Being an MRSA carrier increases risk of infection and death
July 02, 2008
Patients harboring methicillin-resistant Staphylococcus aureus (MRSA)
for long periods of time continue to be at increased risk of MRSA
infection and death, according to a new study in the July 15 issue of
Clinical Infectious Diseases, currently available online.
MRSA is an antibiotic-resistant bacterium that can cause a variety of
serious infections. The bacterium most commonly colonizes the
nostrils, although it can be found in other body sites. Most research
has focused on people who are newly colonized by the bacteria and has
found that they are at substantial risk of subsequent infections.
The new study shows that the increased risk of infection continues,
with almost a quarter of MRSA-colonized patients developing infections
after a year or more has passed since the colonization was confirmed.
The infections include pneumonia and bloodstream events, and some
infections were linked to deaths.
"Since infection risk remains substantial among long-term carriers of
MRSA, these patients should be targeted for interventions to reduce
subsequent risk of infection along with patients who newly acquire
MRSA," said author Susan Huang, MD, MPH.
The researchers built on their previous work in this area, which
showed that one-third of new MRSA carriers in a large tertiary care
medical center developed infections within the year following the
first detection of colonization. But, as, Dr. Huang points out, "risks
beyond the first year of carriage were largely unknown."
In this study, Dr. Huang and coauthor Rupak Datta, MPH, followed 281
patients who had been MRSA-positive for at least one year and some for
more than four years. Of these, 23 percent developed an MRSA infection
within the year-long duration of this study. Pneumonia was the most
common infection. MRSA was identified as a contributor to the deaths
of 14 of the patients.
In their paper, the authors suggest that the MRSA infection risk may
be more closely tied to a hospitalization event than to the duration
of carriage: "We submit that these high risks of MRSA infection among
culture-positive prevalent carriers are not only preferentially
detected because of hospitalization, but may in fact be incurred
because of device related, wound related, and immunologic declines
associated with a current illness."
"One explanation for this may be that patients who have surgical
wounds or intravenous lines may allow MRSA a route of entry and
invasion that would not otherwise exist," added Dr. Huang.
The authors caution that because this study was performed in a large
tertiary care medical center, they may have studied a dispro****tionate
number of critically ill patients who could be at a relatively higher
risk for infection. The results may not be generalizable to all
patient settings.
Source: Infectious Diseases Society of America
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