Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-14T04:31:09.872Z Has data issue: false hasContentIssue false
  • English
  • Français

Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

Published online by Cambridge University Press:  02 January 2015

Pritish K. Tosh ,
Simon Agolory ,
Bethany L. Strong ,
Kerrie VerLee ,
Jennie Finks ,
Kayoko Hayakawa ,
Teena Chopra ,
Keith S. Kaye ,
Nicholas Gilpin  and
Christopher F. Carpenter
...Show all authors
Pritish K. Tosh*
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Infectious Diseases, Mayo Clinic, Rochester, Minnesota
Simon Agolory
Affiliation:
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia Division of Global AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
Bethany L. Strong
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Harvard Medical School, Boston, Massachusetts
Kerrie VerLee
Affiliation:
Michigan Department of Community Health, Lansing, Michigan Council of State and Territorial Epidemiologists, Atlanta, Georgia
Jennie Finks
Affiliation:
Michigan Department of Community Health, Lansing, Michigan
Kayoko Hayakawa
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Teena Chopra
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center, Detroit, Michigan
Nicholas Gilpin
Affiliation:
Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, Michigan
Christopher F. Carpenter
Affiliation:
Division of Infectious Diseases, William Beaumont Hospitals, Royal Oak, Michigan
Nadia Z. Haque
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Lois E. Lamarato
Affiliation:
Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
Marcus J. Zervos
Affiliation:
Division of Infectious Diseases, Henry Ford Health System, Detroit, Michigan
Valerie S. Albrecht
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Sigrid K. McAllister
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Brandi Limbago
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Duncan R. MacCannell
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Linda K. McDougal
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alexander J. Kallen
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Alice Y. Guh
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Division of Infectious Diseases, Mayo Clinic, 200 First Street SW, Rochester, MN 55901 (tosh.pritish@mayo.edu)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background.

Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Incl8-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.

Objective.

Identify the prevalence of VRSA precursor organisms.

Design.

Prospective cohort with embedded case-control study.

Participants.

Southeastern Michigan adults with chronic lower-extremity wounds.

Methods.

Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Incl8-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).

Results.

Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Incl8-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.

Conclusions.

Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 34 , Issue 9 , September 2013 , pp. 954 - 960
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2013

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.Centers for Disease Control and Prevention. Staphylococcus aureus resistant to vancomycin-United States, 2002. MMWR Morb Mortal Wkly Rep 2002;51:565–567.Google Scholar
2.Sievert, DM, Rudrik, JT, Patel, JB, McDonald, LC, Wilkins, MJ, Hageman, JC. Vancomycin-resistant Staphylococcus aureus in the United States, 2002-2006. Clin Infect Dis 2008;46:668–674.CrossRefGoogle ScholarPubMed
3.Centers for Disease Control and Prevention. CDC reminds clinical laboratories and healthcare infection preventionists of their role in the search and containment of vancomycin-resistant Staphylococcus aureus (VRSA). http://www.cdc.gov/HAI/settings/lab/vrsa_lab_search_containment.html. Accessed June 21, 2012.Google Scholar
4.de Niederhausern, S, Bondi, M, Messi, P, et al. Vancomycin-resistance transferability from VanA enterococci to Staphylococcus aureus. Curr Microbiol 2011;62:1363–1367.CrossRefGoogle ScholarPubMed
5.Zhu, W, Murray, PR, Huskins, WC, et al.Dissemination of an enterococcus Incl8-like van A plasmid associated with vancomycin-resistant Staphylococcus aureus. Antimicrob Agents Chemother 2010;54:4314–4320.CrossRefGoogle Scholar
6.McDougal, LK, Fosheim, GE, Nicholson, A, et al.Emergence of resistance among USA300 methicillin-resistant Staphylococcus aureus isolates causing invasive disease in the United States. Antimicrob Agents Chemother 2010;54:3804–3811.CrossRefGoogle ScholarPubMed
7.Zhu, W, Clark, NC, McDougal, LK, Hageman, J, McDonald, LC, Patel, JB. Vancomycin-resistant Staphylococcus aureus isolates associated with Incl8-like vanA plasmids in Michigan. Antimicrob Agents Chemother 2008;52:452–457.CrossRefGoogle ScholarPubMed
8.Zhu, W, Clark, NC, Patel, JB. pSK41-like plasmid is necessary for Incl8-like vanA plasmid transfer from Enterococcus faecalis to Staphylococcus aureus in vitro. Antimicrob Agents Chemother 2012;57:212–219.CrossRefGoogle ScholarPubMed
9.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus-Pennsylvania, 2002. MMWR Morb Mortal Wkiy Rep 2002;51:902.Google Scholar
10.Centers for Disease Control and Prevention. Vancomycin-resistant Staphylococcus aureus-New York, 2004. MMWR Morb Mortal Wkly Rep 2004;53:322–323.Google Scholar
11.Finks, J, Wells, E, Dyke, TL, et al.Vancomycin-resistant Staphylococcus aureus, Michigan, USA, 2007. Emerg Infect Dis 2009;15: 943–945.CrossRefGoogle ScholarPubMed
12.Tenover, FC, Weigel, LM, Appelbaum, PC, et al.Vancomycinresistant Staphylococcus aureus isolate from a patient in Pennsylvania. Antimicrob Agents Chemother 2004;48:275–280.CrossRefGoogle ScholarPubMed
13.Harmsen, D, Claus, H, Witte, W, Rothganger, J, Turnwald, D, Vogel, U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003; 41:5442–5448.CrossRefGoogle Scholar
14.Limbago, B, Fosheim, GE, Schoonover, V, et al.Characterization of methicillin-resistant Staphylococcus aureus isolates collected in 2005 and 2006 from patients with invasive disease: a population-based analysis. J Clin Microbiol 2009;47:1344–1351.CrossRefGoogle ScholarPubMed
15.Katz, S, Downs, TD, Cash, HR, Grotz, RC. Progress in development of the index of ADL. Gerontologist 1970;10:20–30.CrossRefGoogle ScholarPubMed
16.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
17.Flannery, EL, Wang, L, Zollner, S, Foxman, B, Mobley, HL, Mody, L. Wounds, functional disability, and indwelling devices are associated with cocolonization by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in southeast Michigan. Clin Infect Dis 2011;53:1215–1222.CrossRefGoogle ScholarPubMed
18.Mermel, LA, Eells, SJ, Acharya, MK, et al.Quantitative analysis and molecular fingerprinting of methicillin-resistant Staphylococcus aureus nasal colonization in different patient populations: a prospective, multicenter study. Infect Control Hosp Epidemiol 2010;31:592–597.CrossRefGoogle ScholarPubMed
19.Scanvic, A, Denk, 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
20.Weigel, LM, Donlan, RM, Shin, DH, et al.High-level vancomycin-resistant Staphylococcus aureus isolates associated with a polymicrobial biofilm. Antimicrob Agents Chemother 2007;51:231–238.CrossRefGoogle ScholarPubMed