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Prevalence of and Risk Factors for Colonization With Methicillin-Resistant Staphylococcus aureus at the Time of Hospital Admission

Published online by Cambridge University Press:  02 January 2015

John A. Jernigan ,
Amy L. Pullen ,
Laura Flowers ,
Michael Bell  and
William R. Jarvis
John A. Jernigan*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Amy L. Pullen
Affiliation:
Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
Laura Flowers
Affiliation:
Rollins School of Public Health, Emory University, Atlanta, Georgia
Michael Bell
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
William R. Jarvis
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-68, Atlanta, GA 30333
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Abstract

Objectives:

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.

Design:

Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S. aureus. A case-control study was performed to identify risk factors for MRSA colonization.

Setting:

A tertiary-care academic medical center.

Patients:

Adults presenting for hospital admission (N = 974).

Results:

S. aureus was isolated from 205 (21%) of the patients for whom cultures were performed. Methicillin-sensitive S. aureus was isolated from 179 (18.4%) of the patients, and MRSA was isolated from 26 (2.7%) of the patients. All 26 MRSA-colonized patients had been admitted to a healthcare facility in the preceding year, had at least one chronic illness, or both. In multivariate analyses comparing MRSA-colonized patients with control-patients, admission to a nursing home (odds ratio [OR], 16.5; 95% confidence interval [CI95], 1.4 to 192.1; P = .025) or a hospitalization of 5 days or longer during the preceding year (OR, 3.91; CI95, 1.1 to 13.9; P = .035) were independent predictors of MRSA colonization.

Conclusions:

Patients colonized with MRSA admitted to this hospital likely acquired the organism during previous encounters with healthcare facilities. There was no evidence that MRSA colonization occurs commonly among low-risk individuals in this community. These data suggest that evaluation of recent healthcare exposures is essential if true community acquisition of MRSA is to be confirmed.

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 6 , June 2003 , pp. 409 - 414
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. National Nosocomial Infections Surveillance (NNIS) System Report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
2.Craven, DE, Rixinger, AI, Goularte, TA, McCabe, WR. Methicillin-resistant Staphylococcus aureus bacteremia linked to intravenous drug abusers using a “shooting gallery.” Am J Med 1986;80:770–776.Google Scholar
3.Saravolatz, LD, Pohlod, DJ, Arking, LM. Community-acquired methicillin-resistant Staphylococcus aureus infections: a new source for nosocomial outbreaks. Ann Intern Med 1982;97:325–329.Google Scholar
4.Saravolatz, LD, Markowitz, N, Arking, L, Pohlod, D, Fisher, E. Methicillin-resistant Staphylococcus aureus: epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:11–16.Google Scholar
5.Centers for Disease Control and Prevention. Four pediatric deaths from community-acquired methicillin-resistant Staphylococcus aureus: Minnesota and North Dakota, 1997-1999. MMWR 1999;48:707.Google Scholar
6.Naimi, T, LeDell, K, Boxrud, D, et al.Epidemiology and clonality of community-acquired methicillin-resistant Staphylococcus aureus in Minnesota, 1996-1998. Clin Infect Dis 2001;33:990–996.Google Scholar
7.Suggs, AH, Maranan, MC, Boyle-Vavra, S, Daum, RS. Methicillin-resistant and borderline methicillin-resistant asymptomatic Staphylococcus aureus colonization in children without identifiable risk factors. Pediatr Infect Dis J 1999;18:410–414.Google Scholar
8.Frank, AL, Marcinak, JF, Mangat, PD, Schreckenberger, PC. Increase in community-acquired methicillin-resistant Staphylococcus aureus in children. Clin Infect Dis 1999;29:935–936.Google Scholar
9.Shahin, R, Johnson, IL, Jamieson, F, McGeer, A, Tolkin, J, Ford-Jones, EL. Methicillin-resistant Staphylococcus aureus carriage in a child care center following a case of disease: Toronto Child Care Center Study Group. Arch Pediatr Adolesc Med 1999;153:864–868.Google Scholar
10.Embil, J, Ramotar, K, Romance, L, et al.Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies, 1990-1992. Infect Control Hosp Epidemiol 1994;15:646–651.Google Scholar
11.Gorak, EJ, Yamada, SM, Brown, JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999;29:797–800.Google Scholar
12.Groom, A, Wolsey, D, Naimi, Xet al.Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:1201–1205.Google Scholar
13.Gosbell, I, Mercer, J, Neville, S, et al.Non-multiresistant and multiresistant methicillin-resistant Staphylococcus aureus in community-acquired infections. Med J Aust 2001;174:627–630.Google Scholar
14.Baggett, H, Hennessy, T, Leman, R, et al.Outbreak of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin infections among Alaska natives, 2000. Presented at the 39th Annual Meeting of the Infectious Diseases Society of America; October 25-28, 2001; San Francisco, CA. Abstract 16.Google Scholar
15.Berman, DS, Eisner, W, Kreiswirth, B. Community-acquired methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1993;329:1896.Google Scholar
16.Pate, KR, Nolan, RL, Bannerman, TL, Feldman, S. Methicillin-resistant Staphylococcus aureus in the community. Lancet 1995;346:978.Google Scholar
17.O'Brien, FG, Pearman, JW, Gracey, M, Riley, TV, Grubb, WB. Community strain of methicillin-resistant Staphylococcus aureus involved in a hospital outbreak. J Clin Microbiol 1999;37:2858–2862.Google Scholar
18.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.Google Scholar
19.Adcock, PM, Pastor, P, Medley, F, Patterson, JE, Murphy, TV. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998;178:577–580.Google Scholar
20.Stacey, AR, Endersby, KE, Chan, PC, Marples, RR. An outbreak of methicillin-resistant Staphylococcus aureus infection in a rugby football team. Br J Sports Med 1998;32:153–154.CrossRefGoogle Scholar
21.L'Heriteau, F, Lucet, JC, Scanvic, A, Bouvet, E. Community-acquired methicillin-resistant Staphylococcus aureus and familial transmission. JAMA 1999;282:1038–1039.Google Scholar
22.Lindenmayer, JM, Schoenfeld, S, O'Grady, R, Carney, JK. Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895–899.Google Scholar
23.Villar, E, Mohammedi, I, Duperret, S, Bouffard, Y, Bouletreau, P. Community-acquired methicillin-resistant Staphylococcus aureus right-sided infective endocarditis in a non-addict patient with ventricular septal defect. Intensive Care Med 1999;25:236–237.CrossRefGoogle Scholar
24.Layton, MC, Hierholzer, WJ Jr, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:12–17.CrossRefGoogle ScholarPubMed
25.Moreno, F, Crisp, C, Jorgensen, JH, Patterson, JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:1308–1312.Google Scholar
26.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.Google Scholar
27.Kallen, AJ, Driscoll, TJ, Thornton, S, Olson, PE, Wallace, MR. Increase in community-acquired methicillin-resistant Staphylococcus aureus at a naval medical center. J Infect Dis 2000;21:223–226.Google Scholar
28.Goetz, A, Posey, K, Fleming, J, et al.Methicillin-resistant Staphylococcus aureus in the community: a hospital-based study. Infect Control Hosp Epidemiol 1999;20:689–691.Google Scholar
29.Shopsin, B, Mathema, B, Martinez, J, et al.Prevalence of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in the community. J Infect Dis 2000;182:359–362.Google Scholar
30.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically, 2nd ed. Villanova, PA: National Committee for Clinical Laboratory Standards; 1990. Approved standard M7-A2.Google Scholar
31.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: 9th Information Supplement, vol. 19. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999. Document no. M100-S9.Google Scholar
32.Kleinbaum, D. Logistic Regression. New York: Springer-Verlag; 1994.Google Scholar
33.Sanford, MD, Widmer, AF, Bale, MJ, Jones, RN, Wenzel, RP. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994;19:1123–1128.Google Scholar
34.Sarnad, A, Banerjee, D, Carbarns, N, Ghosh, S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect 2002;51:43–46.Google Scholar
35.Frank, AL, Marcinak, JF, Mangat, PD, Schreckenberger, PC. Community-acquired and clindamycin-susceptible methicillin-resistant Staphylococcus aureus in children. Pediatr Infect Dis} 1999;18:993–1000.Google Scholar
36.Abi-Hanna, P, Frank, AL, Quinn, JP, et al.Clonal features of community-acquired methicillin-resistant Staphylococcus aureus in children. Clin Infect Dis 2000;30:630–631.Google Scholar