Prevalence and Risk Factors Associated with Vancomycin-Resistant Staphylococcus aureus Precursor Organism Colonization among Patients with Chronic Lower-Extremity Wounds in Southeastern Michigan

Details

• Alternative Title:
  Infect Control Hosp Epidemiol
• Personal Author:
  Tosh, Pritish K. ; Agolory, Simon ; Strong, Bethany L. ; VerLee, Kerrie ; Finks, Jennie ; Hayakawa, Kayoko ; Chopra, Teena ; Kaye, Keith S. ; Gilpin, Nicholas ; Carpenter, Christopher F. ; Haque, Nadia Z. ; Lamarato, Lois E. ; Zervos, Marcus J. ; Albrecht, Valerie S. ; McAllister, Sigrid K. ; Limbago, Brandi ; MacCannell, Duncan R. ; McDougal, Linda K. ; Kallen, Alexander J. ; Guh, Alice Y.
• Description:
  BACKGROUND
  
  Of the 13 US vancomycin-resistant Staphylococcus aureus (VRSA) cases, 8 were identified in southeastern Michigan, primarily in patients with chronic lower-extremity wounds. VRSA infections develop when the vanA gene from vancomycin-resistant enterococcus (VRE) transfers to S. aureus. Inc18-like plasmids in VRE and pSK41-like plasmids in S. aureus appear to be important precursors to this transfer.
  
  OBJECTIVE
  
  Identify the prevalence of VRSA precursor organisms.
  
  DESIGN
  
  Prospective cohort with embedded case-control study.
  
  PARTICIPANTS
  
  Southeastern Michigan adults with chronic lower-extremity wounds.
  
  METHODS
  
  Adults presenting to 3 southeastern Michigan medical centers during the period February 15 through March 4, 2011, with chronic lower-extremity wounds had wound, nares, and perirectal swab specimens cultured for S. aureus and VRE, which were tested for pSK41-like and Inc18-like plasmids by polymerase chain reaction. We interviewed participants and reviewed clinical records. Risk factors for pSK41-positive S. aureus were assessed among all study participants (cohort analysis) and among only S. aureus-colonized participants (case-control analysis).
  
  RESULTS
  
  Of 179 participants with wound cultures, 26% were colonized with methicillin-susceptible S. aureus, 27% were colonized with methicillin-resistant S. aureus, and 4% were colonized with VRE, although only 17% consented to perirectal culture. Six participants (3%) had pSK41-positive S. aureus, and none had Inc18-positive VRE. Having chronic wounds for over 2 years was associated with pSK41-positive S. aureus colonization in both analyses.
  
  CONCLUSIONS
  
  Colonization with VRSA precursor organisms was rare. Having long-standing chronic wounds was a risk factor for pSK41-positive S. aureus colonization. Additional investigation into the prevalence of VRSA precursors among a larger cohort of patients is warranted.
  
  
• Subjects:
  Adult Aged Aged, 80 And Over Article Female Humans Leg Injuries Male Michigan Middle Aged Prevalence Risk Factors Staphylococcal Infections Vancomycin Resistance Wound Infection

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• Source:
  Infect Control Hosp Epidemiol. 34(9):954-960
• Pubmed ID:
  23917910
• Pubmed Central ID:
  PMC6489131
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  34
• Issue:
  9
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:27a35a18ea8ebf8dbed81881e0850e749500922cc7bf2d7b83279c55b4021622
• Download URL:
  https://stacks.cdc.gov/view/cdc/78293/cdc_78293_DS1.pdf
• File Type:
  [PDF - 324.15 KB ]