Association between nasal methicillin-resistant carriage and infection in liver transplant recipients

Abstract

CommentsStaphylococcus aureus can be an important cause of bacterial infection after liver transplantation. Multidrugresistant strains of S aureus have been reported with increasing frequency worldwide, including isolates that are resistant to methicillin (MRSA), lincosamides, macrolides, aminoglycosides, quinolones, and most recently, vancomycin (see below). It is known that in patients with systemic S aureus infection, there is a strong correlation between strains colonizing the anterior nares and strains isolated from foci of infection, including the blood. 1 Nasal carriage of S aureus has been previously associated with an increased risk for S aureus infection in patients with cirrhosis, S aureus wound infection at the sternotomy site in patients undergoing cardiac surgery, S aureus surgical-site infection in patients undergoing orthopedic surgery, and S aureus bacteremia in hemodialysis, intensive care unit, and HIV-infected patients. 2-7 Nasal carriage of MRSA has been associated with an increased risk for postoperative intra-abdominal MRSA infection in surgical intensive care unit patients. 8 The study by Bert et al 9 shows an association between nasal carriage of S aureus (detected using a nasal swab obtained the day before transplantation) and subsequent S aureus infection in the first 2 months after liver transplantation. This association was statistically significant for MRSA, but not for methicillin-susceptible S aureus (MSSA). 9 It is possible that the greater rate of infection in MRSA carriers than MSSA carriers was related to the perioperative prophylaxis regimen used (cefoxitin or clindamycin and gentamicin), antimicrobial treatment administered posttransplantation, or differences in host characteristics between MSSA carriers and MRSA carriers. MRSA carriers were hospitalized longer and had more intensive care unit days in the year before liver transplantation compared with MSSA carriers. Further studies may be warranted to determine whether there is an increased risk for MSSA infection in MSSA carriers despite the use of perioperative prophylaxis active against MSSA.The study by Bert et al 9 is confirmatory. Chang et al 10 previously showed that nasal MRSA colonization is a significant predictor of MRSA infections in liver transplant recipients. Despite a nasal MSSA colonization rate of 30%, S aureus infections were exclusively caused by MRSA in the study by Chang et al. 10 Among intensive care unit patients, as well as patients in longterm care facilities, the relative risk for S aureus infection in nasal carriers of S aureus has been shown to be greater for nasal carriers of MRSA than for nasal carriers of MSSA. 5,11 The findings reported by Bert et al 9 raise the obvious question of whether the risk for staphylococcal infections can be decreased in those liver transplant recipients found to be colonized with MRSA. In several studies, the elimination of nasal S aureus carriage reduced the incidence of subsequent S aureus infections. For example, a significant reduction in the rate of ...

Feasibility of biodegradable PLGA common bile duct stents: An in vitro and in vivo study

“…Despite prophylaxis, the MRSA infection rate has been 10.3% to 23%. Certainly, as stated by Patel,11 more study is needed to prevent the development of MRSA infections in our liver transplant patients.…”

“…In a 2001 Liver Transplantation Worldwide column, 11 Patel discussed an article on MRSA by Bert et al 12 showing an association between MRSA nasal carriage and subsequent infection at 2 months following liver transplantation. Patel reviewed current treatments, highlighting mupirocin nasal ointment as potentially effective in eradicating MRSA from the nasal cavities.…”

Atopic dermatitis-derived Staphylococcus aureus strains: what makes them special in the interplay with the host

“…After the therapy, the significant improvement of the disease activity was accompanied by the simultaneous eradication of both nasal and skin colonizations, in 28% of AD patients. However, more than half of the AD patients were characterized by persisting S. aureus nasal colonization, confirming the anterior nares as the primary reservoir for S. aureus and as a major source for extra-nasal auto-transmission ( Patel, 2001 ).…”

Caracterização molecular de isolados de Staphylococcus aureus resistentes à meticilina (MRSA) obtidos de colonização e infecção de pacientes hepatopatas e transplantados hepáticos

“…Essas medidas já foram bastante utilizadas no controle de surtos hospitalares de S. aureus resistente a oxacilina. O impacto dessas medidas na redução das taxas de infecção por S. aureus resistente a oxacilina na população de pacientes transplantados hepáticos, entretanto, ainda é controverso (Jerigan et al, 1996;Karchmer et al, 2002, Parras et al, 1995Patel et al, 2001;Pujol et al, 1996;Panterson et al, 2003;Singh et al, 2006 (Paterson et al, 2003). Mostrando assim que esta medida se usada isoladamente pode não ser efetiva no controle de infecções por MRSA.…”