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Staphylococcus Aureus Rectal Carriage and its Association with Infections in Patients in a Surgical Intensive Care Unit and a Liver Transplant Unit

Published online by Cambridge University Press: 02 January 2015

Cheryl Squier
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
John D. Rihs
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Kathleen J. Risa
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Asia Sagnimeni
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Janet Stout
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
Nina Singh*
Affiliation:
Veterans Affairs Medical Center and theUniversity of Pittsburgh, Pittsburgh, Pennsylvania
*
VA Medical Center, Infectious Disease Section,University Drive C, Pittsburgh, PA 15240

Abstract

Background:

The role of rectal carriage ofStaphylococcus aureus as a risk factor for nosocomialS. aureus infections in critically ill patients has not been fully discerned.

Methods:

Nasal and rectal swabs forS. aureus were obtained on admission and weekly thereafter until discharge or death from 204 consecutive patients admitted to the surgical intensive care unit and liver transplant unit.

Results:

Overall, 49.5% (101 of 204) of the patients never harboredS. aureus, 21.6% (44 of 204) were nasal carriers only, 3.4% (7 of 204) were rectal carriers only, and 25.5% (52 of 204) were both nasal and rectal carriers. Infections due toS. aureus developed in 15.7% (32 of 204) of the patients; these included 3% (3 of 101) of the non-carriers, 18.2% (8 of 44) of the nasal carriers only, 0% (0 of 7) of the rectal carriers only, and 40.4% (21 of 52) of the patients who were both nasal and rectal carriers (P = .001). Patients with both rectal and nasal carriage were significantly more likely to developS. aureus infection than were those with nasal carriage only (odds ratio, 3.9; 95% confidence interval, 1.18 to 7.85;P = .025). By pulsed-field gel electrophoresis, the infecting rectal and nasal isolates were clonally identical in 82% (14 of 17) of the patients withS. aureus infections.

Conclusions:

Rectal carriage represents an underappreciated reservoir forS. aureus in patients in the intensive care unit and liver transplant recipients. Rectal plus nasal carriage may portend a greater risk forS. aureus infections in these patients than currently realized.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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