Staphylococcus aureus nasal colonization in patients with cirrhosis: prospective assessment of association with infection.
OBJECTIVE
To determine if Staphylococcus aureus colonization of the anterior nares was a risk factor for S aureus infection in patients with cirrhosis and to determine the predictors of S aureus infection in colonized patients.


METHODS
Prospective cohort study.


METHODS
84 consecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center.


RESULTS
Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MRSA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSSA). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carriers within 1 month, and 7 acquired MRSA carriage more than a month later. Higher Child-Pugh score was independently associated with MRSA carriage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3). S aureus nasal carriers (9 [23%] of 39) were significantly more likely to develop S aureus infections than noncarriers (2 [4%] of 45; P=.02). Central venous catheter use was associated independently with S aureus infections in the carriers (OR, 4.1; CI95 2.8-6.1). Mortality was significantly higher in carriers who developed S aureus infections as compared to those who did not (57% vs 13%; P=.022); S aureus infection was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8).


CONCLUSIONS
Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhosis.
Chang
F Y
FY
Veteran's Affairs Medical Center, Pittsburgh, PA 15240, USA.
Singh
N
N
Gayowski
T
T
Wagener
M M
MM
Marino
I R
IR
D000328:Adult; D000368:Aged; D002353:Carrier State / Q000453:epidemiology*; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008103:Liver Cirrhosis; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D015999:Multivariate Analysis; D009296:Nasal Cavity / Q000382:microbiology*; D010414:Pennsylvania; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000254:growth & development*