Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter?
BACKGROUND
Staphylococcus aureus is an important cause of infection in intensive care unit (ICU) patients. Colonization with methicillin-resistant S. aureus (MRSA) is a risk factor for subsequent S. aureus infection. However, MRSA-colonized patients may have more comorbidities than methicillin-susceptible S. aureus (MSSA)-colonized or noncolonized patients and therefore may be more susceptible to infection on that basis.


OBJECTIVE
To determine whether MRSA-colonized patients who are admitted to medical and surgical ICUs are more likely to develop any S. aureus infection in the ICU, compared with patients colonized with MSSA or not colonized with S. aureus, independent of predisposing patient risk factors.


METHODS
Prospective cohort study.


METHODS
A 24-bed surgical ICU and a 19-bed medical ICU of a 1,252-bed, academic hospital.


METHODS
A total of 9,523 patients for whom nasal swab samples were cultured for S. aureus at ICU admission during the period from December 2002 through August 2007.


METHODS
Patients in the ICU for more than 48 hours were examined for an ICU-acquired S. aureus infection, defined as development of S. aureus infection more than 48 hours after ICU admission.


RESULTS
S. aureus colonization was present at admission for 1,433 (27.8%) of 5,161 patients (674 [47.0%] with MRSA and 759 [53.0%] with MSSA). An ICU-acquired S. aureus infection developed in 113 (2.19%) patients, of whom 75 (66.4%) had an infection due to MRSA. Risk factors associated with an ICU-acquired S. aureus infection included MRSA colonization at admission (adjusted hazard ratio, 4.70 [95% confidence interval, 3.07-7.21]) and MSSA colonization at admission (adjusted hazard ratio, 2.47 [95% confidence interval, 1.52-4.01]).


CONCLUSIONS
ICU patients colonized with S. aureus were at greater risk of developing a S. aureus infection in the ICU. Even after adjusting for patient-specific risk factors, MRSA-colonized patients were more likely to develop S. aureus infection, compared with MSSA-colonized or noncolonized patients.
Honda
Hitoshi
H
Division of Infectious Diseases, Washington University School of Medicine, St Louis, Missouri 63110, USA. hhonda@im.wustl.edu
Krauss
Melissa J
MJ
Coopersmith
Craig M
CM
Kollef
Marin H
MH
Richmond
Amy M
AM
Fraser
Victoria J
VJ
Warren
David K
DK
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002353:Carrier State / Q000175:diagnosis / Q000453:epidemiology; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008403:Mass Screening; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D008923:Missouri / Q000453:epidemiology; D009296:Nasal Cavity / Q000382:microbiology*; D010343:Patient Admission; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013211:Staphylococcus aureus / Q000302:isolation & purification*; D055815:Young Adult