The American Journal of Medicine
Volume 121, Issue 4 , Pages 310-315, April 2008

The Risk of Infection after Nasal Colonization with Staphylococcus Aureus

  • Nasia Safdar, MD, MS

      Affiliations

    • Corresponding Author InformationRequests for reprints should be addressed to Nasia Safdar, H4/572 University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792.
    • ,
  • Elisa A. Bradley, MD

Section of Infectious Diseases, Department of Medicine, University of Wisconsin Medical School, Madison.

Abstract 

Purpose

Nasal, axillary, or inguinal colonization with Staphylococcus aureus generally precedes invasive infection. Some studies have found that colonization with methicillin-resistant S. aureus (MRSA) poses a greater risk of clinical infection than colonization with methicillin-susceptible S. aureus (MSSA). However, the magnitude of risk is unclear.

Methods

We undertook a systematic review to provide an overall estimate of the risk of infection following colonization with MRSA compared with colonization by MSSA. Ten observational studies, with a total of 1170 patients, were identified that provided data on both MSSA and MRSA colonization and infection. A random-effects model was used to obtain pooled estimates of the odds ratio and 95% confidence interval.

Results

Overall, colonization by MRSA was associated with a 4-fold increase in the risk of infection (odds ratio 4.08, 95% confidence interval, 2.10-7.44). Studies differed in the choice of patient population, severity of illness, and frequency of sampling to detect colonization.

Conclusion

Further research is needed to identify effective methods for sustained eradication of MRSA carriage to reduce the high risk of subsequent infection.

Keywords: Colonization, Infection, Methicillin resistance, Staphylococcus aureus

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 Supported by a Society of Critical Care Medicine Vision Grant (NS). Dr. Safdar was also supported by an institutional K-12 training grant from the Institute of Aging, National Institutes of Health, Bethesda, Md.

PII: S0002-9343(07)00974-6

doi:10.1016/j.amjmed.2007.07.034

The American Journal of Medicine
Volume 121, Issue 4 , Pages 310-315, April 2008

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