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http://www.coloradohealthnet.org/CHNReports/nasalstaph_infection.html?printit
The Source of Patient Staph Infections in Hospitals
Nasal Carriage as a Source of Staphylococcus aureus Bacteremia, by Christof von Eiff, Karsten Becker, Konstanze Machka, Holger Stammer, Georg Peters, for the Study Group; The New England Journal of Medicine, January 4, 2001.
Background
Here is the important background information that the authors give us:
about 20% of healthy people almost always carry staph aureus, about 60% have staph aureus from time to time, and about 20% almost never carry staph aureus,
staphylococcus aureus (staph aureus) is one of the most common causes of infection acquired in hospitals and results in substantial morbidity and mortality,
about 10-40% of people tested as hospital outpatients or on admission have staph aureus in their nasal cavities,
nasal carriage of staph aureus is associated with an increased risk of infection in patients after surgery, in patients receiving continuous ambulatory peritoneal dialysis, and in patients receiving hemodialysis,
several studies have shown that elimination of staph aureus from nasal cavities reduces the incidence of staph aureus infections,
for example, the use of mupirocin nasal ointment to treat patients with nasal staph aureus has been found to reduce dramatically the incidence of infections in patients receiving hemodialysis,
treatment with topical mupirocin has been found to eliminate both nasal and hand carriage of staph aureus, as well as reducing staph in other areas of the body.
Purpose of this Study
The authors undertook this study to investigate the link between staph aureus isolated from nasal specimens and that isolated from the blood of infected patients in hospitals.
As a secondary purpose, the authors collected data on the number of patients carrying antibiotic resistant strains of staph.
Participants and Methodology
The authors used 2 approaches to conduct their investigations:
the first study took place from 1993 to 1994 in 32 university and community hospitals in Germany. The patients included in the study were hospitalized with differing diagnoses. In this study, the researchers took swabs from the noses of 219 patients (median age 55). They also took samples from the clinical focus of infection. All of the patients had previously been found to have staph aureus infection by means of a blood test. The authors then compared the 3 strains of staph aureus for each patient by means of molecular typing,
the second study was conducted at a single hospital during a 5 year period from 1994 to 1999 and included 1278 patients (median age 54). All of the patients had previously been found to have staph aureus infection by means of a blood test. The researchers used the same method to compare the 3 samples taken from the patients.
Results
Here is what the authors found:
in the large majority of patients studied, the staph aureus strains isolated from their blood was identical to that isolated from their nasal cavaties,
in the multicenter study, the blood isolates from each of the 219 patients studied were identical to their nasal isolates in 82% of the patients,
in the single hospital study, the blood isolates from each of the 1278 patients studied were identical to their nasal isolates in 86% of the patients,
as to drug resistance, the study found that 9% of the patients in the multicenter study and 5% of those in the single center study were had methicillin-resistant strains of staph aureus.
Authors Summary and Conclusions
According to the authors, the results of their study suggest a prevention strategy to interrupt the transmission of staph aureus by eliminating nasal carriage of staph through the use of ointments. The authors also note that multidrug-resistant strains of staph have been reported with increasing frequency worldwide. In this study, they found methicillin-resistant strains of staph aureus. These facts, along with the severe consequences of infection with staph aureus, heighten the need for prevention.
Related Editorial
In a related editorial Drs. Gordon L. Archer and Michael W. Climo note that staph aureus is one of the most lethal of human pathogens. The prevention of hospital-acquired infections due to staph aureus is, therefore, a major goal of hospital infection-control practices.
Elimination of staph aureus from the nasal cavaties of hospital patients has been attempted with systemic antimicrobial agents, such as rifampin, trimethopprim-sulfamethoxazole, ciprofloxacin, etc. These drugs have drawbacks, however, including adverse side effects and the development of resistant strains. In fact, the CDC estimates that 34% of staph aureus isolates in US hospitals in 1995 were resistant to methicillin.
The most successful preventative treatment so far has been with the use of topical mupirocin. One problem with this treatment, however, is that resistance of staph aureus to mupirocin has been high in areas where the ointment has been heavily used.
The authors of the editorial suggest that all patients admitted to the hospital should be screened for staph aureus in their nasal cavaties by means of a rapid diagnostic test. In addition, there is a need for new topical agents and other agents that prevent staph aureus from attaching to nasal cavaties.
Ed Asks: What Should You Do With This Study?
If you are a patient about to enter a hospital, you should also ask your physician to have you screened for the presence of staph aureus in your nasal cavaties. If you have nasal staph, you are at increased risk for staph infection during your hospitalization. Therefore, you should ask whether the use of a topical ointment is appropriate for you.
If you are a hemodialysis or peritoneal dialysis patient, you should ask your physician to have you screened for staph aureus. Studies have shown that a significant percentage of dialysis patients have staph aureus in their nasal cavaties before their catheter is inserted and that nasal carriage of staph aureus is associated with an increased risk of infection in dialysis patients. Currently, there is at least one topical ointment, mupirocin, that can reduce your chances of contracting a staph aureus blood infection.
Related Reading
Read about the increase in Drug Resistant Salmonella.
Read about the increase in Drug Resistant Strains of Pneumonia.
The Source of Patient Staph Infections in Hospitals
Nasal Carriage as a Source of Staphylococcus aureus Bacteremia, by Christof von Eiff, Karsten Becker, Konstanze Machka, Holger Stammer, Georg Peters, for the Study Group; The New England Journal of Medicine, January 4, 2001.
Background
Here is the important background information that the authors give us:
about 20% of healthy people almost always carry staph aureus, about 60% have staph aureus from time to time, and about 20% almost never carry staph aureus,
staphylococcus aureus (staph aureus) is one of the most common causes of infection acquired in hospitals and results in substantial morbidity and mortality,
about 10-40% of people tested as hospital outpatients or on admission have staph aureus in their nasal cavities,
nasal carriage of staph aureus is associated with an increased risk of infection in patients after surgery, in patients receiving continuous ambulatory peritoneal dialysis, and in patients receiving hemodialysis,
several studies have shown that elimination of staph aureus from nasal cavities reduces the incidence of staph aureus infections,
for example, the use of mupirocin nasal ointment to treat patients with nasal staph aureus has been found to reduce dramatically the incidence of infections in patients receiving hemodialysis,
treatment with topical mupirocin has been found to eliminate both nasal and hand carriage of staph aureus, as well as reducing staph in other areas of the body.
Purpose of this Study
The authors undertook this study to investigate the link between staph aureus isolated from nasal specimens and that isolated from the blood of infected patients in hospitals.
As a secondary purpose, the authors collected data on the number of patients carrying antibiotic resistant strains of staph.
Participants and Methodology
The authors used 2 approaches to conduct their investigations:
the first study took place from 1993 to 1994 in 32 university and community hospitals in Germany. The patients included in the study were hospitalized with differing diagnoses. In this study, the researchers took swabs from the noses of 219 patients (median age 55). They also took samples from the clinical focus of infection. All of the patients had previously been found to have staph aureus infection by means of a blood test. The authors then compared the 3 strains of staph aureus for each patient by means of molecular typing,
the second study was conducted at a single hospital during a 5 year period from 1994 to 1999 and included 1278 patients (median age 54). All of the patients had previously been found to have staph aureus infection by means of a blood test. The researchers used the same method to compare the 3 samples taken from the patients.
Results
Here is what the authors found:
in the large majority of patients studied, the staph aureus strains isolated from their blood was identical to that isolated from their nasal cavaties,
in the multicenter study, the blood isolates from each of the 219 patients studied were identical to their nasal isolates in 82% of the patients,
in the single hospital study, the blood isolates from each of the 1278 patients studied were identical to their nasal isolates in 86% of the patients,
as to drug resistance, the study found that 9% of the patients in the multicenter study and 5% of those in the single center study were had methicillin-resistant strains of staph aureus.
Authors Summary and Conclusions
According to the authors, the results of their study suggest a prevention strategy to interrupt the transmission of staph aureus by eliminating nasal carriage of staph through the use of ointments. The authors also note that multidrug-resistant strains of staph have been reported with increasing frequency worldwide. In this study, they found methicillin-resistant strains of staph aureus. These facts, along with the severe consequences of infection with staph aureus, heighten the need for prevention.
Related Editorial
In a related editorial Drs. Gordon L. Archer and Michael W. Climo note that staph aureus is one of the most lethal of human pathogens. The prevention of hospital-acquired infections due to staph aureus is, therefore, a major goal of hospital infection-control practices.
Elimination of staph aureus from the nasal cavaties of hospital patients has been attempted with systemic antimicrobial agents, such as rifampin, trimethopprim-sulfamethoxazole, ciprofloxacin, etc. These drugs have drawbacks, however, including adverse side effects and the development of resistant strains. In fact, the CDC estimates that 34% of staph aureus isolates in US hospitals in 1995 were resistant to methicillin.
The most successful preventative treatment so far has been with the use of topical mupirocin. One problem with this treatment, however, is that resistance of staph aureus to mupirocin has been high in areas where the ointment has been heavily used.
The authors of the editorial suggest that all patients admitted to the hospital should be screened for staph aureus in their nasal cavaties by means of a rapid diagnostic test. In addition, there is a need for new topical agents and other agents that prevent staph aureus from attaching to nasal cavaties.
Ed Asks: What Should You Do With This Study?
If you are a patient about to enter a hospital, you should also ask your physician to have you screened for the presence of staph aureus in your nasal cavaties. If you have nasal staph, you are at increased risk for staph infection during your hospitalization. Therefore, you should ask whether the use of a topical ointment is appropriate for you.
If you are a hemodialysis or peritoneal dialysis patient, you should ask your physician to have you screened for staph aureus. Studies have shown that a significant percentage of dialysis patients have staph aureus in their nasal cavaties before their catheter is inserted and that nasal carriage of staph aureus is associated with an increased risk of infection in dialysis patients. Currently, there is at least one topical ointment, mupirocin, that can reduce your chances of contracting a staph aureus blood infection.
Related Reading
Read about the increase in Drug Resistant Salmonella.
Read about the increase in Drug Resistant Strains of Pneumonia.
