title: Colonization with methicillin-resistant Staphylococcus aureus after liver transplantation.
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is a frequent cause of infection after orthotopic liver transplantation (OLT). Colonization with MRSA is associated with a higher risk of infection. Previous studies have shown a high prevalence of MRSA colonization among OLT candidates. However, the risk of colonization with MRSA after OLT is still unclear. The objective of this study was to estimate the incidence and the factors associated with colonization with MRSA after OLT. This was a prospective cohort study including patients submitted to OLT between the years 2000 and 2002. Surveillance cultures of nasal swab specimens were performed within the 1st 72 hours of hospital admission and, subsequently, on weeks 2, 6, 13, and 26. Patients whose baseline cultures revealed nasal carriage of MRSA were excluded. A total of 60 patients were included in the study. The median follow-up was 72 days. A total of 9 patients (15%) became colonized. In multiple logistic regression analyses, the use of a urinary catheter for > or =5 days (P = .006), postoperative bleeding at the surgical site (P = .009), and preoperative use of fluoroquinolones (P = .08) were associated with a higher risk of colonization. Patients without any of these risk factors did not become colonized. In conclusion, nasal carriage of MRSA is frequently acquired after OLT. Periodic postoperative screening for MRSA carriage should be an integral component in programs designed to reduce nosocomial MRSA transmission in these patients. Further studies are needed to set up and validate a predictive model that could allow targeting postoperative screening to high-risk OLT recipients.
authors.affiliation: Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. santorolopes@hucff.ufrj.br
authors.forename: Guilherme
authors.initials: G
authors.lastname: Santoro-Lopes
authors.forename: Erika Ferraz
authors.initials: EF
authors.lastname: de Gouvêa
authors.forename: Rodrigo Carreira M
authors.initials: RC
authors.lastname: Monteiro
authors.forename: Rodrigo Castelo
authors.initials: RC
authors.lastname: Branco
authors.forename: José Rodolfo
authors.initials: JR
authors.lastname: Rocco
authors.forename: Márcia
authors.initials: M
authors.lastname: Halpern
authors.forename: Adriana Lúcia Pires
authors.initials: AL
authors.lastname: Ferreira
authors.forename: Elaine Gama Pessoa
authors.initials: EG
authors.lastname: de Araújo
authors.forename: Samanta T
authors.initials: ST
authors.lastname: Basto
authors.forename: Vinicius Gomes
authors.initials: VG
authors.lastname: Silveira
authors.forename: Joaquim
authors.initials: J
authors.lastname: Ribeiro-Filho
mesh_terms: D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D016031:Liver Transplantation; D016015:Logistic Models; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011183:Postoperative Complications / Q000453:epidemiology*; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*