Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T20:45:20.178Z Has data issue: false hasContentIssue false
  • English
  • Français

Duration of Methicillin-Resistant Staphylococcus aureus Carriage, According to Risk Factors for Acquisition

Published online by Cambridge University Press:  21 June 2016

Jonas Marschall  and
Kathrin Mühlemann
Jonas Marschall
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland
Kathrin Mühlemann*
Affiliation:
Department of Infectious Diseases, University Hospital Bern, Bern, Switzerland Institute for Infectious Diseases, University of Bern, Bern, Switzerland
*
Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3010 Bern, Switzerland (kafhrin.muehlemann@ink.unibe.ch)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine the duration of methicillin-resistant Staphylococcus aureus (MRSA) carriage and its determinants and the influence of eradication regimens.

Design.

Retrospective cohort study.

Setting.

A 1,033-bed tertiary care university hospital in Bern, Switzerland, in which the prevalence of methicillin resistance among S. aureus isolates is less than 5%.

Patients.

A total of 116 patients with first-time MRSA detection identified at University Hospital Bern between January 1, 2000, and December 31, 2003, were followed up for a mean duration of 16.2 months.

Results.

Sixty-eight patients (58.6%) cleared colonization, with a median time to clearance of 7.4 months. Independent determinants for shorter carriage duration were the absence of any modifiable risk factor (receipt of antibiotics, use of an indwelling device, or presence of a skin lesion) (hazard ratio [HR], 0.20 [95% confidence interval {CI}, 0.09-0.42]), absence of immunosuppressive therapy (HR, 0.49 [95% CI, 0.23-1.02]), and hemodialysis (HR, 0.08 [95% CI, 0.01-0.66]) at the time MRSA was first MRSA detected and the administration of decolonization regimen in the absence of a modifiable risk factor (HR, 2.22 [95% CI, 1.36-3.64]). Failure of decolonization treatment was associated with the presence of risk factors at the time of treatment (P = .01). Intermittent screenings that were negative for MRSA were frequent (26% of patients), occurred early after first detection of MRSA (median, 31.5 days), and were associated with a lower probability of clearing colonization (HR, 0.34 [95% CI, 0.17-0.67]) and an increased risk of MRSA infection during follow-up.

Conclusions.

Risk factors for MRSA acquisition should be carefully assessed in all MRSA carriers and should be included in infection control policies, such as the timing of decolonization treatment, the definition of MRSA clearance, and the decision of when to suspend isolation measures.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1206 - 1212
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Davis, KA, Stewart, JT, 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
2. Fishbain, JT, Lee, JC, Nguyen, HD, et al. Nosocomial transmission of meth-icillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003; 24:415–421.Google Scholar
3. Muto, CA, Jernigan, JA, Ostrowsky, BE, et al. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003; 24:362–386.Google Scholar
4. Garner, JS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996; 17:53–80.CrossRefGoogle ScholarPubMed
5. Herr, CE, Heckrodt, TH, Hofmann, FA, Schnettler, R, Eikmann, TF. Additional costs for preventing the spread of methicillin-resistant Staphylococcus aureus and a strategy for reducing these costs on a surgical ward. Infect Control Hosp Epidemiol 2003; 24:673–678.Google Scholar
6. Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus . Clin Infect Dis 1994; 19:1123–1128.Google Scholar
7. Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001; 32:1393–1398.Google Scholar
8. Vriens, MR, Blok, HE, Gigengack-Baars, AC, et al. Methicillin-resistant Staphylococcus aureus carriage among patients after hospital discharge. Infect Control Hosp Epidemiol 2005; 26:629–633.CrossRefGoogle ScholarPubMed
9. Harbarth, S, Dharan, S, Liassine, N, Herrault, P, Auckenthaler, R, Pittet, D. Randomized, placebo-controlled, double-blind trial to evaluate the efficacy of mupirocin for eradicating carriage of methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 1999; 43:1412–1416.Google Scholar
10. Parras, F, Guerrero, MC, Bouza, E, et al. Comparative study of mupirocin and oral co-trimoxazole plus topical fusidic acid in eradication of nasal carriage of methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 1995; 39:175–179.Google Scholar
11. Tomic, V, Svetina Sorli, P, Trinkaus, D, Sorli, J, Widmer, AF, Trampuz, A. Comprehensive strategy to prevent nosocomial spread of methicillin-resistant Staphylococcus aureus in a highly endemic setting. Arch Intern Med 2004; 164:2038–2043.Google Scholar
12. Loeb, M, Main, C, Walker-Dilks, C, Eady, A. Antimicrobial drugs for treating methicillin-resistant Staphylococcus aureus colonization. Cochrane Database Syst Rev 2003; (4):CD003340.CrossRefGoogle Scholar
13. Blanc, DS, Pittet, D, Ruef, C, et al. Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland. Swiss Med Wkly 2002; 132:223–229.Google Scholar
14. Fux, CA, Uehlinger, D, Bodmer, T, Droz, S, Zellweger, C, Muhlemann, K. Dynamics of hemodialysis catheter colonization by coagulase-negative staphylococci. Infect Control Hosp Epidemiol 2005; 26:567–574.CrossRefGoogle ScholarPubMed
15. Shimada, M, Kamakura, T, Itasaka, H, Matsumata, T, Hashizume, M, Sugimachi, K. The significance of methicillin-resistant Staphylococcus aureus infection in general surgery: a multivariate analysis of risk factors and preventive approaches. Surg Today 1993; 23:880–884.Google Scholar
16. Asensio, A, Guerrero, A, Quereda, A, Lizan, M, Martinez-Ferrer, M. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996; 17:20–28.CrossRefGoogle ScholarPubMed
17. Dziekan, G, Hahn, A, Thune, K, et al. Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study. J Hosp Infect 2000; 46:263–270.Google Scholar
18. Graffunder, EM, Venezia, R. Risk factors associated with nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 2002; 49:999–1005.CrossRefGoogle ScholarPubMed
19. Von Baum, H, Schmidt, C, Svoboda, D, Bock-Hensley, O, Wendt, C. Risk factors for methicillin-resistant Staphylococcus aureus carriage in residents of German nursing homes. Infect Control Hosp Epidemiol 2002; 23:511–515.Google Scholar
20. Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003; 24:409–414.Google Scholar
21. Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003; 163:181–188.CrossRefGoogle Scholar
22. Coello, R, Jimenez, J, Garcia, M, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994; 13:74–81.Google Scholar
23. MacKinnon, MM, Allen, KD. Long-term MRSA carriage in hospital patients. J Hosp Infect 2000; 46:216–221.Google Scholar
24. Frenay, HME, Vandenbroucke-Grauls, CMJE, Molkenboer, MJCH, Verhoef, J. Long-term carriage and transmission of methicillin-resistant Staphylococcus aureus after discharge from hospital. J Hosp Infect 1992; 22:207–215.Google Scholar
25. Blok, HEM, Vriens, MR, Weersink, AJL, Troelstra, A. Carriage of methicillin-resistant Staphylococcus aureus (MRSA) after discharge from hospital: follow-up for how long? a Dutch multi-centre study. J Hosp Infect 2001; 48:325–327.Google Scholar
26. Crowcroft, NS, Ronveaux, O, Monnet, DL, Mertens, R. Methicillin-resistant Staphylococcus aureus and antimicrobial use in Belgian hospitals. Infect Control Hosp Epidemiol 1999; 20:31–36.Google Scholar
27. Clement, S, Vaudaux, P, Francois, P, et al. Evidence of an intracellular reservoir in the nasal mucosa of patients with recurrent Staphylococcus aureus rhinosinusitis. J Infect Dis 2005; 192:1023–1028.Google Scholar
28. Beaujean, DJMA, Weersink, AJL, Blok, HEM, Frenay, HME, Verhoef, J. Determining risk factors for methicillin-resistant Staphylococcus aureus carriage after discharge from hospital. J Hosp Infect 1999; 42:213–218.Google Scholar
29. Coello, R, Glynn, JR, Gaspar, C, Picazo, JJ, Fereres, J. Risk factors for developing clinical infection with methicillin-resistant Staphylococcus aureus (MRSA) amongst hospital patients initially only colonized with MRSA. J Hosp Infect 1997; 37:39–46.Google Scholar
30. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991; 114:107–112.CrossRefGoogle ScholarPubMed