Format

Send to

Choose Destination
Infect Control Hosp Epidemiol. 2014 Dec;35(12):1458-65. doi: 10.1086/678599. Epub 2014 Nov 5.

Methicillin-resistant Staphylococcus aureus: site of acquisition and strain variation in high-risk nursing home residents with indwelling devices.

Author information

1
University of Michigan School of Public Health, Ann Arbor, Michigan.

Abstract

OBJECTIVE:

Characterize the clinical and molecular epidemiology of new methicillin-resistant Staphylococcus aureus (MRSA) acquisitions at nasal and extranasal sites among high-risk nursing home (NH) residents.

DESIGN:

Multicenter prospective observational study.

SETTING:

Six NHs in southeast Michigan.

PARTICIPANTS:

A total of 120 NH residents with an indwelling device (feeding tube and/or urinary catheter).

METHODS:

Active surveillance cultures from the nares, oropharynx, groin, perianal area, wounds (if present), and device insertion site(s) were collected upon enrollment, at day 14, and monthly thereafter. Pulsed-field gel electrophoresis and polymerase chain reaction for SCCmec, agr, and Panton-Valentine leukocidin were performed.

RESULTS:

Of 120 participants observed for 16,290 device-days, 50 acquired MRSA (78% transiently, 22% persistently). New MRSA acquisitions were common in extranasal sites, particularly at device insertion, groin, and perianal areas (27%, 23%, and 17.6% of all acquisitions, respectively). Screening extranasal sites greatly increases the detection of MRSA colonization (100% of persistent carriers and 97.4% of transient carriers detected with nares, groin, perianal, and device site sampling vs 54.5% and 25.6%, respectively, for nares samples alone). Colonization at suprapubic urinary catheter sites generally persisted. Healthcare-associated MRSA (USA100 and USA100 variants) were the dominant strains (79.3% of all new acquisition isolates). Strain diversity was more common in transient carriers, including acquisition of USA500 and USA300 strains.

CONCLUSION:

Indwelling device insertion sites as well as the groin and perianal area are important sites of new MRSA acquisitions in NH residents and play a role in the persistency of MRSA carriage. Clonal types differ among persistent and transient colonizers.

PMID:
25419767
PMCID:
PMC4394900
DOI:
10.1086/678599
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Cambridge University Press Icon for PubMed Central
Loading ...
Support Center