Methicillin-Resistant Staphylococcus aureus as a Causative Agent of Postoperative Intra-abdominal Infection: Relation to Nasal Colonization

Fierobe, Lisiane; Decré, Dominique; Muller, Claudette; Lucet, Jean‐Christophe; Marmuse, Jean–Pierre; Mantz, Jean; Desmonts, Jean-Marie

doi:10.1086/313454

Cited by 67 publications

(48 citation statements)

References 31 publications

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“…MRSA strains colonize easily in the host particularly in immuno-deficient patients where it can cause a variety of serious infections that are often difficult to control, such as septicemia, pneumonia, endocarditis, meningitis and postoperative intra-abdominal infection (4,6,15,16). Transmission of MRSA occurs through direct person-to-person contact, usually on the hands of health care workers.…”

Section: Methicillin-resistant Staphylococcus Aureus (Mrsa)mentioning

confidence: 99%

Enterocolitis Caused by Methicillin‐Resistant Staphylococcus aureus: Molecular Characterization of Respiratory and Digestive Tract Isolates

Watanabe

Masaki

Asoh

et al. 2001

Microbiology and Immunology

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Abstract:We investigated the mechanism of outbreak of enterocolitis caused by methicillin-resistant Staphylococcus aureus (MRSA). Five epidemiological markers [coagulase type, enterotoxin type, toxic shock syndrome toxin-l (TSST-l) production, ll-Iactamase production and pulsed-field gel electrophoresis (PFGE)] of 45 strains of MRSA isolated simultaneously from the respiratory tract (nasal cavity and/or pharynx and/or sputum) and stool (plus one sample of gastric juice) in 13 patients (8 males and 5 females, mean age, 77.1 years) were compared retrospectively. Forty-four of the 45 isolates of MRSA were positive for enterotoxin C and TSST-l production, and the remaining isolate was positive for enterotoxin A and negative for TSST-l production. All isolates were coagulase type II, and 27 showed ll-Iactamase production. The patterns of coagulase type, enterotoxin type, TSST-l and ll-Iactamase production of MRSA isolated from the respiratory tract were similar to those of MRSA isolated from the intestine in 12 of 13 patients. Molecular typing by PFGE demonstrated that the pattern of respiratory tract isolates was identical to those of stool isolates in 9 (69.2%), similar in 3 (23.1%), and different in 1 (7.7%). The data suggested that enterocolitis might be caused by the MRSA colonized in the respiratory tract and incorporated into the digestive tracts. Therefore, we propose that early eradication of MRSA in the respiratory tract is important for protection of patients against the development of enterocolitis, particularly in susceptible patients, e.g., immunocompromised or pre-operated patients with digestive diseases, especially malignant disease.

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Section: Methicillin-resistant Staphylococcus Aureus (Mrsa)mentioning

confidence: 99%

Enterocolitis Caused by Methicillin‐Resistant Staphylococcus aureus: Molecular Characterization of Respiratory and Digestive Tract Isolates

Watanabe

Masaki

Asoh

et al. 2001

Microbiology and Immunology

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“…This principle is difficult to demonstrate by experiment. However, levels of environmental contamination with Acinetobacter baumannii in intensive care units correlate with colonisation and infection of patients [16], nasal colonisation with MRSA is a risk factor for subsequent MRSA septicaemia [6], and asymptomatic colonisation with Staphylococcus aureus is associated with a greater risk of wound infection [5].…”

Section: Discussionmentioning

confidence: 99%

“…Asymptomatic colonisation with potentially pathogenic bacteria confers a significantly increased risk of clinically important infection [5]. Unsurprisingly, nasal colonisation with methicillin-resistant Staphylococcus aureus (MRSA) has been shown to be a risk factor for severe MRSA sepsis following surgery [6]. Colonisation can be prevented through widespread adoption of simple hygiene measures [7].…”

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confidence: 99%

Contamination of anaesthetic machines with pathogenic organisms*

Baillie

Sultan

Graveling³

et al. 2007

Anaesthesia

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SummaryHospital-acquired infections are commonly resistant to antibiotics and cause substantial morbidity and mortality in susceptible populations. Although there is no direct contact between the anaesthetic machine's controls and the patient, there is considerable potential for colonising organisms to be carried between the anaesthetic machine and the patient on the anaesthetist's hands. We performed two cross-sectional studies of bacterial contamination on anaesthetic machines before and after a simple intervention. Without warning, during theatre sessions, bacterial cultures were obtained from anaesthetic equipment. A new departmental policy of cleaning anaesthetic equipment with detergent wipes between cases was then introduced. Six weeks later, again without warning, a further set of cultures was taken. There was significant reduction in the proportion of cultures containing pathogenic bacteria (from 14 ⁄ 78 cultures (18%; 95% CI 9.4-26.5%) before the intervention to 5 ⁄ 77 cultures (6%; 95% CI 1.0-12%) after the intervention (p = 0.03)). The intervention was quick, easy and enthusiastically taken up by the majority of staff. We conclude that cleaning of anaesthetic equipment between cases should become routine practice.

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“…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).…”

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confidence: 99%

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

Patel

2001

Liver Transplantation

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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 ...

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Methicillin-Resistant Staphylococcus aureus as a Causative Agent of Postoperative Intra-abdominal Infection: Relation to Nasal Colonization

Cited by 67 publications

References 31 publications

Enterocolitis Caused by Methicillin‐Resistant Staphylococcus aureus: Molecular Characterization of Respiratory and Digestive Tract Isolates

Enterocolitis Caused by Methicillin‐Resistant Staphylococcus aureus: Molecular Characterization of Respiratory and Digestive Tract Isolates

Contamination of anaesthetic machines with pathogenic organisms*

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

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