Preoperative risk factors for nasal carriage of Staphylococcus aureus.
BACKGROUND
Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage.


METHODS
While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis.


RESULTS
Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95, 1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients.


CONCLUSIONS
Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.
Herwaldt
Loreen A
LA
Department of Internal Medicine, University of Iowa College of Medicine, Iowa City, Iowa 52242-1081, USA.
Cullen
Joseph J
JJ
French
Pamela
P
Hu
Jianfang
J
Pfaller
Michael A
MA
Wenzel
Richard P
RP
Perl
Trish M
TM
D000328:Adult; D000367:Age Factors; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D005260:Female; D006785:Hospitals, University / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D007484:Iowa / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016712:Mupirocin / Q000008:administration & dosage; D009297:Nasal Mucosa / Q000382:microbiology*; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control
D000900:Anti-Bacterial Agents; D016712:Mupirocin