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Antimicrobial Therapy for Methicillin-Resistant Staphylococcus aureus Colonization in Residents and Staff of a Veterans Affairs Nursing Home Care Unit

Published online by Cambridge University Press:  21 June 2016

Larry J. Strausbaugh ,
Cleone Jacobson ,
David L. Sewell ,
Susan Potter  and
Thomas T. Ward
Larry J. Strausbaugh*
Affiliation:
Infectious Disease Section, Medical Service, the School of Medicine, Oregon Health Sciences University, Portland, Oregon Veterans Affairs Medical Center and the Division of Infectious Diseases, Department of Medicine, the School of Medicine, Oregon Health Sciences University, Portland, Oregon
Cleone Jacobson
Affiliation:
Nursing Service, the School of Medicine, Oregon Health Sciences University, Portland, Oregon
David L. Sewell
Affiliation:
Laboratory Service, the School of Medicine, Oregon Health Sciences University, Portland, Oregon Department of Pathology, the School of Medicine, Oregon Health Sciences University, Portland, Oregon
Susan Potter
Affiliation:
Research Service, the School of Medicine, Oregon Health Sciences University, Portland, Oregon
Thomas T. Ward
Affiliation:
Infectious Disease Section, Medical Service, the School of Medicine, Oregon Health Sciences University, Portland, Oregon Veterans Affairs Medical Center and the Division of Infectious Diseases, Department of Medicine, the School of Medicine, Oregon Health Sciences University, Portland, Oregon
*
Veterans Affairs Medical Center, PO Box 1034, Portland, OR 97207
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Abstract

Objective:

TO evaluate the effect of antimicrobial therapy on patients and staff colonized with methicillin-resistant Staphylococcus aureus (MRSA) in a skilled nursing facility and to assess the role of the environment as a potential reservoir for MRSA in the nursing home setting.

Design:

As part of a comprehensive program to control an MRSA outbreak in a nursing home, patients and staff colonized with MRSA received 1 of 3 antimicrobial decolonization regimens depending upon the site and extent of colonization. Followup cultures were performed during therapy and on days 2, 7, 14, and 30 following the completion of therapy. Cultures of tbe patients' inanimate environment (pajamas, sheet, and floor) were obtained during and after therapy Antimicrobial susceptibility tests were performed on 54 MRSA isolates obtained before and 44 MRSA isolates recovered after therapy

Setting:

A 120-bed Veterans Affairs nursing home care unit.

Participannts:

Thirty-six patients and 7 staff nurses colonized with MRSA at 1 or more sites.

Intervention:

Decolonization therapy with rifampin, trimethoprim-sulfamethoxazole, and clindamycin used alone or in various combinations for 5 or 10 days in conjunction with other infection control measures employed to combat the MRSA outbreak.

Results:

Twenty (56%) of the 36 NHCU patients were either persistently colonized or became recolonized with MRSA during tbe 30-day followup period. Positive cultures on day 3 during therapy frequently identified patients who subsequently exhibited persistent or recurrent colonization. Before therapy, 92% of MRSA isolates were susceptible to rifampin, whereas only 43% of the isolates obtained after therapy were susceptible. Sixteen (80%) of 20 patients with persistent or recurrent colonization had rifampin-resistant strains of MRSA isolated after therapy Twenty-three (18%) of 125 environmental cultures obtained during and after therapy from patients who exhibited persistent or recurrent colonization were positive for MRSA, in contrast to 9 (8%) of 107 from patients who were successfully decolonized.

Conclusions:

The decolonization component of the outbreak control program was judged to be ineffective and potentially hazardous because colonization persisted or recurred in more than half of the patients, and substantial antimicrobial resistance was noted in MRSA strains isolated after therapy Resistance, especially to rifampin, and possibly re-acquisition of MRSA from other human or environmental sources were 2 factors that appeared to impede the decolonization effort.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 3 , March 1992 , pp. 151 - 159
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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