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Staphylococcus Aureus Colonization and the Risk of Infection in Critically Ill Patients

  • Adam Keene (a1), Peter Vavagiakis (a2), Mei-Ho Lee (a1), Kathryn Finnerty (a3), Deborah Nicolls, Christian Cespedes (a1), Bianca Quagliarello (a1), Mary Ann Chiasson (a4), David Chong (a5) and Franklin D. Lowy (a1) (a6)...



To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients.


Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates.


Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of noncolonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%.


The incidence of S. aureusinfection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible. (Infect Control Hosp Epidemiol 2005;26:622-628)


Corresponding author

Division of Critical Care Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, 111 East 210th Street, Bronx, NY


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1.National Nosocomial Infections Surveillance (NNIS) report: data summary from October 1986-April 1997, issued May 1997. Am J Infect Control 1997;25:477487.
2.National Nosocomial Infections Surveillance (NNIS) report: data summary from October 1986-April 1998, issued June 1998. Am J Infect Control 1998;26:522533.
3.Bergmans, D, Bonten, M, Gaillard, C, et al.Clinical spectrum of ventilator-associated pneumonia caused by methicillin-sensitive Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1996;15:437445.
4.Rello, J, Torres, A, Ricart, M, et al.Ventilator-associated pneumonia by Staphylococcus aureus: comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 1994;150:15451549.
5.Blot, S, Vandewoude, K, Hoste, E, Colardyn, F. Outcome and attributable mortality in critically ill patients with bacteremia involving methicil-lin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002;162:22292235.
6.Luzar, MA, Coles, GA, Faller, B, et al.Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med 1990;322:505509.
7.Piraino, B, Perlmutter, JA, Holley, JL, Bernardini, J. Staphylococcus aureus peritonitis is associated with Staphylococcus aureus nasal carriage in peritoneal dialysis patients. Perit Dial Int 1993;13(suppl):S332S334.
8.Sewell, CM, Clarridge, J, Lacke, C, Weinman, EJ, Young, EJ. Staphylococcal nasal carriage and subsequent infection in peritoneal dialysis patients. JAMA 1982;248:14931495.
9.Yu, VL, Goetz, A, Wagener, M, et al.Staphylococcus aureus nasal carriage and infection in patients on hemodialysis: efficacy of antibiotic prophylaxis. NEngl J Med 1986;315:9196.
10.Calia, FM, Wolinsky, E, Mortimer, EA, Abrams, JS, Rammelkamp, CH. Importance of the carrier state as a source of Staphylococcus aureus in wound sepsis. Journal of Hygiene (Cambridge) 1969;67:4957.
11.Kluytmans, JA, Mouton, JW, Ijzerman, EP, et al.Nasal carriage of Staphylococcus aureus as a major risk factor for wound infections after cardiac surgery. J Infect Dis 1995;171:216219.
12.Mest, DR, Wong, DH, Shimoda, KJ, Mulligan, ME, Wilson, SE. Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 1994;78:644650.
13.Weinke, T, Schiller, R, Fehrenbach, FJ, Pohle, HD. Association between Staphylococcus aureus nasal colonization and septicemia in patients infected with the human immunodeficiency virus. Eur J Clin Microbiol Infect Dis 1992;11:985989.
14.Nguyen, MH, Kauffman, CA, Goodman, RP, et al.Nasal carriage of and infection with Staphylococcus aureus in HIV-infected patients. Ann Intern Med 1999;130:221225.
15.Corbella, X, Dominguez, MA, Pujol, M, et al.Staphylococcus aureus nasal carriage as a marker for subsequent staphylococcal infections in intensive care unit patients. Eur J Clin Microbiol Infect Dis 1997;16:351357.
16.Perl, T, Cullen, J, Wenzel, R, et al.Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002;346: 18711877.
17.Netto dos Santos, KR, de Souza Fonseca, L, Gontijo Filho, PP. Emergence of high-level mupirocin resistance in methicillin-resistant Staphylococcus aureus isolated from Brazilian university hospitals. Infect Control Hosp Epidemiol 1996;17:813816.
18.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128140.
19.Martineau, F, Picard, FJ, Roy, PH, Oullette, M, Bergeron, MG. Species specific and ubiquitous-DNA-bases assays for rapid identification of Staphylococcus aureus. J Clin Microbiol 1998;37:618623.
20.Reischl, U, Linde, H-J, Metz, M, Leppmeier, B, Lehn, N. Rapid identification of methicillin-resistant Staphylococcus aureus and simultaneous species conformation using real-time fluorescence PCR. J Clin Microbiol 2000;38:24292433.
21.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, ed. 6. Wayne, PA: National Committee for Clinical Laboratory Standards; 1997. Approved standard M2-A6.
22.Roberts, RB, De Lancastre, H, Eisner, W, et al.Molecular epidemiology of Staphylococcus aureus in 12 New York hospitals: MRSA Collaborative Study Group. J Infect Dis 1998;178:164171.
23.Quagliarello, B, Cespedes, C, Lowy, F, et al.Strains of Staphylococcus aureus obtained from drug-use networks are closely linked. Clin Infect Dis 2002;35:671677.
24.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C.Selective screening of carriers for control of MRSA in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543550.
25.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B.Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit. Arch Intern Med 2003;163:181188.
26.Von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. N Engl J Med 2001;344:1116.
27.Kluytmans, J, Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997;10:505520.
28.Weber, WG, Gold, HS, Hooper, DC, Karchmer, AW, Carmeli, Y. Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 2003;9:14151422.
29.Harbarth, S, Liassine, N, Dharan, S, Pascale, H, Auckenthaler, R, Pittet, D. Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2000;31:13801385.
30.Yu, VL, Goetz, A, Wagener, M, et al.Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. N Engl JMed 1986;315:9196.
31.Lipsky, B, Pecoraro, R, Ahroni, J, Peugeot, R. Immediate and long-term efficacy of systemic antibiotics for eradicating nasal colonization with Staphylococcus aureus. Eur J Clin Microbiol Infect Dis 1992;11:4347.
32.Rumbak, M, Cancio, M. Significant reduction in methicillin-resistant Staphylococcus aureus ventilator-associated pneumonia associated with the institution of a prevention protocol. Crit Care Med 1995;23:12001203.
33.Jensen, AG, Wachmann, CH, Poulsen, KB, et al.Risk factors for hospital-acquired Staphylococcus aureus bacteremia. Arch Intern Med 1999;159:14371444.


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