Staphylococcus aureus colonization and the risk of infection in critically ill patients

Adam Keene, Peter Vavagiakis, Mei Ho Lee, Kathryn Finnerty, Deborah Nicolls, Christian Cespedes, Bianca Quagliarello, Mary Ann Chiasson, David Chong, Franklin D. Lowy

Research output: Contribution to journalArticle

32 Scopus citations

Abstract

OBJECTIVE: To evaluate the relationship between Staphylococcus aureus nasal and tracheal colonization and infection in medical intensive care unit (MICU) patients. The primary outcome was the incidence of S. aureus infection in colonized versus non-colonized patients. DESIGN: Prospective, observational cohort study. Patients admitted to the MICU during the study period were screened for S. aureus nasal and tracheal colonization by culture and a PCR assay twice weekly. Demographic, clinical, and microbiologic data were collected in the MICU and for 30 days after discharge. PFGE and antibiotic susceptibility testing were performed on all S. aureus nasal, tracheal, and clinical isolates. RESULTS: Twenty-three percent of patients (47 of 208) were nasally colonized with S. aureus. Twenty-four percent of these patients developed S. aureus infections versus 2% of non-colonized patients (P < .01). Nine of 11 patients with both nasal colonization and infection were infected by their colonizing strain. Two of 47 nasally colonized patients developed an infection with a different strain of S. aureus. Fifty-three percent of intubated patients with nasal colonization (10 of 19) had tracheal colonization with S. aureus as opposed to 4.9% of intubated, non-colonized patients (3 of 61) (P < .01). Parenteral antibiotics were ineffective at clearing nasal colonization. PCR detected S. aureus colonization (nasal and tracheal) within 6.5 hours with a sensitivity of 83% and a specificity of 99%. CONCLUSIONS: The incidence of S. aureus infection was significantly elevated in nasally colonized MICU patients. Techniques to rapidly detect colonization in this population may make targeted topical prevention strategies feasible.

Original languageEnglish (US)
Pages (from-to)622-628
Number of pages7
JournalInfection Control and Hospital Epidemiology
Volume26
Issue number7
DOIs
StatePublished - Jul 1 2005

ASJC Scopus subject areas

  • Epidemiology
  • Microbiology (medical)
  • Infectious Diseases

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    Keene, A., Vavagiakis, P., Lee, M. H., Finnerty, K., Nicolls, D., Cespedes, C., Quagliarello, B., Chiasson, M. A., Chong, D., & Lowy, F. D. (2005). Staphylococcus aureus colonization and the risk of infection in critically ill patients. Infection Control and Hospital Epidemiology, 26(7), 622-628. https://doi.org/10.1086/502591