence of and risk factors associated with MRSA acquisition.

Design.

Prospective cohort study.

Setting.

Surgical ICU at a teaching hospital.

Patients.

All patients admitted to the surgical ICU.

Results.

Active surveillance for MRSA by nasal culture was performed at ICU admission during a 15-month period. Patients who stayed in the ICU for more than 48 hours had nasal cultures performed weekly and at discharge from the ICU, and clinical data were collected prospectively. Of 1,469 patients, 122 (8%) were colonized with MRSA at admission; 75 (61%) were identified by surveillance alone. Among 775 patients who stayed in the ICU for more than 48 hours, risk factors for MRSA colonization at admission included the following: hospital admission in the past year (1-2 admissions: adjusted odds ratio [aOR], 2.60 [95% confidence interval {CI}, 1.47-4.60]; more than 2 admissions: aOR, 3.56 [95% CI, 1.72-7.40]), a hospital stay of 5 days or more prior to ICU admission (aOR, 2.54 [95% CI, 1.49-4.32]), chronic obstructive pulmonary disease (aOR, 2.16 [95% CI, 1.17-3.96]), diabetes mellitus (aOR, 1.87 [95% CI, 1.10-3.19]), and isolation of MRSA in the past 6 months (aOR, 8.18 [95% CI, 3.38-19.79]). Sixty-nine (10%) of 670 initially MRSA-negative patients acquired MRSA in the ICU (corresponding to 10.7 cases per 1,000 ICU-days at risk). Risk factors for MRSA acquisition included tracheostomy in the ICU (aOR, 2.18 [95% CI, 1.13-4.20]); decubitus ulcer (aOR, 1.72 [95% CI, 0.97-3.06]), and receipt of enteral nutrition via nasoenteric tube (aOR, 3.73 [95% CI, 1.86-7.51]), percutaneous tube (aOR, 2.35 [95% CI, 0.74-7.49]), or both (aOR, 3.33 [95% CI, 1.13-9.77]).

Conclusions.

Active surveillance detected a sizable proportion of MRSA-colonized patients not identified by clinical culture. MRSA colonization on admission was associated with recent healthcare contact and underlying disease. Acquisition was associated with potentially modifiable processes of care.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 10 , October 2006 , pp. 1032 - 1040
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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