Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T06:18:47.720Z Has data issue: false hasContentIssue false
  • English
  • Français

High Prevalence of Carriage of Methicillin-Resistant Staphylococcus aureus at Hospital Admission in Elderly Patients: Implications for Infection Control Strategies

Published online by Cambridge University Press:  21 June 2016

Jean-Christophe Lucet ,
Karine Grenet ,
Laurence Armand-Lefevre ,
Marion Harnal ,
Elisabeth Bouvet ,
Bernard Regnier  and
Antoine Andremont
Jean-Christophe Lucet*
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Karine Grenet
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Laurence Armand-Lefevre
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Marion Harnal
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Elisabeth Bouvet
Affiliation:
Infection Control Committee, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Bernard Regnier
Affiliation:
Medical Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Antoine Andremont
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
*
Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, GH Bichat-Claude Bernard, 75877 Paris Cedex 18, France. jean-christophe.lucet@bch.ap-hop-paris.fr
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Despite contact isolation precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA), MRSA infections are increasing in many countries.

Objective:

To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.

Setting:

A 1,100-bed teaching hospital in Paris, France.

Methods:

Nasal screening cultures were performed at admission to a tertiary-care teaching hospital for patients older than 75 years.

Results:

MRSA was isolated from 63 (7.9%) of 797 patients. On the multivariate analysis, variables significantly associated with MRSA carriage were presence of chronic skin lesions (adjusted odds ratio [AOR], 5.10; 95% confidence interval [CI95], 2.52–10.33); transfer from a nursing home, rehabilitation unit, or long-term-care unit (AOR, 4.52; CI95, 2.23–9.18); and poor chronic health status (AOR, 1.80; CI95, 1.02–3.18). Without admission screening, 84.1% of MRSA carriers would have been missed at hospital admission and 76.2% during their hospital stay. Furthermore, 81.1% of days at risk for MRSA dissemination would have been spent without contact isolation precautions had admission screening not been performed.

Conclusions:

MRSA carriage at hospital admission is far more prevalent than MRSA-positive clinical specimens. This may contribute to failure of contact isolation programs. Screening cultures at admission help to identify the reservoir of unknown MRSA patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 121 - 126
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Diekema, DJ, Pfaller, MA, Schmitz, FJ, et al.Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the Western Pacific region for the SENTRY Antimicrobial Surveillance Program, 1997-1999. Clin Infect Dis 2001; 32:S114–S132.Google ScholarPubMed
2.Fluit, AC, Wielders, CL, Verhoef, J, Schmitz, FJ. Epidemiology and susceptibility of 3,051 Staphylococcus aureus isolates from 25 university hospitals participating in the European SENTRY study. J Clin Microbiol 2001;39:3727–3732.CrossRefGoogle Scholar
3.Barrett, SP, Spencer, RC. MRSA bacteraemia surveillance scheme in England. J Hosp Infect 2002;50:241–242.Google ScholarPubMed
4.Gastmeier, P, Sohr, D, Geffers, C, Nassauer, A, Dettenkofer, M, Ruden, H. Occurrence of methicillin-resistant Staphylococcus aureus infections in German intensive care units. Infection 2002;30:198–202.CrossRefGoogle ScholarPubMed
5.Gastmeier, P, Geffers, C, Sohr, D, Schwab, F, Behnke, M, Ruden, H. Surveillance of nosocomial infections in intensive care units: current data and interpretations. Wien Klin Wochenschr 2003;115:99–103.CrossRefGoogle ScholarPubMed
6.Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al.Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.CrossRefGoogle ScholarPubMed
7.Rubinovitch, B, Pittet, D. Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned? J Hosp Infect 2001;47:9–18.Google ScholarPubMed
8.British Society for Antimicrobial Chemotherapy, Hospital Infection Society, and the Infection Control Nurses Association. Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. J Hosp Infect 1998;39:253–290.Google Scholar
9.Muto, CA, Jernigan, JA, Ostrowsky, BE, et al.SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus. Infect Control Hosp Epidemiol 2003;24:362–386.CrossRefGoogle ScholarPubMed
10.Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B. Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163:181–188.Google Scholar
11.Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718–723.CrossRefGoogle Scholar
12.Girou, E, Pujade, G, Legrand, P, Cizeau, F, Brun-Buisson, C. Selective screening of carriers for control of methicillin-resistant Staphylococcus aureus (MRSA) in high-risk hospital areas with a high level of endemic MRSA. Clin Infect Dis 1998;27:543–550.CrossRefGoogle ScholarPubMed
13.Harbarth, S, Pittet, D. Control of nosocomial methicillin-resistant Staphylococcus aureus: where shall we send our hospital director next time? Infect Control Hosp Epidemiol 2003;24:314–316.CrossRefGoogle ScholarPubMed
14.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.CrossRefGoogle ScholarPubMed
15.Talon, DR, Bertrand, X. Methicillin-resistant Staphylococcus aureus in geriatric patients: usefulness of screening in a chronic-care setting. Infect Control Hosp Epidemiol 2001;22:505–509.CrossRefGoogle Scholar
16.Manian, FA, Senkel, D, Zack, J, Meyer, L. Routine screening for methicillin-resistant Staphylococcus aureus among patients newly admitted to an acute rehabilitation unit. Infect Control Hosp Epidemiol 2002;23:516–519.CrossRefGoogle Scholar
17.Garner, JS. Guideline for isolation precautions in hospitals: the Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
18.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
19.Lucet, JC, Deere, D, Fichelle, A, et al.Control of a prolonged outbreak of extended-spectrum beta-lactamase-producing enterobacteriaceae in a university hospital. Clin Infect Dis 1999;29:1411–1418.CrossRefGoogle ScholarPubMed
20.Scanvic, A, Denic, L, Gaillon, S, Giry, P, Andremont, A, Lucet, JC. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001;32:1393–1398.CrossRefGoogle ScholarPubMed
21.Soussy, CJ. Communiqué 2004 du Comité de l'Antibiogramme de la Société Française de Microbiologie. Paris: French Society for Microbiology; 2004. Available at www.sfm.asso.fr/nouv/general.php?pa=2. Accessed January 19, 2005.Google Scholar
22.Knaus, WA, Zimmerman, JE, Wagner, DP, Draper, EA, Lawrence, DE. APACHE—Acute Physiology and Chronic Health Evaluation: a physiologically based classification system. Crit Care Med 1981;9:591–597.CrossRefGoogle ScholarPubMed
23.McCabe, WR, Jackson, GG. Gram-negative bacteremia: II. Etiology and ecology. Ann Intern Med 1962;110:847–855.CrossRefGoogle Scholar
24.Papia, G, Louie, M, Traila, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective? Infect Control Hosp Epidemiol 1999;20:473–477.CrossRefGoogle Scholar
25.Jernigan, JA, Pullen, AL, Flowers, L, Bell, M, Jarvis, WR. Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission. Infect Control Hosp Epidemiol 2003;24:409–414.CrossRefGoogle ScholarPubMed
26.Fishbain, JT, Lee, JC, Nguyen, HD, et al.Nosocomial transmission of methicillin-resistant Staphylococcus aureus: a blinded study to establish baseline acquisition rates. Infect Control Hosp Epidemiol 2003;24:415–421.CrossRefGoogle ScholarPubMed
27.Girou, E, Azar, J, Wolkenstein, P, Cizeau, F, Brun-Buisson, C, Roujeau, JC. Comparison of systematic versus selective screening for methicillin-resistant Staphylococcus aureus carriage in a high-risk dermatology ward. Infect Control Hosp Epidemiol 2000;21:583–587.CrossRefGoogle Scholar
28.Samad, A, Banerjee, D, Carbarns, N, Ghosh, S. Prevalence of methicillin-resistant Staphylococcus aureus colonization in surgical patients, on admission to a Welsh hospital. J Hosp Infect 2002;51:43–46.CrossRefGoogle ScholarPubMed
29.Lepelletier, D, Richet, H. Surveillance and control of methicillin-resistant Staphylococcus aureus infections in French hospitals. Infect Control Hosp Epidemiol 2001;22:677–682.CrossRefGoogle ScholarPubMed
30.The Hôpital Propre II study group. Methicillin-resistant Staphylococcus aureus in French hospitals: a 2-month survey in 43 hospitals, 1995. Infect Control Hosp Epidemiol 1999;20:478–486.Google Scholar
31.Barrett, SP, Mummery, RV, Chattopadhyay B. Trying to control MRSA causes more problems than it solves. J Hosp Infect 1998;39:85–93.CrossRefGoogle ScholarPubMed
32.Boyce, JM, Pittet, D. Guideline for hand hygiene in health-care settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002;23:S3–S40.CrossRefGoogle ScholarPubMed
33.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181–185.CrossRefGoogle ScholarPubMed
34.Public Health Laboratory Service. The second year of the Department of Health's mandatory MRSA bacteraemia surveillance scheme in acute NHS trusts in England: April 2002-March 2003. CDR Wkly 2003;13:1–9.Google Scholar