Methicillin-resistant Staphylococcus aureus nasal colonization in cardiovascular surgery patients at a university hospital in Bogotá, Colombia
Abstract
Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is a microorganism that colonizes nostrils and different parts of the body, which is considered a risk factor to acquire invasive infections, especially in cardiovascular surgery patients.
Objective: To determine the frequency of nasal colonization by MRSA and to establish the clinical characteristics in patients scheduled for cardiovascular surgery.
Materials and methods: This was a descriptive study conducted between February and December, 2015. We included adult patients scheduled for cardiovascular surgery at the Hospital Universitario San Ignacio in Bogotá, Colombia. Colonization was identified by real-time PCR from nasal swabs. Colonized patients were treated with mupirocin 2.0% intranasally twice a day and bathed with chlorhexidine 4% from the neck downwards for five days. At the end of this treatment, PCR control was carried out.
Results: We included 141 patients with a percentage of nasal colonization of 13.4% (19/141). There were 52 hospitalized patients and 89 outpatients with a percentage of nasal colonization of 17.3% (9/52), and 11.2% (10/89), respectively. All colonized patients who received treatment had a negative PCR at the end of the regime and none of the participating patients had a surgical site infection by S. aureus at the end of the study.
Conclusions: Nasal colonization was observed both in hospitalized patients and outpatients. Decolonization treatment with mupirocin was effective to eradicate the carrier state in the short term, which could impact the rates of surgical wound infection associated with cardiovascular surgery.
Downloads
References
Wertheim HF, Melles DC, Vos MC, van Leeuwen W, van Belkum A, Verbrugh H, et al. The role of nasal carriage in Staphylococcus aureus infections. Lancet Infect Dis. 2005;5:751-62. https://doi.org/10.1016/S1473-3099(05)702
Peacock SJ, de Silva I, Lowy FD. What determines nasal carriage of Staphylococcus aureus? Trends Microbiol. 2001;9:605-10. https://doi.org/10.1016/S0966-842X(01)022
Coates T, Bax R, Coates A. Nasal decolonization of Staphylococcus aureus with mupirocin: Strengths, weaknesses and future prospects. J Antimicrob Chemother. 2009;64:9-15. https://doi.org/10.1093/jac/dkp159
Skov R, Christiansen K, Dancer SJ, Daum RS, Dryden M, Huang YC, et al. Update on the prevention and control of community-acquired meticillin-resistant Staphylococcus aureus (CA-MRSA). Int J Antimicrob Agents. 2012;39:193-200. https://doi.org/10.1016/j.ijantimicag.2011.09.029
Scheckler W, Gaynes R, Gross P, Hierholzer W, Weinstein R, Baker O, et al. An approach to the evaluation of quality indicators of the outcome of care in hospitalized patients, with a focus on nosocomial infection indicators. Am J Infect Control. 1995;16:308-16. https://doi.org/10.2307/30143098
Reyes J, Rincón S, Díaz L, Panesso D, Contreras GA, Zurita J, et al. Dissemination of methicillin-resistant Staphylococcus aureus USA300 sequence type 8 lineage in Latin America. Clin Infect Dis. 2009;49:1861-7. https://doi.org /10.1086/648426
Böcher S, Skov RL, Knudsen MA, Guardabassi L, Mølbak K, Schouenborg P, et al. The search and destroy strategy prevents spread and long-term carriage of methicillin-resistant Staphylococcus aureus: Results from the follow-up screening of a large ST22 (E-MRSA 15) outbreak in Denmark. Clin Microbiol Infect. 2010;16:1427-34. https://doi.org/10.1111/j.1469-0691.201
Chen AF, Heyl AE, Xu PZ, Rao N, Klatt BA. Preoperative decolonization effective at reducing staphylococcal colonization in total joint arthroplasty patients. J Arthroplasty. 2013;28:18-20. https://doi.org/10.1016/j.arth.2013.03.036
Lepelletier D, Bourigault C, Roussel JC, Lasserre C, Leclère B, Corvec S, et al. Epidemiology and prevention of surgical site infections after cardiac surgery. Med Mal Infect. 2013;43:403-9. https://doi.org/10.1016/j.medmal.2013.07
Lepelletier D, Perron S, Bizouarn P, Caillon J, Drugeon H, Michaud J-L, et al. Surgical-site infection after cardiac surgery: Incidence, microbiology, and risk factors. Infect Control Hosp Epidemiol. 2005;26:466-72. https://doi.org/10.1086/502569
Organización Mundial de la Salud. Obesidad y sobrepeso. Ginebra: Organización Mundial de la Salud. Fecha de consulta: 10 de agosto del 2018. Disponible en: http://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
McKibben L, Horan T, Tokars JI, Fowler G, Cardo DM, Pearson ML, et al. Guidance on public reporting of healthcare-associated infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. Am J Infect Control. 2005;33:217-26. https://doi.org/10.1016/j.ajic.2005.04.00
Vandenesch F, Naimi T, Enright MC, Lina G, Nimmo GR, Heffernan H, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying panton-valentine leukocidin genes: Worldwide emergence. Emerg Infect Dis. 2003;9:978-84. https://doi.org/10.3201/eid0908.030089
Chaberny IF, Bindseil A, Sohr D, Gastmeier P. A point-prevalence study for MRSA in a German university hospital to identify patients at risk and to evaluate an established admission screening procedure. Infection. 2008;36:526-32. https://doi.org/10.1007/s15010-008-7436–1
Woltering R, Hoffmann G, Daniels-Haardt I, Gastmeier P, Chaberny IF. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in patients in long-term care in hospitals, rehabilitation centers and nursing homes of a rural district in Germany. Dtsch Med Wochenschr. 2008;9:999-1003. https://doi.org/10.1055/s-2008–1075683
Wernitz MH, Swidsinksi S, Weist K, Sohr D, White W, Franke KP, et al. Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections. Clin Microbiol Infect. 2005;11:457-65. https://doi.org/10.1111/j.1469-0691.2005
Gorwitz RJ, Kruszon-Moran D, McAllister SK, McQuillan G, McDougal LK, Fosheim GE, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis. 2008;197:1226-34. https://doi.org/10.1086/533494
Barrufet MP, Vendrell E, Force L, Sauca G, Rodríguez S, Martínez E, et al. Prevalence and risk factors for meticillin-resistant Staphylococcus aureus in an acute care hospital and longterm care facilities located in the same geographic area. Rev Esp Quimioter. 2014;27:190-5.
Álvarez CA, Barrientes OJ, Leal AL, Contreras GA, Barrero L, Rincón S, et al. Community associated methicillin-resistant Staphylococcus aureus, Colombia. Emerg Infect Dis. 2006;12:2000-1. https://doi.org/10.3201/eid1212.060814
Lozano D, Díaz L, Echeverry M, Pineda S, Máttar S. Staphylococcus aureus resistentes a meticilina (SARM) positivos para PVL aislados en individuos sanos de Montería-Córdoba. Universitas Scientiarum. 2010;15:159-65.
Restrepo JAA. Determinación de la posible asociación de los factores de riesgo por colonización de Staphylococcus aureus en una cohorte de pacientes con VIH y sometidos a hemodiálisis en el Hospital Universitario San Ignacio (HUSI). Bogotá: Pontificia Unniversidad Javeriana; 2012.
Jain R, Kralovic SM, Evans ME, Ambrose M, Simbartl L, Obrosky DS, et al. Veterans affairs initiative to prevent methicillin-resistant Staphylococcus aureus infections. N Engl J Med. 2011;364:1419-30. https://doi.org/10.1056/NEJMoa1007474
Olarte N, Valderrama I, Reyes K, Garzón M, Escobar J, Castro B, et al. Colonización por Staphylococcus aureus resistente a la meticilina en una unidad de cuidados intensivos de adultos de un hospital colombiano: caracterización fenotípica y molecular con detección de un clon de circulación en la comunidad. Biomédica. 2010;30:353-61. https://doi.org/10.7705/biomedica.v30i3.26
Keib CN, Pelham JC. Mediastinitis following coronary artery bypass graft surgery: Pathogenesis, clinical presentation, risks, and management. J Cardiovasc Nurs. 2006;21:493-9. https://doi.org/10.1097/00005082-20061100
Musallam E. The predictors of surgical site infection post cardiac surgery: A systematic review. J Vasc Nurs. 2014;32:105-18. https://doi.org/10.1016/j.jvn.2014.01.003
Harrington G, Russo P, Spelman D, Borrell S, Watson K, Barr W, et al. Surgical-site infection rates and risk factor analysis in coronary artery bypass graft surgery. Infect Control Hosp Epidemiol. 2004;25:472-6. https://doi.org/10.1086/502424
Ávila M, Triana L, Guerrero C. Boletín epidemiológico de infecciones asociadas a la atención en salud (IAAS) y resistencia bacteriana. 2015. p. 45. Fecha de consulta: 1° de septiembre de 2016. Disponible en: http://www.saludcapital.gov.co/DSP/Infecciones%20Asociadas%20a%20Atencin%20en%20Salud/Boletines/BOLETIN_IAAS_2015.pdf
Hong JC, Saraswat MK, Ellison TA, Magruder JT, Crawford T, Gardner JM, et al. Staphylococcus aureus prevention strategies in cardiac surgery: A cost-effectiveness analysis. Ann Thorac Surg. 2018;105:47-53. https://doi.org/10.1016/j.athoracsur.2017.0
Huang SS, Singh R, McKinnell JA, Park S, Gombosev A, Eells SJ, et al. Decolonization to reduce postdischarge infection risk among MRSA carriers. N Engl J Med. 2019;380:638-50. https://doi.org/10.1056/NEJMoa1716771
George S, Leasure AR, Horstmanshof D. Effectiveness of decolonization with chlorhexidine and mupirocin in reducing surgical site infections: A systematic review. Dimens Crit Care Nurs. 2016;35:204-22. https://doi.org/10.1097/DCC.00000000000001
Saraswat MK, Magruder JT, Crawford TC, Gardner JM, Duquaine D, Sussman MS, et al. Preoperative Staphylococcus aureus screening and targeted decolonization in cardiac surgery. Ann Thorac Surg. 2017;104:1349-56. https://doi.org/10.1016/j.athoracsur.20
Septimus EJ . Nasal decolonization: What antimicrobials are most effective prior to surgery? Am J Infect Control. 2019;47S:A53-7. https://doi.org/10.1016/j.ajic.2019.02.02
Doebbeling BN, Reagan DR, Pfaller MA, Houston AK, Hollis RJ, Wenzel RP. Long-term efficacy of intranasal mupirocin ointment: A prospective cohort study of Staphylococcus aureus carriage. Arch Intern Med. 1994;154:150-8. https://doi.org/10.1001/archinte.1994.00420
Some similar items:
- Narda María Olarte, Ismael Alberto Valderrama, Karlo Roberto Reyes, Martha Isabel Garzón, Javier Antonio Escobar, Betsy Esperanza Castro, Natasha Vanegas, Methicillin-resistant Staphylococcus aureus colonization in a Colombian hospital intensive care unit: phenotypic and molecular characterization , Biomedica: Vol. 30 No. 3 (2010)
- Óscar García , Tatiana Álvarez, Santiago Granados, Vanessa Garzón, Santiago González, Comparison of quick SOFA and SIRS scales at the bedside of patients with Staphylococcus aureus bacteremia , Biomedica: Vol. 40 No. Supl. 1 (2020): Mayo, Infecciones en el trópico
- Liliana I. Barrero, Juan S. Castillo, Aura L. Leal, Ricardo Sánchez, Jorge A. Cortés, Carlos A. Álvarez, Andrés L. González, Economic burden of methicillin-resistant Staphylococcus aureus bacteremia in critical care patients in hospitals in Bogotá , Biomedica: Vol. 34 No. 3 (2014)
- David Yepes, Francisco Molina, Gloria Ortiz, Ricardo Aguirre, Risk factors associated with the presence of pneumonia in patients with brain injury , Biomedica: Vol. 29 No. 2 (2009)
- José Ramón Mantilla, María Teresa Reguero, Elsa Beatriz González, Ibonne Ayde García, Aura Lucía Leal, Paula Andrea Espinal, Celia Alpuche, Ismael Alberto Valderrama, Martha Isabel Garzón, Narda María Olarte, Molecular characterization of an outbreak caused by CTX-M-12-producing Klebsiella pneumoniae in a Colombian hospital´s neonatal intensive care unit , Biomedica: Vol. 26 No. 3 (2006)
- Javier Antonio Escobar, Ingrid Tatiana Gómez, Martha Johanna Murillo, Betsy Esperanza Castro, Bibiana Chavarro, Ricaurte Alejandro Márquez, Natasha Vanegas, Design of two molecular methodologies for the rapid identification of Colombian community-acquired methicillin-resistant Staphylococcus aureus isolates , Biomedica: Vol. 32 No. 2 (2012)
- Beatriz Millan, David Castro, Maria Araque, Bárbara Ghiglione, Gabriel Gutkind, ISCR1 associated with blaCTX-M-1 y blaCTX-M-2 genes in IncN and IncFIIA plasmids isolated from Klebsiella pneumoniae of nosocomial origin in Mérida, Venezuela , Biomedica: Vol. 33 No. 2 (2013)
- Ana María García, María Virginia Villa, María Elena Escudero, Patricia Gómez, Margarita M. Vélez, María Isabel Múnera, Gloria Franco, Use of nasal mupirocin for Staphylococcus aureus: effect on nasal carriers and nosocomial infections. , Biomedica: Vol. 23 No. 2 (2003)
- Andrea Patricia Villalobos, Liliana Isabel Barrero, Sandra Milena Rivera, María Victoria Ovalle, Danik Valera, Surveillance of healthcare associated infections, bacterial resistance and antibiotic consumption in high-complexity hospitals in Colombia, 2011 , Biomedica: Vol. 34 (2014): Abril, Suplemento 1, Resistencia bacteriana
- Robinson Pacheco, Lyda Osorio, Adriana M. Correa, Maria Virginia Villegas, Prevalence of Gram-negative bacteria harboring blaKPC gene in Colombian hospitals , Biomedica: Vol. 34 (2014): Abril, Suplemento 1, Resistencia bacteriana
Article metrics | |
---|---|
Abstract views | |
Galley vies | |
PDF Views | |
HTML views | |
Other views |