Hostname: page-component-848d4c4894-m9kch Total loading time: 0 Render date: 2024-05-23T07:42:25.528Z Has data issue: false hasContentIssue false
  • English
  • Français

Staphylococcus aureus Nasal Colonization and Colonization or Infection at Other Body Sites in Patients on a Burn Trauma Unit

Published online by Cambridge University Press:  02 January 2015

Amber Reighard ,
Daniel Diekema ,
Lucy Wibbenmeyer ,
Melissa Ward  and
Loreen Herwaldt
Amber Reighard
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Daniel Diekema
Affiliation:
Department of Internal Medicine, Iowa City, Iowa Department of Pathology, Iowa City, Iowa University of Iowa, and the Department of Clinical Quality, Safety, and Performance Improvement, the University of Iowa Hospitals and Clinics, Iowa City, Iowa Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Lucy Wibbenmeyer
Affiliation:
Department of Surgery, Iowa City, Iowa Iowa City Veterans Affairs Medical Center, Iowa City, Iowa
Melissa Ward
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Loreen Herwaldt*
Affiliation:
Department of Internal Medicine, Iowa City, Iowa Carver College of Medicine, and the Department of Epidemiology, College of Public Health, Iowa City, Iowa University of Iowa, and the Department of Clinical Quality, Safety, and Performance Improvement, the University of Iowa Hospitals and Clinics, Iowa City, Iowa
*
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1081 (loreen-herwaldt@uiowa.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To determine whether Staphylococcus aureus isolates from the nares of patients on a burn trauma unit were related to isolates colonizing or infecting other body sites.

Design.

Active surveillance for S. aureus, a case-control study, and pulsed-field gel electrophoresis of S. aureus isolates.

Setting.

A burn trauma unit of a Midwestern university teaching hospital.

Patients.

Patients admitted from February 1, 2002, through March 30, 2007, who had S. aureus isolated either from a nasal culture and from another body site (case patients) or from a nasal culture alone (control subjects).

Results.

Nineteen patients met the case patient definition and had paired isolates from the nares and an additional site available for typing. Of the 19 case patients, 8 had infections, 7 of which were caused by methicillin-resistant S. aureus (5 USA100 strain and 2 USA300 strain). A total length of stay of more than 3 weeks (odds ratio [OR], 8.75 [95% confidence interval {CI}, 2.2–34.6]; P = .002), residence in a long-term care facility (OR, 9.4 [95% CI, 2.1–42.5]; P = .004), and diabetes (OR, 3.2 [95% CI, 1.0–10.0]; P = .05) were associated with the isolation of S. aureus from the nares and other sites. Seventeen case patients (89.5%) had closely related isolates obtained from culture of samples from the nares and from other sites.

Conclusions.

Prolonged length of stay, diabetes, or residing in a long-term care facility increased the risk of having S. aureus at sites other than the nares. S. aureus isolates from other body sites usually were closely related to nasal isolates. Most case patients had colonized or infected wounds that could be a source of S. aureus for other patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 8 , August 2009 , pp. 721 - 726
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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.Barlow, Y. T lymphocytes and immunosuppression in the burned patient: a review. Burns 1994;20:487–490.Google Scholar
2.Cook, N. Methicillin-resistant Staphylococcus aureus versus the burn patient. Burns 1998;24:91–98.Google Scholar
3.Fuchs, PC, Kopp, J, Hafner, H, Kleiner Pallua, N. MRSA: retrospective analysis of an outbreak in the burn centre Aachen. Burns 2002;28:575–578.Google Scholar
4.Embil, JM, McLeod, JA, Al-Barrak, AM, et, al. An outbreak of methicillin-resistant Staphylococcus aureus on a burn unit: potential role of contaminated hydrotherapy equipment. Burns 2001;27:681–688.Google Scholar
5.Herwaldt, LA, Latenser, BA, Wibbenmeyer, L, Coffman, S, Winokur, P, Diekema, D. “Miliary” infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in a burn center. In: Program and abstracts of the 16th Annual Scientific Meeting of the Society for Healthcare Epidemiology of America; March 18-21, 2006; Chicago, IL. Abstract 321.Google Scholar
6.Keene, A, Vavagiakis, P, Lee, MH, et al.Staphylococcus aureus colonization and the risk of infection in critically ill patients. Infect Control Hosp Epidemiol 2005;26:622–628.Google Scholar
7.Von Eiff, C, Becker, K, Machka, K, et al.Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:11–16.CrossRefGoogle ScholarPubMed
8.Pujol, M, Pena, C, Pallares, R, et al.Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains. Am J Med 1996;100:509–516.CrossRefGoogle ScholarPubMed
9.Davis, KA, Stewart, JJ, 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.CrossRefGoogle ScholarPubMed
10.Huang, SS, Platt, R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003;36:281–285.CrossRefGoogle ScholarPubMed
11.Huang, SS, Rifas-Shiman, SL, Warren, DK, et al; Centers for Disease Control and Prevention Epicenters Program. Improving MRSA surveillance and reporting in ICUs. J Infect Dis 2007;195:330–338.CrossRefGoogle Scholar
12.Wibbenmeyer, L, Danks, R, Faucher, L, et al.Prospective analysis of nosocomial infection rates, antibiotic use and patterns of resistance in a bum population. J Burn Care Res 2006;27:152–160.CrossRefGoogle Scholar
13.Bannerman, TL, Peacock, SJ. Staphylococcus, Micrococcus, and other cat-alase-positive cocci. In: Murray, P, Baron, E, Jorgensen, J, Landry, M, Pfaller, M, eds. Manual of Clinical Microbiology. 9th ed. Washington, DC: American Society for Microbiology; 2007.Google Scholar
14.Clinical and Laboratory Standards Institute (CLSI). Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria that Grow Aerobically. Villanova, PA: CLSI; 2006:M07–A7.Google Scholar
15.Flayhart, D, Hindler, JF, Bruckner, DA, et al.Multicenter evaluation of BBL CHROMagar MRSA medium for direct detection of MRSA from surveillance cultures of the anterior nares. J Clin Microbiol 2005;43:5536–5540.Google Scholar
16.Pfaller, MA, Hollis, RJ, Sader, HS. Chromosomal restriction fragment analysis by pulsed-field gel electrophoresis. In: Isenberg, HD, ed. Clinical Microbiology Procedures Handbook. Supplement 1. Washington, DC: American Society for Microbiology; 1994:10.5.c.1–10.5.c.12.Google Scholar
17.McDougal, LK, Steward, CD, Killgore, GE, Chaitram, JM, McAllister, SK, Tenover, FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003;41:5113–5120.Google Scholar
18.Taylor, GD, Kibsey, P, Kirkland, T, Burroughs, E, Tredget, E. Predominance of staphylococcal organisms in infections occurring in a burns intensive care unit. Burns 1992;18:332–335.Google Scholar
19.Applegren, P, Björnhagen, V, Bragderyd, K, Evert Jonsson, C, Ransjö, U. A prospective study of infections in burn patients. Burns 2002;28:39–46.CrossRefGoogle Scholar
20.Kooistra-Smid, M, van Dijk, S, Beerthuizen, G, et al.Molecular epidemiology of Staphylococcus aureus colonization in a burn center. Burns 2004;30:27–33.Google Scholar
21.Hoefhagels-Schuermans, A, Niclaes, L, Buntinx, F, et al.Molecular epidemiology of methicillin-resistant Staphylococcus aureus in nursing homes: a cross-sectional study. Infect Control Hosp Epidemiol 2002;23:546–549.Google Scholar
22.Bradley, SF. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999;106:2S–10S.CrossRefGoogle ScholarPubMed
23.Tuazon, CU, Perez, A, Kishaba, T, Sheagren, JN. Staphylococcus aureus among insulin-injecting diabetic patients: an increased carrier rate. JAMA 1975;231:1272.CrossRefGoogle ScholarPubMed
24.Mody, L, Kauffman, CA, Donabedian, S, Zervos, M, Bradley, SF. Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 2008;46:1368–1373.CrossRefGoogle ScholarPubMed
25.Garrouste-Orgeas, M, Timsit, JF, Kallel, H, et al.Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: morbidity, mortality, and glycopeptides. Infect Control Hosp Epidemiol 2001;22:687–692.CrossRefGoogle Scholar