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Prevalence of and Risk Factors for Colonization With Methicillin-Resistant Staphylococcus aureus in an Outpatient Clinic Population

  • John A. Jernigan (a1) (a2), Amy L. Pullen (a3), Clyde Partin (a4) and William R. Jarvis (a2)

Abstract

Objecttves:

To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in an outpatient population and to identify risk factors for MRSA colonization.

Design:

Surveillance cultures were performed during outpatient visits to identify S. aureus colonization. A case-control study was performed to identify risk factors for MRSA colonization.

Setting:

Primary care internal medicine clinic. PATTENTS: Adults presenting for non-acute primary care (N = 494).

Results:

S. aureus was isolated from 122 (24.7%) of the patients for whom cultures were performed. Methicillin-susceptible S. aureus was isolated from 107 (21.7%) of the patients, whereas MRSA was isolated from 15 (3.0%) of the patients. All MRSA isolates were resistant to multiple non-beta-lactam antimicrobial agents. In multivariate analyses, MRSA colonization was independently associated with admission to a nursing home (adjusted odds ratio [OR], 103; 95% confidence interval [CI95], 7 to 999) or hospital in the previous year, although the association with hospital admission was observed only among those without chronic illness (adjusted OR 7.1; CI95, 1.3 to 38.1). In addition, MRSA colonization was associated with the presence of at least one underlying chronic illness, although this association was observed only among those who had not been hospitalized in the previous year (adjusted OR, 5.1; CI95, 1.2 to 21.9).

Conclusions:

We found a low prevalence of MRSA colonization in an adult outpatient population. MRSA carriers most likely acquired the organism through contact with healthcare facilities rather than in the community. These data show that care must be taken when attributing MRSA colonization to the community if detected in outpatients or during the first 24 to 48 hours of hospitalization.

Copyright

Corresponding author

Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Mailstop E-68, Atlanta, GA 30333

References

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1.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.
2.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;33:990996.
3.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;18:410414.
4.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.
5.Adcock, PM, Pastor, P, Medley, F, Patterson, JE, Murphy, TV. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998;178:577580.
6.Frank, AL, Marcinak, IF, Mangat, PD, Schreckenberger, PC. Increase in community-acquired methicillin-resistant Staphylococcus aureus in children. Clin Infect Dis 1999;29:935936.
7.Embil, J, Rarnotar, K, Romance, L, et al.Methicillin-resistant Staphylococcus aureus in tertiary care institutions on the Canadian prairies, 1990-1992. Infect Control Hosp Epidemiol 1994;15:646651.
8.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;153:864868.
9.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;29:797800.
10.Groom, A, Wolsey, D, Naimi, T, et al.Community-acquired methicillinresistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:12011205.
11.Gosbell, I, Mercer, J, Neville, S, et al.Non-multiresistant and multiresis-tant methicillin-resistant Staphylococcus aureus in community-acquired infections. Med J Aust 2001;174:627630.
12.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.
13.Berman, DS, Eisner, W, Kreiswirth, B. Community-acquired methicillin-resistant Staphylococcus aureus infection. N Engl J Med 1993;329:1896.
14.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;32:153154.
15.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;158:895899.
16.Goetz, A, Posey, K, Fleming, J, et al.Methicillin-resistant Staphylococcus aureus in the community: a hospital-based study. Infect Control Hosp Epidemiol 1999;20:689691.
17.Suntharam, N, Hacek, D, Petersen, L. Low prevalence of community-acquired methicillin-resistant Staphylococcus aureus in adults at a university hospital in the central United States. J Clin Microbiol 2001;39:16691671.
18.Rezende, N, Blumberg, H, Metzger, B, Larsen, N, Ray, S, McGowan, J. Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 2002;323:117123.
19.Bukharie, H, Abdelhadi, M, Saeed, I, Rubaish, A, Larbi, E. Emergence of methicillin-resistant Staphylococcus aureus as a community pathogen. Diagn Microbiol Infect Dis 2001;40:14.
20.Layton, MC, Hierholzer, WJ Jr, Patterson, JE. The evolving epidemiology of methicillin-resistant Staphylococcus aureus at a university hospital. Infect Control Hosp Epidemiol 1995;16:1217.
21.Moreno, F, Crisp, C, Jorgensen, JH, Patterson, JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:13081312.
22.Morin, C, Hadler, J. Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. J Infect Dis 2001;184:10291034.
23.Hollis, RJ, Barr, JL, Doebbeling, BN, Pfaller, MA, Wenzel, RP. Familial carriage of methicillin-resistant Staphylococcus aureus and subsequent infection in a premature neonate. Clin Infect Dis 1995;21:328332.
24.Charlebois, E, Bangsberg, D, Moss, N, et al.Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clin Infect Dis 2002;34:425433.
25.Abudu, L, Blair, I, Fraise, A, Cheng, K. Methicillin-resistant Staphylococcus aureus (MRSA): a community-based prevalence survey. Epidemiol Infect 2001;126:351356.
26.Sa-Leao, R, Sanches, I, Couto, I, Alves, C, de Lancastre, H. Low prevalence of methicillin-resistant strains among Staphylococcus aureus colonizing young and healthy members of the community in Portugal. Microb Drug Resist 2001;7:237245.
27.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.
28.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing: 9th Information Supplement. Wayne, PA: National Committee for Clinical Laboratory Standards; 1999. Document no. M100-S9.
29.Kleinbaum, D. Logistic Regression. New York: Springer-Verlag; 1994.
30.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24:409414.
31.Samad, 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;51:4346.
32.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181185.
33.Shopsin, B, Mathema, B, Martinez, J, et al.Prevalence of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in the community. J Infect Dis 2000;182:359362.
34.Fergie, J, Purcell, K. Community-acquired methicillin-resistant Staphylococcus aureus infections in South Texas children. Pediatr Infect Dis J 2001;20:860863.
35.Maguire, G, Arthur, A, Boustead, P, Dwyer, B, Currie, B. Clinical experience and outcomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 1998;38:273281.
36.Boyce, JM. Are the epidemiology and microbiology of methicillin-resistant Staphylococcus aureus changing? JAMA 1998;279:623624.
37.Warshawsky, B, Hussain, Z, Gregson, D, et al.Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol 2000;21:724727.
38.Thompson, R, Cabezudo, I, Wenzel, R. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982;97:309317.
39.Jernigan, JA, Titus, MG, Groschel, DH, Getchell-White, SI, Farr, BM. Effectiveness of contact isolation during a hospital outbreak of methicillin-resistant Staphylococcus aureus. Am J Epidemiol 1996;143:496504.
40.Haley, RW, Cushion, NB, Tenover, FC, et al.Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614624.
41.Verhoef, J, Beaujean, D, Blok, H, et al.A Dutch approach to methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1999;18:461466.
42.Salmenlinna, S, Lyytikainen, O, Kotilainen, P, Scotford, R, Siren, E. Molecular epidemiology of methicillin-resistant Staphylococcus aureus in Finland. Eur J Clin Microbiol Infect Dis 2000;19:10101107.
43.Jernigan, JA, Clemence, MA, Stott, GA, et al.Control of methicillin resistant Staphylococcus aureus at a university hospital: one decade later. Infect Control Hosp Epidemiol 1995;16:686696.
44.Chiax, C, Durand-Zaleski, I, Alberti, C, Brun-Buisson, C. Control of endemic methicillin-resistant Staphylococcus aureus: a cost benefit analysis in an intensive care unit. JAMA 1999;282:17451751.
45.Jans, B, Suetens, C, Struelens, MJ. Decreasing MRSA rates in Belgian hospitals: results from the national surveillance network after introduction of national guidelines. Infect Control Hosp Epidemiol 2000;21:419.
46.Bager, F, ed. DANMAP 98: Consumption of Antimicrobial Agents and Occurrence of Antimicrobial in Bacteria From Food Animals, Food and Humans in Denmark. Copenhagen: Danish Zoonosis Centre; 1999.
47.Harbarth, S, Martin, Y, Rohner, P, Henry, N, Auckenthaler, R, Pittet, D. Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus. J Hosp Infect 2000;46:4349.
48.Farr, BM, Jarvis, W. Would active surveillance cultures help control healthcare-related methicillin-resistant Staphylococcus aureus infections? Infect Control Hosp Epidemiol 2002;23:6568.

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