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Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus (MRSA) among Patients Admitted to Adult Intensive Care Units: The STAR*ICU Trial

Published online by Cambridge University Press:  02 January 2015

Nisha Nair ,
Ekaterina Kourbatova ,
Katharine Poole ,
Charmaine M. Huckabee ,
Patrick Murray ,
W. Charles Huskins  and
Henry M. Blumberg
Nisha Nair
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
Ekaterina Kourbatova
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Katharine Poole
Affiliation:
Rho Federal Systems Division, Chapel Hill, North Carolina
Charmaine M. Huckabee
Affiliation:
Rho Federal Systems Division, Chapel Hill, North Carolina
Patrick Murray
Affiliation:
National Institutes of Health Clinical Center, Bethesda, Maryland
W. Charles Huskins
Affiliation:
College of Medicine, Mayo Clinic, Rochester, Minnesota
Henry M. Blumberg*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia Epidemiology Department, Grady Memorial Hospital, Atlanta, Georgia
*
Division of Infectious Diseases, Emory University School of Medicine, 49 Jesse Hill Jr. Drive, Atlanta, GA30303 (henry.m.blumberg@emory.edu)
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Abstract

Background.

The multicenter, cluster-randomized Strategies to Reduce Transmission of Antimicrobial Resistant Bacteria in Intensive Care Units (STAR*ICU) trial was performed in 18 U.S. adult intensive care units (ICUs). It evaluated the effectiveness of infection control strategies to reduce the transmission of methicillin-resistant Staphylococcus aureus (MRSA) colonization and/or infection. Our study objective was to examine the molecular epidemiology of MRSA and assess the prevalence and risk factors for community acquired (CA)-MRSA genotype nasal carriage at the time of ICU admission.

Methods.

Selected MRSA isolates were subjected to molecular typing using pulsed-field gel electrophoresis.

Results.

Of 5,512 ICU patient admissions in the STAR*ICU trial during the intervention period, 626 (11%) had a nares sample culture result that was positive for MRSA. A total of 210 (34%) of 626 available isolates were selected for molecular typing by weighted random sampling. Of 210 patients, 123 (59%) were male; mean age was 63 years. Molecular typing revealed that 147 isolates (70%) were the USAIOO clone, 26 (12%) were USA300, 12 (6%) were USA500, 8 (4%) were USA800, and 17 (8%) were other MRSA genotypes. In a multivariate analysis, patients who were colonized with a CA-MRSA genotype (USA300, USA400, or USA1000) were less likely to have been hospitalized during the previous 12 months (PR [prevalence ratio], 0.39 [95% confidence interval (CI), 0.21-0.73]) and were less likely to be older (PR, 0.97 [95% CI, 0.95-0.98] per year) compared with patients who were colonized with a healthcare-associated (HA)-MRSA genotype.

Conclusion.

CA-MRSA genotypes have emerged as a cause of MRSA nares colonization among patients admitted to adult ICUs in the United States. During the study period (2006), the predominant site of CA-MRSA genotype acquisition appeared to be in the community.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 11 , November 2011 , pp. 1057 - 1063
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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