Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers.
Staphylococcus aureus is the second most frequent cause of nosocomial blood infections. We screened 14008 non-bacteraemic, non-surgical patients for S aureus nasal carriage at admission, and monitored them for development of bacteraemia. Nosocomial S aureus bacteraemia was three times more frequent in S aureus carriers (40/3420, 1.2%) than in non-carriers (41/10588, 0.4%; relative risk 3.0, 95% CI 2.0-4.7). However, in bacteraemic patients, all-cause mortality was significantly higher in non-carriers (19/41, 46%) than in carriers (seven/40, 18%, p=0.005). Additionally, S aureus bacteraemia-related death was significantly higher in non-carriers than in carriers (13/41 [32%] vs three/40 [8%], p=0.006). S aureus nasal carriers and non-carriers differ significantly in risk and outcome of nosocomial S aureus bacteraemia. Genotyping revealed that 80% of strains causing bacteraemia in carriers were endogenous.
Erasmus MC, University Medical Centre, Rotterdam, Department of Medical Microbiology and Infectious Diseases, Dr Molewaterplein 40, 3015 GD Rotterdam, Netherlands. h.wertheim@erasmusmc.nl
Heiman F L
HF
Wertheim
Margreet C
MC
Vos
Alewijn
A
Ott
Alex
A
van Belkum
Andreas
A
Voss
Jan A J W
JA
Kluytmans
Peter H J
PH
van Keulen
Christina M J E
CM
Vandenbroucke-Grauls
Marlene H M
MH
Meester
Henri A
HA
Verbrugh
D016470:Bacteremia / Q000382:microbiology*; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology / Q000401:mortality / Q000635:transmission*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology*; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000382:microbiology / Q000401:mortality / Q000635:transmission*; D013211:Staphylococcus aureus / Q000145:classification / Q000302:isolation & purification*