title: Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract.
abstract: OBJECTIVE
  Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) may contaminate their immediate environment with this organism. However, the extent to which gastrointestinal colonization with MRSA affects environmental contamination is not known. We investigated the frequency of environmental contamination in the rooms of patients with diarrheal stools and heavy gastrointestinal colonization with MRSA.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  A 500-bed teaching hospital.
  
  
  METHODS
  Stool specimens submitted for Clostridium difficile toxin assays were inoculated onto colistin-naladixic acid agar. MRSA was identified with standard methods. Samples from a standardized list of 10 environmental surfaces were cultured, from the rooms of 8 patients who had diarrhea that yielded heavy growth of MRSA (case patients) and from the rooms of 6 MRSA-positive patients with stool cultures negative for MRSA (control patients). MRSA isolates from 13 patients (8 case patients and 5 control patients) and 64 of the environmental isolates recovered from their rooms were compared by pulsed-field gel electrophoresis (PFGE). One clinical isolate from a control patient was excluded because there was no corresponding environmental MRSA isolate with which to compare it.
  
  
  RESULTS
  Overall, MRSA were recovered from 47 (58.8%) of 80 surfaces in the rooms of case patients, compared with 14 (23.3%) of 60 surfaces in the rooms of control patients (58.8% [95% CI, 47.8-68.9] vs 23.3% [95% CI, 14.3-35.5]; P<.0001). The items most commonly contaminated were bedside rails, blood pressure cuffs, television remote controls, and toilet seats. Seventy-eight percent of the environmental isolates in patients' rooms had PFGE types that were indistinguishable or closely related to those recovered from the patients' clinical specimens.
  
  
  CONCLUSIONS
  Patients who have diarrheal stools and heavy gastrointestinal colonization with MRSA are associated with significantly greater environmental MRSA contamination than patients without MRSA in their stool, and they are likely to be the source of that contamination.
authors.affiliation: Hospital of Saint Raphael, New Haven, CT 06511, USA. JBoyce@srhs.org
authors.forename: John M
authors.initials: JM
authors.lastname: Boyce
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Havill
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Otter
authors.forename: Nicholas M T
authors.initials: NM
authors.lastname: Adams
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000382:microbiology / Q000635:transmission; D016022:Case-Control Studies; D003967:Diarrhea / Q000382:microbiology*; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D010362:Patients' Rooms; D011446:Prospective Studies; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects / Q000302:isolation & purification*