Are Nasal Carriers of
            <i>Staphylococcus aureus</i>
            More Likely To Become Colonized or Infected with Methicillin-Resistant
            <i>Staphylococcus aureus</i>
            on Admission to a Hospital?

Krebes, Juliane; Al-Ghusein, Hasan; Feasey, Nicholas A.; Breathnach, Aodhán S.; Lindsay, Jodi A.

doi:10.1128/jcm.02039-10

Cited by 18 publications

(12 citation statements)

References 18 publications

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“…All infection isolates were from blood culture bottles of patients with clinical symptoms of bacteraemia. Colonization isolates were from routine nasal specimens taken for MRSA screening purposes at admission to the same hospital in 2009 (n516) (Krebes et al, 2011). Two sequenced isolates were also included: MRSA5096 (CC22) and MRSA252 (CC30) (Holden et al, 2004) Whole genome DNA extraction.…”

Section: Methodsmentioning

confidence: 99%

Large mobile genetic elements carrying resistance genes that do not confer a fitness burden in healthcare-associated meticillin-resistant Staphylococcus aureus

2013

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Section: Methodsmentioning

confidence: 99%

Large mobile genetic elements carrying resistance genes that do not confer a fitness burden in healthcare-associated meticillin-resistant Staphylococcus aureus

2013

Self Cite

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“…The few published studies have shown contradictory results. 17,18 For instance, Krebes et al 18 showed that noncarriers of MSSA were not more susceptible to acquiring MRSA compared with MSSA carriers. Among 840 included patients, 9 (21.4%) of 42 patients who acquired MRSA during their hospitalization versus 178 (23%) of 775 patients who did not acquire MRSA were MSSA carriers.…”

Section: Discussionmentioning

confidence: 99%

“…17 By contrast, a small retrospective study suggested that carriage of MSSA was not protective against MRSA acquisition. 18 Of note, both studies evaluated MRSA in the nares only.…”

Section: Does Colonization With Methicillin-susceptiblementioning

confidence: 99%

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Landelle

Iten

Uçkay

et al. 2014

Infect. Control Hosp. Epidemiol.

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OBJECTIVE: To test the hypothesis that methicillin-susceptible Staphylococcus aureus (MSSA) carriage may protect against nosocomial methicillin-resistant S. aureus (MRSA) acquisition by competing for colonization of the anterior nares. DESIGN: Prospective cohort and nested case-control study. SETTING: Swiss university hospital. PATIENTS: All adult patients admitted to 14 wards of the general medicine division between April 1 and October 31, 2007. METHODS: Patients were screened for MRSA and MSSA carriage at admission to and discharge from the division. Associations between nosocomial MRSA acquisition and MSSA colonization at admission and other confounders were analyzed by univariable and multivariable analysis. RESULTS: Of 898 patients included, 183 (20%) were treated with antibiotics. Nosocomial MRSA acquisition occurred in 70 (8%) of the patients (case patients); 828 (92%) of the patients (control subjects) were free of MRSA colonization at discharge. MSSA carriage at admission was 20% and 21% for case patients and control subjects, respectively. After adjustment by multivariate logistic regression, no association was observed between MSSA colonization at admission and nosocomial MRSA acquisition (adjusted odds ratio [aOR], 1.2 [95% confidence interval (CI), 0.6-2.3]). By contrast, 4 independent predictors of nosocomial MRSA acquisition were identified: older age (aOR per 1-year increment, 1.05 [95% CI, 1.02-1.08]); increased length of stay (aOR per 1-day increment, 1.05 [95% CI, 1.02-1.09]); increased nursing workload index (aOR per 1-point increment, 1.02 [95% CI, 1.01-1.04]); and previous treatment with macrolides (aOR, 5.6 [95% CI, JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org.

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“…Consequently, the effect of prior colonization on S. aureus endo-versus exo-infection is unclear. It has been shown that patients re-admitted to the hospital benefitted from a protective effect of being colonised with MSSA [22,23]. The protective efficacy of such colonization in the prevention of acquisition of MRSA was calculated to be 78%.…”

Section: Introductionmentioning

confidence: 99%

Nasal carriers are more likely to acquire exogenous Staphylococcus aureus strains than non-carriers

Ghasemzadeh-Moghaddam

Neela

Wamel

et al. 2015

Clinical Microbiology and Infection

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We performed a prospective observational study in a clinical setting to test the hypothesis that prior colonization by a Staphylococcus aureus strain would protect, by colonization interference or other processes, against de novo colonization and, hence, possible endo-infections by newly acquired S. aureus strains. Three hundred and six patients hospitalized for >7 days were enrolled. For every patient, four nasal swabs (days 1, 3, 5, and 7) were taken, and patients were identified as carriers when a positive nasal culture for S. aureus was obtained on day 1 of hospitalization. For all patients who acquired methicillin-resistant S. aureus (MRSA) or methicillin-susceptible S. aureus via colonization and/or infection during hospitalization, strains were collected. We note that our study may suffer from false-negative cultures, local problems with infection control and hospital hygiene, or staphylococcal carriage at alternative anatomical sites. Among all patients, 22% were prior carriers of S. aureus, including 1.9% whom carried MRSA upon admission. The overall nasal staphylococcal carriage rate among dermatology patients was significantly higher than that among neurosurgery patients (n = 25 (55.5%) vs. n = 42 (16.1%), p 0.005). This conclusion held when the carriage definition included individuals who were nasal culture positive on day 1 and day 3 of hospitalization (p 0.0001). All MRSA carriers were dermatology patients. There was significantly less S. aureus acquisition among non-carriers than among carriers during hospitalization (p 0.005). The mean number of days spent in the hospital before experiencing MRSA acquisition in nasal carriers was 5.1, which was significantly lower than the score among non-carriers (22 days, p 0.012). In conclusion, we found that nasal carriage of S. aureus predisposes to rather than protects against staphylococcal acquisition in the nose, thereby refuting our null hypothesis.

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Are Nasal Carriers of Staphylococcus aureus More Likely To Become Colonized or Infected with Methicillin-Resistant Staphylococcus aureus on Admission to a Hospital?

Cited by 18 publications

References 18 publications

Large mobile genetic elements carrying resistance genes that do not confer a fitness burden in healthcare-associated meticillin-resistant Staphylococcus aureus

Large mobile genetic elements carrying resistance genes that do not confer a fitness burden in healthcare-associated meticillin-resistant Staphylococcus aureus

Does Colonization with Methicillin-Susceptible Staphylococcus aureus Protect against Nosocomial Acquisition of Methicillin-Resistant S. aureus?

Nasal carriers are more likely to acquire exogenous Staphylococcus aureus strains than non-carriers

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