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Preoperative Risk Factors for Nasal Carriage of Staphylococcus aureus

Published online by Cambridge University Press:  02 January 2015

Loreen A. Herwaldt ,
Joseph J. Cullen ,
Pamela French ,
Jianfang Hu ,
Michael A. Pfaller ,
Richard P. Wenzel  and
Trish M. Perl
Loreen A. Herwaldt*
Affiliation:
Department of Internal Medicine, Iowa City, Iowa Department of Epidemiology, Iowa City, Iowa
Joseph J. Cullen
Affiliation:
Department of Surgery, Iowa City, Iowa
Pamela French
Affiliation:
Glaxo SmithKline Pharmaceuticals, Collegeville, Pennsylvania
Jianfang Hu
Affiliation:
Department of Biostatistics, College of Public Health, Iowa City, Iowa
Michael A. Pfaller
Affiliation:
Department of Pathology, University of Iowa College of Medicine, Iowa City, Iowa
Richard P. Wenzel
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
Trish M. Perl
Affiliation:
Department of Internal Medicine, Iowa City, Iowa
*
C520-1 GH, University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1081
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Abstract

Background:

Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage.

Methods:

While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis.

Results:

Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95,1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients.

Conclusion:

Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 481 - 484
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

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