Risk and outcome of nosocomial Staphylococcus aureus bacteraemia in nasal carriers versus non-carriers

• Published in: The Lancet (British edition) Vol. 364; no. 9435; pp. 703 - 705
• Main Authors: Wertheim, Heiman FL, Vos, Margreet C, Ott, Alewijn, van Belkum, Alex, Voss, Andreas, Kluytmans, Jan AJW, van Keulen, Peter HJ, Vandenbroucke-Grauls, Christina MJE, Meester, Marlene HM, Verbrugh, Henri A
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 21.08.2004; Elsevier Limited
• Subjects: Bacteremia - microbiology; Bacteria; Bacterial Typing Techniques; Blood; Carrier State - microbiology; Clinical outcomes; Cross Infection - microbiology; Cross Infection - mortality; Cross Infection - transmission; Female; Health risk assessment; Hospital Mortality; Humans; Infections; Length of Stay; Male; Medical instruments; Middle Aged; Mortality; Nasal Cavity - microbiology; Nose; Nosocomial infection; Risk Factors; Staphylococcal Infections - microbiology; Staphylococcal Infections - mortality; Staphylococcal Infections - transmission; Staphylococcus aureus - classification; Staphylococcus aureus - isolation & purification
• ISSN: 0140-6736; 1474-547X
• DOI: 10.1016/S0140-6736(04)16897-9

Staphylococcus aureus is the second most frequent cause of nosocomial blood infections. We screened 14 008 non-bacteraemic, non-surgical patients for S aureus nasal carriage at admission, and monitored them for development of bacteraemia. Nosocomial S aureus bacteraemia was three times more frequent in S aureus carriers (40/3420, 1·2%) than in non-carriers (41/10 588, 0·4%; relative risk 3·0, 95% CI 2·0–4·7). However, in bacteraemic patients, all-cause mortality was significantly higher in non-carriers (19/41, 46%) than in carriers (seven/40, 18%, p=0·005). Additionally, S aureus bacteraemia-related death was significantly higher in non-carriers than in carriers (13/41 [32%] vs three/40 [8%], p=0·006). S aureus nasal carriers and non-carriers differ significantly in risk and outcome of nosocomial S aureus bacteraemia. Genotyping revealed that 80% of strains causing bacteraemia in carriers were endogenous.