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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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