Prevalence and risk factors associated with vancomycin-resistant Staphylococcus aureus precursor organism colonization among patients with chronic lower-extremity wounds in Southeastern Michigan.

Abstract:

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.

authors

Tosh PK,Agolory S,Strong BL,Verlee K,Finks J,Hayakawa K,Chopra T,Kaye KS,Gilpin N,Carpenter CF,Haque NZ,Lamarato LE,Zervos MJ,Albrecht VS,McAllister SK,Limbago B,Maccannell DR,McDougal LK,Kallen AJ,Guh AY

doi

10.1086/671735

subject

Has Abstract

pub_date

2013-09-01 00:00:00

pages

954-60

issue

9

eissn

0899-823X

issn

1559-6834

journal_volume

34

pub_type

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