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Serial Survey of Methicillin-Resistant Staphylococcus aureus Nasal Carriage Among Residents in a Nursing Home

Published online by Cambridge University Press:  21 June 2016

Clement C.S. Hsu*
Affiliation:
Section of Infectious Diseases, Department of Medicine, Northwestern University Medical School, Columbus Hospital, Chicago, Illinois, and Tz'u-Chi Buddhist General Hospital, Hualien, Taiwan, Republic of China
*
Tz'u-Chi Buddhist General Hospital, No. 8, Hsin-Shen South Road, Hualien, Taiwan, Republic of China

Abstract

Objective:

To study the natural course of nasal colonization by methicillin-resistant Staphylococcus aureus (MRSA) among residents in a nursing home.

Design:

A cohort study with eight surveys of nasal cultures over 15 months.

Setting:

A community nursing home in Chicago, Illinois.

Participants:

Between 117 and 129 residents of the nursing home in each survey.

Results:

MRSA carriers were present throughout the study period. On the average, 24.4% (range: 17.1% to 34.2%) of the residents carried S aureus, and 35.3% (range: 20% to 62.5%) of the isolates were methicillin resistant at each survey. The carrier state was persistent or transient and was affected little by a roommate's carrier status. Approximately 70% to 80% of residents who were bedridden or who had decubitus ulcers or foreign bodies carried MRSA at least once during the study period. Residents' prior hospitalization was not associated with MRSA carriage.

Conclusion:

This study demonstrated that MRSA was perpetuated in the nursing home by persistently or intermittently colonizing debilitated residents who required more intensive nursing care and that the prior hospitalization of the residents was not an important cause of its perpetuation. (Infect Control Hosp Epidemiol. 1991;12:416-421.)

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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References

1. Boyce, JM, Causey, WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982;3:377383.Google Scholar
2. Haley, RW, Culver, DH, White, JW, et al. The nation-wide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol. 1985;121:159167.10.1093/oxfordjournals.aje.a113988Google Scholar
3. Preheim, LC, Rimland, D, Bittner, MJ. Methicillin-resistant Staphylococcus aureus in Veterans Administration medical centers. Infect Control. 1987;8:191194.10.1017/S0195941700065929Google Scholar
4. Centers for Disease Control. Nosocomial infection surveillance, 1984. MMWR. 1986;36:19SS29SS.Google Scholar
5. Montecalvo, MA, Craven, DE. Methicillin-resistant Staphylococcus aureus: epidemiology and current concept for treatment. Internal Medicine. 1989;10:5577.Google Scholar
6. McManus, AT, Mason, AD, McManus, WF, Pruitt, BA Jr. What's in a name? Is methicillin-resistant Staphylococcus aureus just another S aureus when treated with vancomycin? Arch Surg. 1989;124:14561459.Google Scholar
7. Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med. 1988;148:569570.Google Scholar
8. O'Toole, RD, Drew, WL, Dahlgren, BJ, et al. An outbreak of methicillin-resistant Staphylococcus aureus infection: observation in hospital and nursing home. JAMA. 1970;213:257263.10.1001/jama.1970.03170280017003Google Scholar
9. Cederna, JE, Terpenning, MS, Ensberg, M. Bradlev, SE Kaufman, CA. Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hosp Epidemiol. 1990;11:1316.10.2307/30144250Google Scholar
10. Thomas, JC, Bridge, J, Waterman, S, Vagt, J, Kilman, L, Hancock, G. Transmission and control of methicillin-resistant Stuphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol. 1989;10:106110.Google Scholar
11. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med. 1991;114:107112.10.7326/0003-4819-114-2-1-107Google Scholar
12. Storch, CA, Radclii, JL, Meyer, PL, et al. Methicillm-resistant Staphylococcus aureus in a nursing home. infect Control. 1987;8:2429.10.1017/S0195941700066947Google Scholar
13. Chow, JW, Yu, VL. Staphylococcus aureus nasal carriage in hemodialysis patients. Its role in infection and approaches to prophylaxis. Arch Intern Med. 1989;149:12581262.10.1001/archinte.1989.00390060012003Google Scholar
14. Yu, VL, Goetz, A, Wagener, M, et al. Staphylococcus aureus nasal carriage and infection in patients on hemodialysis. Efficacy of antibiotic prophylaxis. N Engl J Med. 1986;315:9196.Google Scholar
15. Sewell, CM, Clarridge, J, Lacke, C, Weinman, EJ, Young, EJ. Staphylococcal nasal carriage and subsequent infection in peritoneal dialysis patients. JAMA. 1982;248:14931495.10.1001/jama.1982.03330120051030Google Scholar
16. Luzar, MA, Coles, GA, Faller, B, et al. Staphylococcus aureus nasal carriage and infection in patients on continuous ambulatory peritoneal dialysis. N Engl J Med. 1990;322:505509.Google Scholar
17. Tuazon, CU, Sheagren, JN. Increased rate of carriage of Staphylococcus aureus among narcotic addicts. J Infect Dis. 1974;129:725727.Google Scholar
18. Aeilts, GD, Sapico, FL, Cenawati, HN, Malik, GM, Montgomerie, JZ. Methicillin-resistant Staphylococcus aureus colonization and infection in a rehabilitation facility. J Clin Microbiol. 1982;16:218223.Google Scholar
19. Haley, RW, Hightower, AW, Khalbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals: possible role of the house-staff-patient transfer circuit. Ann Intern Med. 1983;97:297308.Google Scholar
20. Rhinehart, E, Shlaes, DM, Keys, TF, et al. Nosocomial clonal dissemination of methicillin-resistant Staphylococcus aureus. Elucidation by plasmid analysis. Arch Intern Med. 1987;147:521524.Google Scholar
21. Thompson, RL, Cabezudo, I, Wenzel, RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus . Ann Intern Med. 1982;97:309317.10.7326/0003-4819-97-3-309Google Scholar
22. Boyce, JM, White, RL, Spruill, EY. Impact of methicillin-resistant Staphylococcus aureus on the incidence of nosocomial staphylococcal infection. J Infect Dis. 1983;148:763.Google Scholar
23. Crossley, K, Loesch, D, Landesman, B, Mead, K, Chern, M, Strate, R. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides, I: clinical studies. J Infect Dis. 1979;139:273279.10.1093/infdis/139.3.273Google Scholar
24. Crossley, K, Iandesman, B, Zaske, D. An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II: epidemiological studies. 1 Infect Dis. 1979;139:280287.Google Scholar
25. Craven, DE, Reed, C, Kollisch, N, et al. A large outbreak of infections caused by a strain of Staphylococcus aureus resistant to oxacillin and aminoglycosides. Am J Med. 1981;71:5358.Google Scholar
26. Peacock, JE Jr Marski, JF, Wenzel, RI? Methicillin-resistant Staphylococcus aureus: introduction and spread within a hospital. Ann Intern Med. 1980;93:526532.Google Scholar
27. Bartzokas, CA, Paton, SH, Gibson, MF, Graham, R, Mclaughlen, GA, Croton, RS. Control and eradication of methicillin-resistant Staphylococcus aureus on a surgical unit. N Engl J Med. 1984;311:14221425.Google Scholar
28. Brumfitt, W, Hamilton-Miller, J. Methicillin-resistant Staphylococcus aureus . N Engl J Med. 1989;320:11881196.Google Scholar
29. Standiford, HC. Methicillin-resistant Staphylococcus aureus: it's time to get tough. Infect Control. 1987;8:187189.Google Scholar
30. Lacy, RW. Multi-resistant Staphylococcus aureus-a suitable case for inactivity? J Hosp Infect. 1987;2:103105.10.1016/0195-6701(87)90046-6Google Scholar