1. Incidence of and risk factors for community-associated methicillin-resistant Staphylococcus aureus acquired infection or colonization in intensive-care-unit patients.
- Author
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Wang JT, Liao CH, Fang CT, Chie WC, Lai MS, Lauderdale TL, and Chang SC
- Subjects
- Abdomen microbiology, Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents pharmacology, Axilla microbiology, Bacterial Toxins genetics, Cross Infection microbiology, Exotoxins genetics, Female, Humans, Incidence, Intensive Care Units, Leukocidins genetics, Male, Methicillin-Resistant Staphylococcus aureus classification, Methicillin-Resistant Staphylococcus aureus genetics, Microbial Sensitivity Tests, Middle Aged, Multilocus Sequence Typing, Nose microbiology, Pharynx microbiology, Risk Factors, Sputum microbiology, Young Adult, Carrier State epidemiology, Carrier State microbiology, Community-Acquired Infections microbiology, Cross Infection epidemiology, Methicillin-Resistant Staphylococcus aureus isolation & purification, Staphylococcal Infections epidemiology, Staphylococcal Infections microbiology
- Abstract
The incidence of and risk factors for acquiring community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) among patients staying in intensive care units (ICUs) remain unclear. We enrolled patients staying in two ICUs at the Far Eastern Memorial Hospital during the period of 1 September 2008 to 30 September 2009 to clarify this issue. Surveillance cultures for MRSA were taken from nostril, sputum or throat, axillae, and the inguinal area in all enrolled patients upon admission to the ICU, every 3 days thereafter, and on the day of discharge from the ICU. For each MRSA isolate, we performed multilocus sequence typing, identified the type of staphylococcal cassette chromosome mec, detected the presence of the Panton-Valentine leukocidin gene, and conducted drug susceptibility tests. Among the 1,906 patients who were screened, 203 patients were carriers of MRSA before their admission to the ICU; 81 patients acquired MRSA during their stay in the ICU, including 31 who acquired CA-MRSA. The incidence rates of newly acquired MRSA and CA-MRSA during the ICU stay were 7.9 and 3.0 per 1,000 patient-days, respectively. Prior usage of antipseudomonal penicillins and antifungals and the presence of a nasogastric tube were found to be independent risk factors for acquiring CA-MRSA during the ICU stay when data for CA-MRSA carriers and patients without carriage of MRSA were compared (P=0.0035, 0.0330, and 0.0262, respectively). Prior usage of carbapenems was found to be a protective factor against acquiring CA-MRSA when data for patients with CA-MRSA and those with health care-associated MRSA acquired during ICU stay were compared (P=0.0240).
- Published
- 2010
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