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Abstract
Background
Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been known as a predictor of intensive care unit (ICU)-acquired MRSA infections. We performed this study to survey the nasal colonization of MRSA among the patients admitted to an ICU and analyze risk factors associated with the colonization.
Methods
A retrospective 1 : 1 matched case-control study was conducted with patients admitted to the ICU from March to December 2010 at Samsung Changwon Hospital.
Results
A total of 602 patients among 846 patients admitted to the ICU during the study period were evaluated. The prevalence of nasal MRSA colonization was 67 (11.1%) of 602. Other factors, including underlying renal disease (odds ratio [OR]=12.37, 95% confidence interval [CI] 3.60-42.54; Pä.001), MRSA infection within the previous 3 months (OR=7.43, 95% CI 1.31-42.05; P=0.023), nursing home resident within the previous 1 month (OR=6.25, 95% CI 1.82-21.53; P=0.004), surgical procedure within the previous 1 month (OR=5.93, 95% CI 1.86-18.85; P=0.003), and current use of nasogastric tube (OR=4.98, 95% CI 1.84-13.45; P=0.002) were independently associated with nasal MRSA colonization in patients admitted to ICU.
Conclusion
A significant number of patients admitted to the ICU in a secondary hospital were colonized with MRSA. The present study showed the possible impact of the presence of a nasogastric tube on the nasal colonization by MRSA. More effective infection control procedures must be developed for patients with nasogastric tube use.
References
1. Soriano A, Martínez JA, Mensa J, Marco F, Almela M, Moreno-Martínez A. . Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis. 2000; 30:368–73.
2. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med. 2002; 162:2229–35.
3. Jensen AG, Wachmann CH, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med. 2002; 162:25–32.
4. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998; 279:593–8.
5. Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003; 290:2976–84.
6. 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; 344:11–6.
7. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004; 364:703–5.
8. Honda H, Krauss MJ, Coopersmith CM, Kollef MH, Richmond AM, Fraser VJ. et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol. 2010; 31:584–91.
9. Huang SS, Yokoe DS, Hinrichsen VL, Spurchise LS, Datta R, Miroshnik I, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2006; 43:971–8.
10. Jeyaratnam D, Whitty CJ, Phillips K, Liu D, Orezzi C, Ajoku U, et al. Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ. 2008; 336:927–30.
11. Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson RB Jr, Kaul KL, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008; 148:409–18.
12. Struelens MJ, Denis O. Rapid molecular detection of methicillin-resistant Staphylococcus aureus: a cost-effective tool for infection control in critical care? Crit Care. 2006; 10:128.
13. Huang SS, Rifas-Shiman SL, Warren DK, Fraser VJ, Climo MW, Wong ES, Centers for Disease Control and Prevention Epicenters Program, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis. 2007; 195:330–8.
14. Harbarth S, Sax H, Fankhauser-Rodriguez C, Schrenzel J, Agostinho A, Pittet D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med. 2006; 119:275. e15-23.
15. Coia JE, Leanord AT, Reilly J. Screening for meticillin resistant Staphylococcus aureus (MRSA): who, when, and how? BMJ. 2014; 348:g1697.
16. Mody L, Maheshwari S, Galecki A, Kauffman CA, Bradley SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc. 2007; 55:1921–6.
17. Segal R, Dan M, Eger G, Lubart E, Leibovitz A. Staphylococcus aureus colonization in the nasopharynx of nasogastric tube-fed patients in a long-term care facility. Eur J Clin Microbiol Infect Dis. 2009; 28:1147–9.
18. Eun SH, Lee YS, Cha JO, Yoo JI, Lee JG, Lee HJ, et al. The point prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus colonisation in eight geriatric hospitals in Korea. Clin Microbiol Infect. 2006; 12:81–3.
19. Seong HK, Bae YS, Kim YH. The epidemiological survey of nasal colonization of methicillin resistant Staphylococcus aureus in patients and doctors. Korea J Exp Biomed Sei. 2004; 10:309–15.
20. Kim OS, Yoon SW, Kang YJ, Kim YK, Lee NY, Lee JH, et al. Rate of nasal colonization of methicillin-resistant Staphylococcus aureus at admission to a medical intensive care unit. Korean J Nosocomial Infect Control. 2007; 12:42–9.
21. Song W, Lee TJ, Kim SJ, Park MJ, Lee KM. Methicillin-resistant Staphylococcus aureus infections in intensive care unit (ICU) patients: relation to nasal carriage of patients or ICU personnels. Korean J Clin Microbiol. 2001; 4:45–51.
22. Kwak OS, Kwon MH, Jeong JH, Kang MI, Cheun JY, Lee GE, et al. Molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolated from nasal swab at intensive care unit. Tuberc Respir Dis. 2008; 65:91–8.
23. Xue Y, Gyi AA. Predictive risk factors for methicillin-resistant Staphylococcus aureus (MRSA) colonisation among adults in acute care settings: a systematic review. JBI Library Syst Rev. 2012; 10:3487–560.
24. Payne-James JJ, De Gara CJ, Grimble GK, Bray MJ, Rana SK, Kapadia S, et al. Artificial nutrition support in hospitals in the United Kingdom - 1991: Second national survey. Clin Nutr. 1992; 11:187–92.
25. Lin LC, Li MH, Watson R. A survey of the reasons patients do not chose percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) as a route for long-term feeding. J Clin Nurs. 2011; 20:802–10.
26. Warren DK, Guth RM, Coopersmith CM, Merz LR, Zack JE, Fraser VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2006; 27:1032–40.
27. Wang CY, Wu VC, Wang WJ, Lin YF, Lin YH, Chen YM, et al. Risk factors for nasal carriage of methicillin-resistant Staphylococcus aureus among patients with end-stage renal disease in Taiwan. J Formos Med Assoc. 2012; 111:14–8.
28. Matheson A, Christie P, Stari T, Kavanagh K, Gould IM, Masterton R, et al. Nasal swab screening for methicillin-resistant Staphylococcus aureus-how well does it perform? A cross-sectional study. Infect Control Hosp Epidemiol. 2012; 33:803–8.
29. Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009; 48:910–3.
30. Compernolle V, Verschraegen G, Claeys G. Combined use of Pastorex Staph-Plus and either of two new chromogenic agars, MRSA ID and CHRO Magar MRSA, for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2007; 45:154–8.
Table 1.
Characteristics of MRSA nasal carrier and non-carrier
Table 2.
Risk factors of MRSA nasal carrier using logistic regression analysis
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