Successful long-term program for controlling methicillin-resistant Staphylococcus aureus in intensive care units

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.

Section: Discussionsupporting

confidence: 91%

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

Landelle

Iten

Uçkay

et al. 2014

“…This value reflects a more accurate estimate of incidence, as it accounts for length of stay in the ICU before the time of MRSA colonization, as opposed to including all ICU-days in the denominator. Others have used the total number of patient-days to calculate the incidence density of MRSA colonization, 31,32 which would underestimate the true acquisition rate.…”

Section: Discussionmentioning

confidence: 99%

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

Warren

Guth

Coopersmith

et al. 2006

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.

“…[77][78][79][80][81][82] ii. Not all studies, however, have come to the same conclusion, 83,84 including the single cluster-randomized trial of targeted MRSA active surveillance where active surveillance and use of barrier precautions in ICU patients was not associated with a reduction in MRSA colonization or infection, although limitations in the study design and suboptimal use of barrier precautions prevent definitive conclusions from being drawn.…”

Section: Section 2: Background-strategies To Detect Mrsamentioning

confidence: 99%

Strategies to Prevent Methicillin-ResistantStaphylococcus aureusTransmission and Infection in Acute Care Hospitals: 2014 Update

Calfee

Salgado

Milstone

et al. 2014

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their methicillin-resistant Staphylococcus aureus (MRSA) prevention efforts. This document updates “Strategies to Prevent Transmission of Methicillin-Resistant Staphylococcus aureus in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.