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Identifying the Risk Factors for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection among Patients Colonized with MRSA on Admission

Published online by Cambridge University Press:  02 January 2015

Yuriko Fukuta ,
Candace A. Cunningham ,
Patricia L. Harris ,
Marilyn M. Wagener  and
Robert R. Muder
Yuriko Fukuta
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania
Candace A. Cunningham
Affiliation:
Infectious Disease Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Patricia L. Harris
Affiliation:
Infectious Disease Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder*
Affiliation:
Division of Infectious Diseases, University of Pittsburgh, Pittsburgh, Pennsylvania Infectious Disease Section, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
*
University Drive C, Pittsburgh, PA 15240 (robert.muder@med.va.gov)
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Abstract

Background.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospital-acquired infections. MRSA-colonized inpatients who may benefit from undergoing decolonization have not been identified.

Objective.

To identify risk factors for MRSA infection among patients who are colonized with MRSA at hospital admission.

Design.

A case-control study.

Setting.

A 146-bed Veterans Affairs hospital.

Participants.

Case patients were those patients admitted from January 2003 to August 2011 who were found to be colonized with MRSA on admission and then developed MRSA infection. Control subjects were those patients admitted during the same period who were found to be colonized with MRSA on admission but who did not develop MRSA infection.

Methods.

A retrospective review.

Results.

A total of 75 case patients and 150 control subjects were identified. A stay in the intensive care unit (ICU) was the significant risk factor in univariate analysis (P<.001). Prior history of MRSA (P = .03), transfer from a nursing home (P = .002), experiencing respiratory failure (P<.001), and receipt of transfusion (P = .001) remained significant variables in multivariate analysis. Prior history of MRSA colonization or infection (P = .02), difficulty swallowing (P = .04), presence of an open wound (P = .002), and placement of a central line (P = .02) were identified as risk factors for developing MRSA infection for patients in the ICU. Duration of hospitalization, readmission rate, and mortality rate were significantly higher in case patients than in control subjects (P< .001, .001, and <.001, respectively).

Conclusions.

MRSA-colonized patients admitted to the ICU or admitted from nursing homes have a high risk of developing MRSA infection. These patients may benefit from undergoing decolonization.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 12 , December 2012 , pp. 1219 - 1225
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Kallen, AJ, Mu, Y, Bulens, S, et al.Health care–associated invasive MRSA infections, 2005–2008. JAMA 2010;304:641–648.Google Scholar
2.Safdar, N, Bradley, EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 2008;121:310–315.Google Scholar
3.Honda, H, Krauss, MJ, Coopersmith, CM, et al.Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol 2010;31:584–591.Google Scholar
4.Muder, RR, Cunningham, C, McCray, E, et al.Implementation of an industrial systems-engineering approach to reduce the incidence of methicillin-resistant Staphylococcus aureus infection. Infect Control Hosp Epidemiol 2008;29:702–708.Google Scholar
5.Jain, R, Kralovic, S, Evans, M, et al.Veterans Affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med 2011;364:1419–1430.Google Scholar
6.Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.Google Scholar
7.von Eiff, C, Becker, K, Machka, K, Stammer, H, Peters, G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med 2001;344:11–16.Google Scholar
8.Seybold, U, Schubert, S, Bogner, JR, Hogardt, M. Staphylococcus aureus infection following nasal colonization: an approach to rapid risk stratification in a university healthcare system. J Hosp Infect 2011;79:297–301.Google Scholar
9.Bode, LG, Kluytmans, JA, Wertheim, HF, et al.Preventing surgical-site infections in nasal carriers of Staphylococcus aureus. N Engl J Med 2010;362:9–17.Google Scholar
10.Portigliatti Barbos, M, Mognetti, B, Pecoraro, S, Picco, W, Veglio, V. Decolonization of orthopedic surgical team S. aureus carriers: impact on surgical-site infections. J Orthop Traumatol 2010;11:47–49.Google Scholar
11.Rao, N, Cannella, BA, Crossett, LS, Yates, AJ JrMcGough, RL, 3rd Hamilton, CW. Preoperative screening/decolonization for Staphylococcus aureus to prevent orthopedic surgical site infection prospective cohort study with 2-year follow-up. J Arthroplast 2011;26:1501–1507.Google Scholar
12.Fraser, TG, Fatica, C, Scarpelli, M, et al.Decrease in Staphylococcus aureus colonization and hospital-acquired infection in a medical intensive care unit after institution of an active surveillance and decolonization program. Infect Control Hosp Epidemiol 2010;31:779–783.Google Scholar
13.Harbarth, S, Fankhauser, C, Schrenzel, J, et al.Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA 2008;299:1149–1157.Google Scholar
14.Mermel, LA, Cartony, JM, Covington, P, Maxey, G, Morse, D. Methicillin-resistant Staphylococcus aureus colonization at different body sites: a prospective, quantitative analysis. J Clin Microbiol 2011;49:1119–1121.Google Scholar
15.Baker, SE, Brecher, SM, Robillard, E, Strymish, J, Lawler, E, Gupta, K. Extranasal methicillin-resistant Staphylococcus aureus colonization at admission to an acute care Veterans Affairs hospital. Infect Control Hosp Epidemiol 2010;31:42–46.Google Scholar