METHICILLIN-RESISTANT STAPHYLOCOCCAL COLONIZATION AND INFECTION IN A LONG-TERM CARE FACILITY

被引:297
作者
MUDER, RR
BRENNEN, C
WAGENER, MM
VICKERS, RM
RIHS, JD
HANCOCK, GA
YEE, YC
MILLER, JM
YU, VL
机构
[1] UNIV PITTSBURGH, SCH MED, PITTSBURGH, PA 15261 USA
[2] CTR DIS CONTROL, ATLANTA, GA 30333 USA
关键词
D O I
10.7326/0003-4819-114-2-1-107
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective: To determine the natural history of colonization by methicillin-resistant Staphylococcus aureus (MRSA) among patients in a long-term care facility. We specifically sought to determine if MRSA colonization was predictive of subsequent infection. Design: Cohort study. Setting: Long-term Veterans Affairs Medical Center. Patients: A total of 197 patients residing on two units were followed with regular surveillance cultures of the anterior nares. Main Outcome Measurement: The development of staphylococcal infection. Results: Thirty-two patients were persistent carriers of MRSA and 44 were persistent carriers of methicillin-susceptible strains (MSSA). Twenty-five percent of MRSA carriers had an episode of staphylococcal infection compared with 4% of MSSA carriers and 4.5% of non-carriers (P < 0.01; relative risk 3.8%; 95% CI, 2.0 to 6.4). The rate of development of infection among MRSA carriers was 15% for every 100 days of carriage. Using logistic regression analysis, persistent MRSA carriage was the most significant predictor of infection (P < 0.001; odds ratio, 3.7). Seventy-three percent of all MRSA infections occurred among MRSA carriers. Isolates of MRSA from 7 patients were typed. Colonizing and infecting strains had the same phage type in all 7 patients and the same pattern of plasmid EcoRI restriction endonuclease fragments in 5 patients. Conclusions: Colonization of the anterior nares by MRSA predicts the development of staphylococcal infection in long-term care patients; most infections arise from endogenously carried strains. Colonization by MRSA indicates a significantly greater risk for infection than does colonization by MSSA. The results offer a theoretic rationale for reduction in MRSA infections by interventions aimed at eliminating the carrier state.
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页码:107 / 112
页数:6
相关论文
共 33 条
  • [1] METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS COLONIZATION AND INFECTION IN A REHABILITATION FACILITY
    AEILTS, GD
    SAPICO, FL
    CANAWATI, HN
    MALIK, GM
    MONTGOMERIE, JZ
    [J]. JOURNAL OF CLINICAL MICROBIOLOGY, 1982, 16 (02) : 218 - 223
  • [2] BIRNBOIM HC, 1979, NUCLEIC ACIDS RES, V7, P1513
  • [3] EPIDEMIOLOGIC STUDIES OF AN OUTBREAK OF NOSOCOMIAL METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS INFECTIONS
    BOYCE, JM
    LANDRY, M
    DEETZ, TR
    DUPONT, HL
    [J]. INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY, 1981, 2 (02) : 110 - 116
  • [4] BRENNEN C, 1990, AM J MED, V88, pN14
  • [5] METHICILLIN-RESISTANT STAPHYLOCOCCUS-AUREUS
    BRUMFITT, W
    HAMILTONMILLER, J
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 1989, 320 (18) : 1188 - 1196
  • [6] CEDERNA JE, 1990, INFECT CONT HOSP EP, V11, P13, DOI 10.1086/646072
  • [7] STAPHYLOCOCCUS-AUREUS NASAL CARRIAGE IN HEMODIALYSIS-PATIENTS - ITS ROLE IN INFECTION AND APPROACHES TO PROPHYLAXIS
    CHOW, JW
    YU, VL
    [J]. ARCHIVES OF INTERNAL MEDICINE, 1989, 149 (06) : 1258 - 1262
  • [8] MECHANISMS OF PATHOGENICITY OF MULTIRESISTANT STAPHYLOCOCCUS-AUREUS
    COLEMAN, DC
    CAFFERKEY, M
    KEANE, CT
    BAXTER, L
    POMEROY, H
    FOSTER, TJ
    HONE, R
    MULVEY, M
    ARBUTHNOTT, JP
    [J]. JOURNAL OF HOSPITAL INFECTION, 1986, 7 : 29 - 35
  • [9] A LARGE OUTBREAK OF INFECTIONS CAUSED BY A STRAIN OF STAPHYLOCOCCUS-AUREUS RESISTANT TO OXACILLIN AND AMINOGLYCOSIDES
    CRAVEN, DE
    REED, C
    KOLLISCH, N
    DEMARIA, A
    LICHTENBERG, D
    SHEN, K
    MCCABE, WR
    [J]. AMERICAN JOURNAL OF MEDICINE, 1981, 71 (01) : 53 - 58
  • [10] INFECTION CONTROL PRACTICES IN MINNESOTA NURSING-HOMES
    CROSSLEY, KB
    IRVINE, P
    KASZAR, DJ
    LOEWENSON, RB
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1985, 254 (20): : 2918 - 2921