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Prevalence and Characteristics of Staphylococcus aureus Colonization among Healthcare Professionals in an Urban Teaching Hospital

Published online by Cambridge University Press:  02 January 2015

Marie-Carmelle Elie-Turenne ,
Helen Fernandes ,
José R. Mediavilla ,
Marnie Rosenthal ,
Barun Mathema ,
Ashima Singh ,
Tiffany R. Cohen ,
Kimmerle A. Pawar ,
Hosseinali Shahidi  and
Barry N. Kreiswirth
...Show all authors
Marie-Carmelle Elie-Turenne*
Affiliation:
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Helen Fernandes
Affiliation:
New Jersey Medical School, the Department of Pathology, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
José R. Mediavilla
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Marnie Rosenthal
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Department of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, Massachusetts
Barun Mathema
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Ashima Singh
Affiliation:
Department of Health Informatics, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Tiffany R. Cohen
Affiliation:
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Department of Emergency Medicine, Beth Israel Medical Center, New York, New York
Kimmerle A. Pawar
Affiliation:
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey Department of Emergency Medicine, New York University, New York, New York
Hosseinali Shahidi
Affiliation:
Department of Emergency Medicine, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Barry N. Kreiswirth
Affiliation:
Public Health Research Institute, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
Edwin A. Deitch
Affiliation:
Department of Surgery, University of Medicine and Dentistry of New Jersey, Newark, New Jersey
*
University of Medicine and Dentistry of New Jersey-New Jersey Medical School, UH M219, 150 Bergen Street, Newark, NJ 07103, (eliema@umdnj.edu)
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Extract

Objective.

To determine the prevalence of asymptomatic carriage of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) among healthcare professionals (HCPs) who experience varying degrees of exposure to ambulatory patients and to genetically characterize isolates.

Methods.

This single-center, cross-sectional study enrolled 256 staff from the intensive care units, emergency department, and prehospital services of an urban tertiary care university hospital in 2008. Occupational histories and nasal samples for S. aureus cultures were obtained. S. aureus isolates were genetically characterized with the use of spa typing and screened for mecA. MRSA isolates underwent further characterization.

Results.

S. aureus was isolated from 112 of 256 (43.8%) HCPs, including 30 of 52 (57.7%) paramedics, 51 of 124 (41.1%) nurses, 11 of 28 (39.3%) clerical workers, and 20 of 52 (38.5%) physicians. MRSA was isolated from 17 (6.6%) HCPs, including 1 (1.9%) paramedic, 13 (10.5%) nurses, 1 (3.6%) clerical worker, and 2 (3.8%) physicians. Among S. aureus isolates, 15.2% were MRSA. MRSA prevalence was 9.6% (12/125) in emergency department workers, 5.1% (4/79) in intensive care unit workers, and 1.9% (1/52) in emergency medical services workers. Compared with paramedics, who had the lowest prevalence of methicillin resistance among S. aureus isolates (1 of 30 [3.3%] isolates), nurses, who had the highest prevalence (13 of 51 [25.4%] isolates), had an odds ratio of 9.92 (95% confidence interval, 1.32-435.86; P = .02) for methicillin resistance. Analysis of 15 MRSA isolates revealed 7 USA100 strains, 6 USA300 strains, 1 USA800 strain, and 1 EMRSA-15 strain. All USA300 strains were isolated from emergency department personnel.

Conclusions.

The observed prevalence of S. aureus and MRSA colonization among HCPs exceeds previously reported prevalences in the general population. The proportion of community-associated MRSA among all MRSA in this colonized HCP cohort reflects the distribution of the USA300 community-associated strain observed increasingly among US hospitalized patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 6 , June 2010 , pp. 574 - 580
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593–598.CrossRefGoogle ScholarPubMed
2.Klevens, RM, Morrison, MA, Nadle, J, et al.Invasive methicillin-resistant Staphybcoccus aureus infections in the United States. JAMA 2007;298: 1763–1771.CrossRefGoogle ScholarPubMed
3.Pallin, D, Egan, D, Pelletier, A, Espinola, J, Hooper, D, Camargo, CJ. Increased US emergency department visits for skin and soft tissue infections, and changes in antibiotic choices, during the emergence of community-associated methicillin-resistant Staphylococcus aureus. Ann Emerg Med 2008;51:291–298.Google Scholar
4.Frazee, BW, Lynn, J, Charlebois, ED, Lambert, L, Lowery, D, Perdreau-Remington, F. High prevalence of methicillin-resistant Staphylococcus aureus in emergency department skin and soft tissue infections. Ann Emerg Med 2005;45:311–320.Google Scholar
5.Cosgrove, SE, Qi, Y, Kaye, KS, Harbarth, S, Karchmer, AW, Carmeli, Y. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005;26:166–174.CrossRefGoogle ScholarPubMed
6.Jeanes, A, Rao, G, Osman, M, Merrick, P. Eradication of persistent environmental MRSA. J Hosp Infect 2005;61:85–86.Google Scholar
7.Roline, C, Crumpecker, C, Dunn, T. Can methicillin-resistant Staphylococcus aureus be found in an ambulance fleet? Prehosp Emerg Care 2007; 11:241–244.Google Scholar
8.Albrich, WC, Harbarth, S. Health-care workers: source, vector, or victim of MRSA? Lancet Infect Dis 2008;8:289–301.CrossRefGoogle ScholarPubMed
9.Wang, JT, Chang, SC, Ko, WJ, et al.A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 2001;47:104–109.Google Scholar
10.Wagenvoort, JH, De Brauwer, EI, Sijstermans, ML, Toenbreker, HM. Risk of re-introduction of methicillin-resistant Staphylococcus aureus into the hospital by intrafamilial spread from and to healthcare workers. J Hosp Infect 2005;59:67–68.CrossRefGoogle ScholarPubMed
11.Suffoletto, BP, Cannon, EH, Ilkhanipour, K, Yealy, DM. Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel. Ann Emerg Med 2008;52:529–533.CrossRefGoogle ScholarPubMed
12.Bisaga, A, Paquette, K, Sabatini, L, Lovell, EO. A prevalence study of methicillin-resistant Staphylococcus aureus colonization in emergency department health care workers. Ann Emerg Med 2008;52:525–528.CrossRefGoogle ScholarPubMed
13.Sinsimer, D, Leekha, S, Park, S, et al.Use of a multiplex molecular beacon platform for rapid detection of methicillin and vancomycin resistance in Staphylococcus aureus. J Clin Microbiol 2005;43:4585–4591.CrossRefGoogle ScholarPubMed
14.Mathema, B, Mediavilla, J, Kreiswirth, BN. Sequence analysis of the variable number tandem repeat in Staphylococcus aureus protein A gene: spa typing. Methods Mol Biol 2008;431:285–305.Google Scholar
15.Strommenger, B, Kettlitz, C, Weniger, T, Harmsen, D, Friedrich, AW, Witte, W. Assignment of Staphylococcus isolates to groups by spa typing, Smal macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006;44:2533–2540.Google Scholar
16.Chen, L, Mediavilla, JR, Oliveira, DC, Willey, BM, de Lencastre, H, Kreiswirth, BN. Multiplex real-time PCR for rapid staphylococcal cassette chromosome mec (SCCmec) typing. J Clin Microbiol 2009;47:3692–3706.CrossRefGoogle Scholar
17.Diep, BA, Gill, SR, Chang, RF, et al.Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet 2006;367:731–739.Google Scholar
18.Anthony, RM, Connor, AM, Power, EG, French, GL. Use of the polymerase chain reaction for rapid detection of high-level mupirocin resistance in staphylococci. Eur J Clin Microbiol Infect Dis 1999;18:30–34.CrossRefGoogle ScholarPubMed
19.Mulvey, MR, Chui, L, Ismail, J, et al.Development of a Canadian standardized protocol for subtyping methicillin-resistant Staphylococcus aureus using pulsed-field gel electrophoresis. J Clin Microbiol 2001;39:3481–3485.CrossRefGoogle ScholarPubMed
20.Harmsen, D, Claus, H, Witte, W, Rothganger, J, Turnwald, D, Vogel, U. Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–5448.CrossRefGoogle Scholar
21.Gorwitz, RJ, Kruszon-Moran, D, McAllister, SK, et al.Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008;197:1226–1234.CrossRefGoogle ScholarPubMed
22.Jarvis, W, Shlosser, J, Chinn, R, Tweeten, S. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006. Am J Infect Control 2007;35:631–637.CrossRefGoogle ScholarPubMed
23.Naimi, TS, LeDell, KH, Como-Sabetti, K, et al.Comparison of community-and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003;290:2976–2984.CrossRefGoogle ScholarPubMed
24.Huang, H, Flynn, NM, King, JH, Monchaud, C, Morita, M, Cohen, SH. Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MSRA infections in Sacramento, California. J Clin Microbiol 2006;44:2423–2427.CrossRefGoogle ScholarPubMed
25.Weber, JT. Community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2005;41(suppl 4):S269–S272.Google Scholar
26.Frazee, BW, Salz, TO, Lambert, L, Perdreau-Remington, F. Fatal community-associated methicillin-resistant Staphylococcus aureus pneumonia in an immunocompetent young adult. Ann Emerg Med 2005;46:401–404.Google Scholar
27.Miller, LG, Perdreau-Remington, F, Rieg, G, et al.Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med 2005;352:1445–1453.Google Scholar
28.Moran, GJ, Krishnadasan, A, Gorwitz, RJ, et al.Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006;355:666–674.CrossRefGoogle ScholarPubMed
29.Wertheim, HF, Melles, DC, Vos, MC, et al.The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis 2005;5:751–762.Google Scholar
30.Dietrich, DW, Auld, DB, Mermel, LA. Community-acquired methicillin resistant Staphylococcus aureus in southern New England children. Pediatrics 2004;113:e347-e352.CrossRefGoogle ScholarPubMed
31.Ellis, MW, Hospenthal, DR, Dooley, DP, Gray, PJ, Murray, CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004;39:971–979.Google Scholar
32.Centers for Disease Control and Prevention. Outbreaks of communityassociated methicillin-resistant Staphylococcus aureus skin infections- Los Angeles County, California, 2002-2003. MMWR Morb Mortal Wkly Rep 2003;52:88.Google Scholar
33.Haley, RW, Hightower, AW, Khabbaz, RF, et al.The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals: possible role of the house staff-patient transfer circuit. Ann Intern Med 1982;97:297–308.CrossRefGoogle ScholarPubMed