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

Adam B. 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 Citations (Scopus)

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 2005

Fingerprint

Critical Illness
Staphylococcus aureus
Nose
Infection
Intensive Care Units
Anti-Bacterial Agents
Polymerase Chain Reaction
Incidence
Observational Studies
Cohort Studies
Demography

ASJC Scopus subject areas

  • Microbiology (medical)
  • Immunology

Cite this

Keene, A. B., Vavagiakis, P., Lee, M. H., Finnerty, K., Nicolls, D., Cespedes, C., ... 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

Staphylococcus aureus colonization and the risk of infection in critically ill patients. / Keene, Adam B.; Vavagiakis, Peter; Lee, Mei Ho; Finnerty, Kathryn; Nicolls, Deborah; Cespedes, Christian; Quagliarello, Bianca; Chiasson, Mary Ann; Chong, David; Lowy, Franklin D.

In: Infection Control and Hospital Epidemiology, Vol. 26, No. 7, 07.2005, p. 622-628.

Research output: Contribution to journalArticle

Keene, AB, Vavagiakis, P, Lee, MH, Finnerty, K, Nicolls, D, Cespedes, C, Quagliarello, B, Chiasson, MA, Chong, D & Lowy, FD 2005, 'Staphylococcus aureus colonization and the risk of infection in critically ill patients', Infection Control and Hospital Epidemiology, vol. 26, no. 7, pp. 622-628. https://doi.org/10.1086/502591
Keene, Adam B. ; Vavagiakis, Peter ; Lee, Mei Ho ; Finnerty, Kathryn ; Nicolls, Deborah ; Cespedes, Christian ; Quagliarello, Bianca ; Chiasson, Mary Ann ; Chong, David ; Lowy, Franklin D. / Staphylococcus aureus colonization and the risk of infection in critically ill patients. In: Infection Control and Hospital Epidemiology. 2005 ; Vol. 26, No. 7. pp. 622-628.
@article{a85360ee52434b4fb64c1f2e8d9c0523,
title = "Staphylococcus aureus colonization and the risk of infection in critically ill patients",
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.",
author = "Keene, {Adam B.} and Peter Vavagiakis and Lee, {Mei Ho} and Kathryn Finnerty and Deborah Nicolls and Christian Cespedes and Bianca Quagliarello and Chiasson, {Mary Ann} and David Chong and Lowy, {Franklin D.}",
year = "2005",
month = "7",
doi = "10.1086/502591",
language = "English (US)",
volume = "26",
pages = "622--628",
journal = "Infection Control and Hospital Epidemiology",
issn = "0899-823X",
publisher = "University of Chicago Press",
number = "7",

}

TY - JOUR

T1 - Staphylococcus aureus colonization and the risk of infection in critically ill patients

AU - Keene, Adam B.

AU - Vavagiakis, Peter

AU - Lee, Mei Ho

AU - Finnerty, Kathryn

AU - Nicolls, Deborah

AU - Cespedes, Christian

AU - Quagliarello, Bianca

AU - Chiasson, Mary Ann

AU - Chong, David

AU - Lowy, Franklin D.

PY - 2005/7

Y1 - 2005/7

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=23044461721&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=23044461721&partnerID=8YFLogxK

U2 - 10.1086/502591

DO - 10.1086/502591

M3 - Article

C2 - 16092742

AN - SCOPUS:23044461721

VL - 26

SP - 622

EP - 628

JO - Infection Control and Hospital Epidemiology

JF - Infection Control and Hospital Epidemiology

SN - 0899-823X

IS - 7

ER -