Methicillin-resistant Staphylococcus aureus nasal colonization in cardiovascular surgery patients at a university hospital in Bogotá, Colombia

Heidy C. Martínez-Díaz, Sandra L. Valderrama-Beltrán, Ana C. Hernández, Silvia K. Pinedo, Juan R. Correa, Édgar G. Ríos, Julie J. Rojas, Yessica Y. Hernández, Marylin Hidalgo, .

Keywords: Methicillin-resistant Staphylococcus aureus, carrier state, nasal mucosa, surgical wound infection, mupirocin, cross infection

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

Download data is not yet available.
  • Heidy C. Martínez-Díaz Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Grupo de Investigación en Enfermedades Infecciosas, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia; Unidad de Cirugía Cardiovascular, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia; Maestría en Ciencias – Microbiología, Universidad Nacional de Colombia, Bogotá, D.C., Colombia
  • Sandra L. Valderrama-Beltrán Grupo de Investigación en Enfermedades Infecciosas, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
  • Ana C. Hernández Grupo de Investigación en Enfermedades Infecciosas, Hospital Universitario San Ignacio, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
  • Silvia K. Pinedo Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia
  • Juan R. Correa Unidad de Cirugía Cardiovascular, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
  • Édgar G. Ríos Unidad de Cirugía Cardiovascular, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
  • Julie J. Rojas Unidad de Cirugía Cardiovascular, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
  • Yessica Y. Hernández Unidad de Cirugía Cardiovascular, Hospital Universitario San Ignacio, Bogotá, D.C., Colombia
  • Marylin Hidalgo Grupo de Enfermedades Infecciosas, Departamento de Microbiología, Facultad de Ciencias, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia

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

How to Cite
1.
Martínez-Díaz HC, Valderrama-Beltrán SL, Hernández AC, Pinedo SK, Correa JR, Ríos Édgar G, et al. Methicillin-resistant Staphylococcus aureus nasal colonization in cardiovascular surgery patients at a university hospital in Bogotá, Colombia. biomedica [Internet]. 2020 May 1 [cited 2024 May 17];40(Supl. 1):37-44. Available from: https://revistabiomedica.org/index.php/biomedica/article/view/4791

Some similar items:

Published
2020-05-01

Altmetric

Article metrics
Abstract views
Galley vies
PDF Views
HTML views
Other views
Crossref Cited-by logo
QR Code