This study assessed the relationship between nasal colonization and ventilator-associated pneumonia (VAP) by Staphylococcus aureus, as well the role of the environment in the transmission of this organism.
We performed a cohort study of patients with VAP caused by methicillin-resistant S aureus (MRSA) or methicillin-sensitive S aureus during 2 years in an adult intensive care unit (ICU). All patients had nasal swab specimens obtained at admission and during the ICU stay. Clinical samples also were collected for analysis, as were samples from the hands of health care professionals and the environment, and were typed using pulsed-field gel electrophoresis.
S aureus VAP represented 12.5% of the cases, and statistical analysis identified colonization as a risk factor for the development of this infection. MRSA was isolated from the environment and hands, indicating the existence of a secondary reservoir. Molecular typing revealed a polyclonal profile; however, clone J was the most frequent (45.5%) among isolates of MRSA tested, with a greater profile of resistance than the other isolates. There was strong evidence suggesting transmission of MRSA to patients from the environment.
Nasal colonization for S aureus is a risk factor for development of VAP.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to American Journal of Infection Control
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Acquisition and cross-transmission of Staphylococcus aureus in European intensive care units.Infect Cont Hosp Epidemiol. 2009; 30: 117-124
- Methicillin-resistant Staphylococcus aureus control in an intensive care unit: a 10-year analysis.J Hosp Infect. 2007; 67: 308-315
- The role of colonization pressure in nosocomial transmission of methicillin-resistant Staphylococcus aureus.Am J Infect Control. 2009; 37: 106-110
- Nasal methicillin-resistant Staphylococcus aureus carriage among intensive care unit hospitalized adult patients in a Taiwanese medical center: one time-point prevalence, molecular characteristics, and risk factors for carriage.J Hosp Infect. 2010; 74: 238-244
- Monitoring environmental cleanliness on two surgical wards.Int J Environ Health Res. 2008; 18: 357-364
- A study of the relationship between environmental contamination with methicillin-resitant Staphylococcus aureus (MRSA) and patients' acquisition of MRSA.Infect Cont Hosp Epidemiol. 2006; 27: 127-132
- Changes in hands microbiota associated with skin damage because of hand hygiene procedures on the healthy care workers.Am J Infect Control. 2009; 37: 155-159
- How do we assess hospital cleaning? A proposal for microbiological standards for surface hygiene in hospitals.J Hosp Infect. 2004; 56: 10-15
- Measuring the effect of enhanced in a UK hospital: a prospective cross-over study.BMC Med. 2009; 7: 1-12
- Hospital surface contamination in wards occupied by patients infected with MRSA or MSSA in a Brazilian university hospital.Rev Cienc Farm Basica Apl. 2007; 28: 159-163
- Aerial dispersal of methicillin-resistant Staphylococcus aureus in hospital rooms by infected or colonized patients.J Hosp Infect. 2009; 71: 256-262
- Risk factors and evolution of ventilator-associated pneumonia by Staphylococcus aureus sensitive or resistant to oxacillin in patients at the intensive care unit of a Brazilian university hospital.Braz J Infect Dis. 2008; 12: 499-503
- Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia.Clin Infect Dis. 2010; 51: S81-S87
- Early ICU energy deficit is a risk factor for Staphylococcus aureus ventilator-associated pneumonia.Chest. 2011; 140: 1254-1260
- Impact of active surveillance on meticillin-resistant Staphylococcus aureus transmission and hospital resource utilization.J Hosp Infect. 2010; 74: 232-237
- High frequency of colonization and absence of identifiable risk factors for methicillin-resistant Staphylococcus aureus (MRSA) in intensive care units in Brazil.Braz J Infect Dis. 2001; 5: 1-7
- Ventilator-associated pneumonia in intensive care units in Hubei Province, China: a multicenter prospective cohort survey.J Hosp Infect. 2011; 78: 284-288
- Risk factors for ventilator-associated pneumonia by Pseudomonas aeruginosa in presence of recent antibiotic exposure.Anesthesiology. 2006; 4: 709-714
- Multicenter evaluation of the Cepheid Xpert methicillin-resitant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares.J Clin Microbiol. 2009; 47: 758-764
- Polyclonal presence of non-multiresistant methicillin-resistant Staphylococcus aureus isolates carrying SCCmec IV in health care-associated infections in a hospital in Rio de Janeiro, Brazil.Diagn Microbiol Infect Dis. 2009; 64: 434-441
- Performance standards for antimicrobial susceptibility testing; twentieth informational supplement. CLSI document M100–S18.Clinical and Laboratory Standards Institute, Wayne [PA]2009
- Spread of a methicillin-resistant Staphylococcus aureus clone isolated from bacteremia in elderly patients in a Brazilian general hospital.Rev Panam Infectol. 2007; 9: 18-22
- How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists.Infect Cont Hosp Epidemiol. 1997; 18: 426-439
- Comparison of traditional and molecular methods of typing isolates of Staphylococcus aureus.J Clin Microbiol. 1994; 32: 407-415
- A compendium of strategies to prevent healthcare-associated infections in acute care hospitals.Infect Cont Hosp Epidemiol. 2008; 29: S12-S21
- Ventilator-associated pneumonia in an adult clinical-surgical intensive care unit of a Brazilian university hospital: incidence, risk factors, etiology, and antibiotic resistance.Braz J Infect Dis. 2008; 12: 80-85
- Case-case-control study of risk factors for nasopharyngeal colonization with methicillin-resistant Staphylococcus aureus in a medical-surgical intensive care unit.Braz J Infect Dis. 2009; 13: 398-402
- Risk factors for methicillin-resistant and -sensitive Staphylococcus aureus infections in a Brazilian university hospital.Braz J Infect Dis. 2000; 4: 135-143
- How clean is clean? Proposed methods for hospital cleaning assessment.J Hosp Infect. 2008; 70: 328-334
- Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury: incidence, risk factors, and association with ventilator-associated pneumonia.Am J Crit Care Med. 1999; 159: 188-198
- Sensitivities of nasal and rectal swabs for detection of methicillin-resistant Staphylococcus aureus colonization in an active surveillance program.J Clin Microbiol. 2008; 46: 3101-3103
- Environmental decontamination of a hospital isolation room using high-intensity narrow-spectrum light.J Hosp Infect. 2010; 76: 247-251
- An evaluation of hospital cleaning regimes and standards.J Hosp Infect. 2000; 45: 19-28
- How long do nosocomial pathogens persist on inanimate surfaces? A systematic review.BMC Infect Dis. 2006; 6: 130
Published online: July 25, 2013
This study was supported in part by the Coordination of Improvement of Higher Education Personnel (CAPES).
Conflict of interest: None to report.
© 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.