MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers

Roghmann, Mary-Claire; Siddiqui, Ahsan; Plaisance, Karen I.; Standiford, Harold C.

doi:10.1053/jhin.2000.0903

Cited by 98 publications

(69 citation statements)

References 10 publications

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“…Without active surveillance methods, 17 (41%) of the 41 patients with admission MRSA would not have been identified. Although these 17 patients were found only to be colonized with MRSA, it has been shown that patients with only MRSA colonization can be significant sources for the spread of MRSA in a hospital (5,12,17,19,31,36). If rapid MRSA identification methods, such as CHROMagar or PCR, were used for admission surveillance cultures but not for clinical cultures, active admission surveillance would provide advance identification of MRSA for 26 (63%) of the 41 patients with admission MRSA.…”

Section: Discussionmentioning

confidence: 99%

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Methicillin-Resistant Staphylococcus aureus Infection or Colonization Present at Hospital Admission: Multivariable Risk Factor Screening To Increase Efficiency of Surveillance Culturing

Haley

Mittal²,

LaViolette

et al. 2007

J Clin Microbiol

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Identifying methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection present at admission has become important in reducing subsequent nosocomial transmission, but the most efficient surveillance methods remain to be defined. We performed anterior nares surveillance cultures of all patients upon admission to and discharge from the general internal medicine floor in our community hospital over a 7-week period, and patients completed a questionnaire on MRSA risk factors. Of the 401 patients, 41 (10.2%) had MRSA upon admission. Of the 48 risk measures analyzed, 10 were significantly associated with admission MRSA, and 7 of these were independently associated in stepwise logistic regression analysis. Factor analysis identified eight latent variables that contained most of the predictive information in the 48 risk measures. Repeat logistic regression analysis including the latent variables revealed three independent risk measures for admission MRSA: a nursing home stay (relative risk [RR], 6.18; 95% confidence interval [95% CI], 3.56 to 10.72; P < 0.0001), prior MRSA infection (RR, 3.97; 95% CI, 1.94 to 8.12; P ‫؍‬ 0.0002), and the third latent variable (factor 3; RR, 3.14; 95% CI, 1.56 to 6.31; P ‫؍‬ 0.0013), representing the combined effects of homelessness, jail stay, promiscuity, intravenous drug use, and other drug use. Multivariable models had greater sensitivity at detecting admission MRSA than any single risk measure and allowed detection of 78% to 90% of admission MRSA from admission surveillance cultures on 46% to 58% of admissions. If confirmed in additional studies, multivariable questionnaire screening at admission might identify a subset of admissions for surveillance cultures that would more efficiently identify most admission MRSA.Methicillin-resistant Staphylococcus aureus (MRSA) continues to be a cause of significant morbidity and mortality. Infection with MRSA, compared to methicillin-sensitive Staphylococcus aureus strains, has been associated with higher mortality rates (4,9,11,14), longer hospital stays, and higher hospital charges (1,9,27,30). In recent years, the prevalence of community-acquired MRSA has increased in certain segments of the community, resulting in admission to hospitals of increasing numbers of patients who are MRSA positive at admission and can then spread the organism in the hospital. These findings have increased the need to devise systems that efficiently screen admitted patients in order to identify those at high risk for having MRSA and isolate them to prevent subsequent nosocomial spread.Presently a highly contested question is whether to culture all patients for MRSA at hospital admission, a proposition that has been criticized as too expensive (32,38). To identify a more cost-effective middle ground, we undertook a quality improvement study in our hospital to identify high-risk groups who could be cultured selectively upon admission so as to detect all patients with MRSA upon admission more efficiently. Commonly, investigators have made a distinctio...

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Section: Discussionmentioning

confidence: 99%

“…Also, use of the recently described generalized linear modeling approach for multivariable estimation of RRs when outcomes are not rare (36) provided unbiased prevalence RR estimates for the risk measures appearing in our logistic regression models. Any of the 6 measures in Table 4 other than age 31-45 80 58 46…”

Section: Discussionmentioning

confidence: 99%

Methicillin-Resistant Staphylococcus aureus Infection or Colonization Present at Hospital Admission: Multivariable Risk Factor Screening To Increase Efficiency of Surveillance Culturing

Haley

Mittal²,

LaViolette

et al. 2007

J Clin Microbiol

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“…MRSA colonization in wounds and skin ulcers is well documented. 21,25,33 Microbial contamination of tube feeding solution has been associated with nosocomial infection. 34 In this study, tube feeding via a percutaneous tube alone did not significantly elevate the risk of MRSA acquisition in the multivariate model, suggesting that the route was the risk factor, rather than tube feeding solution itself.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

Warren

Guth

Coopersmith

et al. 2006

Infect. Control Hosp. Epidemiol.

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of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit." Infection Control and Hospital Epidemiology. 27,10. 1032-1040. (2006 http://www.jstor.org/page/info/about/policies/terms.jsp 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. The University of Chicago Press andThe Society for Healthcare Epidemiology of America are collaborating with JSTOR to digitize, preserve and extend access to Infection Control and Hospital Epidemiology.

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“…A follow-up study (4) demonstrated that the number of foot wounds from which MRSA was isolated doubled in a 3-year period. Although terms such as critical colonization are not clearly defined, the risk of MRSA infection and bacteremia in patients with colonized ulcers is recognized (5,6). Furthermore, there is evidence (4) that MRSA colonization of chronic ulcers is associated with delayed healing times.…”

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confidence: 99%

Larval Therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus From Diabetic Foot Ulcers

2007

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MRSA colonization and the risk of MRSA bacteraemia in hospitalized patients with chronic ulcers

Cited by 98 publications

References 10 publications

Methicillin-Resistant Staphylococcus aureus Infection or Colonization Present at Hospital Admission: Multivariable Risk Factor Screening To Increase Efficiency of Surveillance Culturing

Methicillin-Resistant Staphylococcus aureus Infection or Colonization Present at Hospital Admission: Multivariable Risk Factor Screening To Increase Efficiency of Surveillance Culturing

Epidemiology of Methicillin-Resistant Staphylococcus aureus Colonization in a Surgical Intensive Care Unit

Larval Therapy: A Novel Treatment in Eliminating Methicillin-Resistant Staphylococcus aureus From Diabetic Foot Ulcers

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