Nosocomial Staphylococcus aureus bacteremia among nasal carriers of methicillin-resistant and methicillin-susceptible strains.
OBJECTIVE
To determine the relevance of nasal carriage of Staphylococcus aureus, either methicillin-sensitive (MSSA) or methicillin-resistant (MRSA), as a risk factor for the development of nosocomial S aureus bacteremia during an MRSA outbreak.


METHODS
In this prospective cohort study, 488 patients admitted to an intensive care unit (ICU) during a 1-year period were screened with nasal swabs within 48 hours of admission and weekly thereafter in order to identify nasal S aureus carriage. Nasal staphylococcal carriers were observed until development of S aureus bacteremia, ICU discharge, or death.


RESULTS
One hundred forty-seven (30.1%) of 488 patients were nasal S aureus carriers; 84 patients (17.2%) harbored methicillin-sensitive S aureus; and 63 patients (12.9%) methicillin-resistant S aureus. Nosocomial S aureus bacteremia was diagnosed in 38 (7.7%) of 488 patients. Rates of bacteremia were 24 (38%) of the MRSA carriers, eight (9.5%) of the MSSA carriers, and six (1.7%) of noncarriers. After adjusting for other predictors of bacteremia by means of a Cox proportional hazard regression model, the relative risk for S aureus bacteremia was 3.9 (95% confidence interval, 1.6-9.8; P = 0.002) for MRSA carriers compared with MSSA carriers.


CONCLUSIONS
Among ICU patients, nasal carriers of S aureus are at higher risk for S aureus bacteremia than are noncarriers; in the setting of an MRSA outbreak, colonization by methicillin-resistant strains represents a greater risk than does colonization by MSSA and strongly predicts the occurrence of MRSA bacteremia.
Pujol
M
M
Infectious Disease Service, Hospital de Bellvitge, University of Barcelona, L'Hospitalet, Spain.
Peña
C
C
Pallares
R
R
Ariza
J
J
Ayats
J
J
Dominguez
M A
MA
Gudiol
F
F
D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000209:etiology*; D002353:Carrier State; D015331:Cohort Studies; D016001:Confidence Intervals; D003428:Cross Infection / Q000209:etiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008712:Methicillin / Q000494:pharmacology*; D016106:Methicillin Resistance; D008875:Middle Aged; D009666:Nose / Q000382:microbiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000209:etiology*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000302:isolation & purification*
D008712:Methicillin