Korean J Nosocomial Infect Control.  2014 Dec;19(2):37-44. 10.14192/kjnic.2014.19.2.37.

The Rate of Nasal Colonization of Methicillin-resistant Staphylococcus aureus at Admission to Intensive Care Units in a Secondary Hospital: The Importance of Nasogastric Tube

• Lee ES
• Yang HJ
• Wi YM
• Jin SJ
• Seo KH
• Kim JH
• Kwon YJ
• Kim JD
• Kim YS
• Lee YJ

• KMID: 1834993
• DOI: http://doi.org/10.14192/kjnic.2014.19.2.37

Abstract

BACKGROUND
Methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization has been known as a predictor of intensive care unit (ICU)-acquired MRSA infections. We performed this study to survey the nasal colonization of MRSA among the patients admitted to an ICU and analyze risk factors associated with the colonization.
METHODS
A retrospective 1:1 matched case-control study was conducted with patients admitted to the ICU from March to December 2010 at Samsung Changwon Hospital.
RESULTS
A total of 602 patients among 846 patients admitted to the ICU during the study period were evaluated. The prevalence of nasal MRSA colonization was 67 (11.1%) of 602. Other factors, including underlying renal disease (odds ratio [OR]=12.37, 95% confidence interval [CI] 3.60-42.54; P<0.001), MRSA infection within the previous 3 months (OR=7.43, 95% CI 1.31-42.05; P=0.023), nursing home resident within the previous 1 month (OR=6.25, 95% CI 1.82-21.53; P=0.004), surgical procedure within the previous 1 month (OR=5.93, 95% CI 1.86-18.85; P=0.003), and current use of nasogastric tube (OR=4.98, 95% CI 1.84-13.45; P=0.002) were independently associated with nasal MRSA colonization in patients admitted to ICU.
CONCLUSION
A significant number of patients admitted to the ICU in a secondary hospital were colonized with MRSA. The present study showed the possible impact of the presence of a nasogastric tube on the nasal colonization by MRSA. More effective infection control procedures must be developed for patients with nasogastric tube use.

Keyword

ICU; MRSA; Nasal colonization; Nasogastric tube

MeSH Terms

Case-Control Studies
Colon*
Gyeongsangnam-do
Humans
Infection Control
Intensive Care Units*
Methicillin-Resistant Staphylococcus aureus*
Nursing Homes
Prevalence
Retrospective Studies
Risk Factors

Figure

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  Fig. 1. Description of the study population.

Reference

References

1. Soriano A, Martínez JA, Mensa J, Marco F, Almela M, Moreno-Martínez A. . Pathogenic significance of methicillin resistance for patients with Staphylococcus aureus bacteremia. Clin Infect Dis. 2000; 30:368–73.

2. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med. 2002; 162:2229–35.

3. Jensen AG, Wachmann CH, Espersen F, Scheibel J, Skinhøj P, Frimodt-Møller N. Treatment and outcome of Staphylococcus aureus bacteremia: a prospective study of 278 cases. Arch Intern Med. 2002; 162:25–32.

4. Herold BC, Immergluck LC, Maranan MC, Lauderdale DS, Gaskin RE, Boyle-Vavra S, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998; 279:593–8.

5. Naimi TS, LeDell KH, Como-Sabetti K, Borchardt SM, Boxrud DJ, Etienne J, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003; 290:2976–84.

6. von Eiff C, Becker K, Machka K, Stammer H, Peters G. Nasal carriage as a source of Staphylococcus aureus bacteremia. Study Group. N Engl J Med. 2001; 344:11–6.

7. Wertheim HF, Vos MC, Ott A, van Belkum A, Voss A, Kluytmans JA, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers. Lancet. 2004; 364:703–5.

8. Honda H, Krauss MJ, Coopersmith CM, Kollef MH, Richmond AM, Fraser VJ. et al. Staphylococcus aureus nasal colonization and subsequent infection in intensive care unit patients: does methicillin resistance matter? Infect Control Hosp Epidemiol. 2010; 31:584–91.

9. Huang SS, Yokoe DS, Hinrichsen VL, Spurchise LS, Datta R, Miroshnik I, et al. Impact of routine intensive care unit surveillance cultures and resultant barrier precautions on hospital-wide methicillin-resistant Staphylococcus aureus bacteremia. Clin Infect Dis. 2006; 43:971–8.

10. Jeyaratnam D, Whitty CJ, Phillips K, Liu D, Orezzi C, Ajoku U, et al. Impact of rapid screening tests on acquisition of meticillin resistant Staphylococcus aureus: cluster randomised crossover trial. BMJ. 2008; 336:927–30.

11. Robicsek A, Beaumont JL, Paule SM, Hacek DM, Thomson RB Jr, Kaul KL, et al. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Ann Intern Med. 2008; 148:409–18.

12. Struelens MJ, Denis O. Rapid molecular detection of methicillin-resistant Staphylococcus aureus: a cost-effective tool for infection control in critical care? Crit Care. 2006; 10:128.

13. Huang SS, Rifas-Shiman SL, Warren DK, Fraser VJ, Climo MW, Wong ES, Centers for Disease Control and Prevention Epicenters Program, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis. 2007; 195:330–8.

14. Harbarth S, Sax H, Fankhauser-Rodriguez C, Schrenzel J, Agostinho A, Pittet D. Evaluating the probability of previously unknown carriage of MRSA at hospital admission. Am J Med. 2006; 119:275. e15-23.

15. Coia JE, Leanord AT, Reilly J. Screening for meticillin resistant Staphylococcus aureus (MRSA): who, when, and how? BMJ. 2014; 348:g1697.

16. Mody L, Maheshwari S, Galecki A, Kauffman CA, Bradley SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc. 2007; 55:1921–6.

17. Segal R, Dan M, Eger G, Lubart E, Leibovitz A. Staphylococcus aureus colonization in the nasopharynx of nasogastric tube-fed patients in a long-term care facility. Eur J Clin Microbiol Infect Dis. 2009; 28:1147–9.

18. Eun SH, Lee YS, Cha JO, Yoo JI, Lee JG, Lee HJ, et al. The point prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus colonisation in eight geriatric hospitals in Korea. Clin Microbiol Infect. 2006; 12:81–3.

19. Seong HK, Bae YS, Kim YH. The epidemiological survey of nasal colonization of methicillin resistant Staphylococcus aureus in patients and doctors. Korea J Exp Biomed Sei. 2004; 10:309–15.

20. Kim OS, Yoon SW, Kang YJ, Kim YK, Lee NY, Lee JH, et al. Rate of nasal colonization of methicillin-resistant Staphylococcus aureus at admission to a medical intensive care unit. Korean J Nosocomial Infect Control. 2007; 12:42–9.

21. Song W, Lee TJ, Kim SJ, Park MJ, Lee KM. Methicillin-resistant Staphylococcus aureus infections in intensive care unit (ICU) patients: relation to nasal carriage of patients or ICU personnels. Korean J Clin Microbiol. 2001; 4:45–51.

22. Kwak OS, Kwon MH, Jeong JH, Kang MI, Cheun JY, Lee GE, et al. Molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus isolated from nasal swab at intensive care unit. Tuberc Respir Dis. 2008; 65:91–8.

23. Xue Y, Gyi AA. Predictive risk factors for methicillin-resistant Staphylococcus aureus (MRSA) colonisation among adults in acute care settings: a systematic review. JBI Library Syst Rev. 2012; 10:3487–560.

24. Payne-James JJ, De Gara CJ, Grimble GK, Bray MJ, Rana SK, Kapadia S, et al. Artificial nutrition support in hospitals in the United Kingdom - 1991: Second national survey. Clin Nutr. 1992; 11:187–92.

25. Lin LC, Li MH, Watson R. A survey of the reasons patients do not chose percutaneous endoscopic gastrostomy/jejunostomy (PEG/PEJ) as a route for long-term feeding. J Clin Nurs. 2011; 20:802–10.

26. Warren DK, Guth RM, Coopersmith CM, Merz LR, Zack JE, Fraser VJ. Epidemiology of methicillin-resistant Staphylococcus aureus colonization in a surgical intensive care unit. Infect Control Hosp Epidemiol. 2006; 27:1032–40.

27. Wang CY, Wu VC, Wang WJ, Lin YF, Lin YH, Chen YM, et al. Risk factors for nasal carriage of methicillin-resistant Staphylococcus aureus among patients with end-stage renal disease in Taiwan. J Formos Med Assoc. 2012; 111:14–8.

28. Matheson A, Christie P, Stari T, Kavanagh K, Gould IM, Masterton R, et al. Nasal swab screening for methicillin-resistant Staphylococcus aureus-how well does it perform? A cross-sectional study. Infect Control Hosp Epidemiol. 2012; 33:803–8.

29. Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis. 2009; 48:910–3.

30. Compernolle V, Verschraegen G, Claeys G. Combined use of Pastorex Staph-Plus and either of two new chromogenic agars, MRSA ID and CHRO Magar MRSA, for detection of methicillin-resistant Staphylococcus aureus. J Clin Microbiol. 2007; 45:154–8.