Risk Assessment for Methicillin-Resistant Staphylococcus aureus

  • Evelind Tacconelli


Nosocomial infections pose a significant threat to patients worldwide. A recent paper reported excess mortality of 4% for infections due to medical care and 23% mortality for postoperative septicemia (Zhan and Miller 2003). Antibiotic resistant bacteria cause the majority of these nosocomial infection-related deaths. European surveillance has documented that methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gramnegative bacteria are rapidly increasing (Biedenbach et al. 2004).


Staphylococcus Aureus Nasal Carriage Emerg Infect Prior Hospitalization National Nosocomial Infection Surveillance 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Biedenbach DJ, Moet GJ, Jones RN (2004) Occurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997–2002). Diagn Microbiol Infect Dis 50(1):59–69.CrossRefPubMedGoogle Scholar
  2. Buck JM, Como-Sabetti K, Harriman KH, Danila RN, Boxrud DJ, Glennen A, Lynfield R (2005) Community-associated methicillin-resistant Staphylococcus aureus, Minnesota, 2000–2003. Emerg Infect Dis 11:1532–8PubMedGoogle Scholar
  3. Calfee DP, Durbin LJ, Germanson TP, Toney DM, Smith EB, Farr BM (2003) Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol 24:422–6.CrossRefPubMedGoogle Scholar
  4. Campbell AL, Bryant KA, Stover B, Marshall GS (2003) Epidemiology of methicillin-resistant Staphylococcus aureus at a children’s hospital. Infect Control Hosp Epidemiol 24:427–30.CrossRefPubMedGoogle Scholar
  5. CDC NNIS System (2003) National nosocomial infections surveillance (NNIS) system report, data summary from January 1992 through June 2003, issued August 2003. Am J Infect Control 31:481–98.Google Scholar
  6. Centers for Disease Control and Prevention (2002) Staphylococcus aureus resistant to vancomycin—United States, 2002. MMWR 51:565–7.Google Scholar
  7. Charlebois E D, Bangsberg DR, Moss NJ, Moore MR, Moss AR, Chambers HF, Perdreau-Remington F (2002) Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clin Infect Dis 34:425–33.CrossRefPubMedGoogle Scholar
  8. Chow JW, Yu VL (1989) Staphylococcus aureus nasal carriage in hemodialysis patients. Its role in infection and approaches to prophylaxis. Arch Intern Med 149:1258–62.CrossRefPubMedGoogle Scholar
  9. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y (2003) Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: A meta-analysis. Clin Infect Dis 36:53–9.CrossRefPubMedGoogle Scholar
  10. Cosgrove SE, Qi Y, Kaye KS, Harbarth S, Karchmer AW, Carmeli Y (2005) The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: Mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 26:166–74.CrossRefPubMedGoogle Scholar
  11. D’Agata EM, Horn MA, Webb GF (2002) The impact of persistent gastrointestinal colonization on the transmission dynamics of vancomycin-resistant enterococci. J Infect Dis 185:766–73.CrossRefPubMedGoogle Scholar
  12. Eveillard M, Ernst C, Cuviller S, Lescure FX, Malpaux M, Defouilloy I, Gresanleux M, Duboisset M, Lienard J, Eb F (2002) Prevalence of methicillin-resistant Staphylococcus aureus carriage at the time of admission in two acute geriatric wards. J Hosp Infect 50:122–6.CrossRefPubMedGoogle Scholar
  13. Eveillard M, Lancien E, Barnaud G, Hidri N, Gaba S, Benlolo JA, Joly-Guillou ML (2005) Impact of screening for MRSA carriers at hospital admission on risk-adjusted indicators according to the imported MRSA colonization pressure. J Hosp Infect 59:254–8.CrossRefPubMedGoogle Scholar
  14. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, Lamm W, Clark C, MacFarquhar J, Walton AL, Reller LB, Sexton DJ (2002) Health care-associated bloodstream infections in adults: A reason to change the accepted definition of community-acquired infections. Ann Intern Med 137:791–7.PubMedGoogle Scholar
  15. Fridkin SK, Hageman JC, Morrison M, Sanza LT, Como-Sabetti K, Jernigan JA, Harriman K, Harrison LH, Lynfield R, Farley MM (2005) Active Bacterial Core Surveillance Program of the Emerging Infections Program Network. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 352:1436–44.CrossRefPubMedGoogle Scholar
  16. Furuno JP, Harris AD, Wright MO, McGregor JC, Venezia RA, Zhu J, Perencevich EN (2004) Prediction rules to identify patients with methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci upon hospital admission. Am J Infect Control 32:436–40.CrossRefPubMedGoogle Scholar
  17. Furuno JP, Perencevich EN, Johnson JA, Wright MO, McGregor JC, Morris JG, Strauss SM, Roghman MC, Nemoy LL, Standiford H, Hebden JN, Harris AD (2005) Methicillin-resistant Staphylococcus aureus and vancomycin-resistant co-colonisation. Emerg Infect Dis 11: 1539–44.PubMedGoogle Scholar
  18. Garrouste-Orgeas M, Timsit JF, Kallel H, Ben Ali A, Dumay MF, Paoli B, Misset B, Carlet J (2001) Colonization with methicillin-resistant Staphylococcus aureus in ICU patients: Morbidity, mortality, and glycopeptide use. Infect Control Hosp Epidemiol 22:687–92.CrossRefPubMedGoogle Scholar
  19. Graffunder EM, Venezia RA (2002) Risk factors associated with nosocomial methicillin- resistant Staphylococcus aureus (MRSA) infection including previous use of antimicrobials. J Antimicrob Chemother 49:999–1005.CrossRefPubMedGoogle Scholar
  20. Grundmann H, Hori S, Winter B, Tami A, Austin DJ(2002) Risk factors for the transmission of methicillin-resistant Staphylococcus aureus in an adult intensive care unit: Fitting a model to the data. J Infect Dis 185:481–8.CrossRefPubMedGoogle Scholar
  21. Ho PL; For the Hong Kong intensive care unit antimicrobial resistance study (HK-ICARE) Group (2003) Carriage of methicillin-resistant Staphylococcus aureus, ceftazidimeresistant Gram-negative bacilli, and vancomycin-resistant enterococci before and after intensive care unit admission. Crit Care Med 31:1175–82.CrossRefPubMedGoogle Scholar
  22. Huang SS, Labus BJ, Samuel MC, Wan DT, Reingold AL (2002) Antibiotic resistance patterns of bacterial isolates from blood in San Francisco County, California, 1996–1999. Emerg Infect Dis 8:195–201.CrossRefPubMedGoogle Scholar
  23. Huang SS, Platt R (2003) Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 36:281–5.CrossRefPubMedGoogle Scholar
  24. Kenner J, O’Connor T, Piantanida N, Fishbain J, Eberly B, Viscount H, Uyehara C, Hospenthal D (2003) Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population. Infect Control Hosp Epidemiol 24:439–44.CrossRefPubMedGoogle Scholar
  25. Laupland KB, Conly JM (2003) Treatment of Staphylococcus aureus colonization and prophylaxis for infection with topical intranasal mupirocin: An evidence-based review. Clin Infect Dis 37:933–8.CrossRefPubMedGoogle Scholar
  26. Levine DP, Fromm BS, Reddy BR (1991) Slow response to vancomycin or vancomycin plus rifampin in methicillin-resistant Staphylococcus aureus endocarditis. Ann Intern Med 115:674–80.PubMedGoogle Scholar
  27. Lucet JC, Chevret S, Durand-Zaleski I, Chastang C, Regnier B; Multicenter Study Group (2003) Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: Results of a multicenter study. Arch Intern Med 163:181–8.CrossRefPubMedGoogle Scholar
  28. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR (1999) Guideline for prevention of surgical site infection, 1999. Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 20:250–78.CrossRefPubMedGoogle Scholar
  29. Melzer M, Eykyn SJ, Gransden WR, Chinn S (2003) Is methicillin-resistant Staphylococcus aureus more virulent than methicillin-susceptible S.aureus? A comparative cohort study of British patients with nosocomial infection and bacteremia. Clin Infect Dis 37:1453–60.CrossRefPubMedGoogle Scholar
  30. Mest DR, Wong DH, Shimoda KJ, Mulligan ME, Wilson SE (1994) Nasal colonization with methicillin-resistant Staphylococcus aureus on admission to the surgical intensive care unit increases the risk of infection. Anesth Analg 78:644–50.CrossRefPubMedGoogle Scholar
  31. Miller MA, Dascal A, Portnoy J, Mendelson J (1996) Development of mupirocin resistance among methicillin-resistant Staphylococcus aureus after widespread use of nasal mupirocin ointment. Infect Control Hosp Epidemiol 17:811–3.CrossRefPubMedGoogle Scholar
  32. Onorato M, Borucki MJ, Baillargeon G, Paar DP, Freeman DH, Cole CP, Mayhall CG (1999) Risk factors for colonization or infection due to methicillin-resistant Staphylococcus aureus in HIV-positive patients: A retrospective case–control study. Infect Control Hosp Epidemiol 20:26–30.CrossRefPubMedGoogle Scholar
  33. Osmon S, Ward S, Fraser VJ, Kollef MH (2004) Hospital mortality for patients with bacteremia due to Staphylococcus aureus or Pseudomonas aeruginosa. Chest 125:607–16.CrossRefPubMedGoogle Scholar
  34. Papia G, Louie M, Tralla A, Johnson C, Collins V, Simor AE (1999) Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: Is it cost effective? Infect Control Hosp Epidemiol 20:473–7.CrossRefPubMedGoogle Scholar
  35. Paterson DL, Rihs JD, Squier C, Gayowski T, Sagnimeni A, Singh N (2003) Lack of efficacy of mupirocin in the prevention of infections with Staphylococcus aureus in liver transplant recipients and candidates. Transplantation 75:194–8.CrossRefPubMedGoogle Scholar
  36. Perl TM, Cullen JJ, Wenzel RP, Zimmerman MB, Pfaller MA, Sheppard D, Twombley J, French PP, Herwaldt LA (2002) Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. New Engl J Med 346:1871–7.CrossRefPubMedGoogle Scholar
  37. Rezende NA, Blumberg HM, Metzger BS, Larsen NM, Ray SM, McGowan JE Jr (2002) Risk factors for methicillin-resistance among patients with Staphylococcus aureus bacteremia at the time of hospital admission. Am J Med Sci 323:117–23.CrossRefPubMedGoogle Scholar
  38. Rubinovitch B, Pittet D (2001) Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: What have we learned? J Hosp Infect 47:9–18.CrossRefPubMedGoogle Scholar
  39. Salgado CD, Farr BM, Calfee DP (2003) Community-acquired methicillin-resistant Staphylococcus aureus: A meta-analysis of prevalence and risk factors. Clin Infect Dis 36:131–9.CrossRefPubMedGoogle Scholar
  40. Sax H, Harbarth S, Gavazzi G, Henry N, Schrenzel J, Rohner P, Michel JP, Pittet D (2005) Prevalence and prediction of previously unknown MRSA carriage on admission to a geriatric hospital. Age Ageing 34:456–62.CrossRefPubMedGoogle Scholar
  41. Scarnato F, Mallaret MR, Croize J, Kouabenan DR, Dubois M, Maitre A, DeGaudemaris R (2003) Incidence and prevalence of methicillin-resistant Staphylococcus aureus nasal carriage among healthcare workers in geriatric departments: Relevance to preventive measures. Infect Control Hosp Epidemiol 24:456–8.CrossRefPubMedGoogle Scholar
  42. Schelenz S, Tucker D, Georgeu C, Daly S, Hill M, Roxburgh J, French GL (2005) Significant reduction of endemic MRSA acquisition and infection in cardiothoracic patients by means of an enhanced targeted infection control programme. J Hosp Infect 60:104–10.CrossRefPubMedGoogle Scholar
  43. Small PM, Chambers HF (1990) Vancomycin for Staphylococcus aureus endocarditis in intravenous drug users. Antimicrob Agents Chemother 34:1227–31.PubMedGoogle Scholar
  44. Strippoli GF, Tong A, Johnson D, Schena FP, Craig JC (2004) Antimicrobial agents for preventing peritonitis in peritoneal dialysis patients. Cochrane Database Syst Rev Oct 18;(4):CD004679.Google Scholar
  45. Suzuki Y, Kamigaki T, Fujino Y, Tominaga M, Ku Y, Kuroda Y (2003) Randomized clinical trial of preoperative intranasal mupirocin to reduce surgical-site infection after digestive surgery. Br J Surg 90:1072–5.CrossRefPubMedGoogle Scholar
  46. Tacconelli E, Carmeli Y, Aizer A, Ferreira G, Foreman MG, D’Agata EM (2003a) Mupirocin prophylaxis to prevent Staphylococcus aureus infection in patients undergoing dialysis: A meta-analysis. Clin Infect Dis 37:1629–38.CrossRefPubMedGoogle Scholar
  47. Tacconelli E, D’Agata EM, Karchmer AW (2003b) Epidemiological comparison of true methicillin-resistant and methicillin-susceptible coagulase-negative staphylococcal bacteremia at hospital admission. Clin Infect Dis 37:644–9.CrossRefPubMedGoogle Scholar
  48. Tacconelli E, Karchmer AW, Yokoe D, D’Agata EM (2004a) Preventing the influx of vancomycin-resistant enterococci into health care institutions, by use of a simple validated prediction rule. Clin Infect Dis 39:964–70.CrossRefPubMedGoogle Scholar
  49. Tacconelli E, Venkataraman L, De Girolami PC, DAgata EM (2004b) Methicillin-resistant Staphylococcus aureus bacteraemia diagnosed at hospital admission: Distinguishing between community-acquired versus healthcare-associated strains. J Antimicrob Chemother 53:474–9.CrossRefPubMedGoogle Scholar
  50. Tsiodras S, Gold S, Sakoulas G, Eliopoulos GM, Wennersten C, Venkataraman L, Moellering RC, Ferraro MJ (2001) Linezolid resistance in a clinical isolate of Staphylococcus aureus. Lancet 358:207–8.CrossRefPubMedGoogle Scholar
  51. Tumbarello M, de Gaetano Donati K, Tacconelli E, Citton R, Spanu T, Leone F, Fadda G, Cauda R (2002) Risk factors and predictors of mortality of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia in HIV-infected patients. J Antimicrob Chemother 50:375–82.CrossRefPubMedGoogle Scholar
  52. Weber JT (2005) Community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 41 (Suppl 4): 269–72.CrossRefGoogle Scholar
  53. Weber SG, Gold HS, Hooper DC, Karchmer AW, Carmeli Y (2003) Fluoroquinolones and the risk for methicillin-resistant Staphylococcus aureus in hospitalized patients. Emerg Infect Dis 9:1415–22.PubMedGoogle Scholar
  54. Wilcox MH, Hall J, Pike H, Templeton PA, Fawley WN, Parnell P, Verity P (2003) Use of perioperative mupirocin to prevent methicillin-resistant Staphylococcus aureus (MRSA) orthopaedic surgical site infections. J Hosp Infect 54:196–201.CrossRefPubMedGoogle Scholar
  55. Whitby M, McLaws ML, Berry G (2001) Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: A meta-analysis. Med J Aust 175:264–7.PubMedGoogle Scholar
  56. Working Party Report (1998) Revised guidelines for the control of methicillin-resistant Staphylococcus aureus infection in hospitals. British Society for Antimicrobial Chemotherapy, Hospital Infection Society and the Infection Control Nurses Association. J Hosp Infect 39:253–90.Google Scholar
  57. Zhan C, Miller MR (2003) Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA 290:1868–74.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Evelind Tacconelli
    • 1
    • 2
  1. 1.Department of Infectious DiseasesCatholic UniversityRomeItaly
  2. 2.Division of Infectious DiseasesBeth Israel Deaconess Medical Center and Harvard Medical SchoolBostonUSA

Personalised recommendations