STAPHYLOCOCCUS-AUREUS NASAL COLONIZATION IN PATIENTS WITH CIRRHOSIS -PROSPECTIVE ASSESSMENT OF ASSOCIATION WITH INFECTION

OBJECTIVE: To determine if Staphylococcus aureus colonization of the a nterior nares was a risk factor for S aureus infection in patients wit h cirrhosis and to determine the predictors of S aureus infection in c olonized patients. DESIGN: Prospective cohort study. PATIENTS: 84 cons ecutive patients with cirrhosis admitted to the liver transplant unit of a university-affiliated Veterans' Affairs Medical Center. RESULTS: Overall, 39 (46%) of the 84 patients were nasal carriers of S aureus, of which 24 (29%) were methicillin-resistant Staphylococcus aureus (MR SA) and 15 (18%) were methicillin-sensitive Staphylococcus aureus (MSS A). Only MRSA, but never MSSA, carriage was acquired in the hospital; all 15 of the MSSA versus 14 (58%) of the 24 MRSA carriers were nasal carriers on first (admission) culture (P=.001). Of the 10 (42%) of 24 MRSA carriers who were not colonized on admission, 3 became MRSA carri ers within 1 month, and 7 acquired MRSA carriage more than a month lat er. Higher Child-Pugh score was independently associated with MRSA car riage (odds ratio [OR], 1.54; 95% confidence interval [CI95], 1.1-2.3) . S aureus nasal carriers (9 [23%] of 39) were significantly more like ly to develop S aureus infections than noncarriers (2 [4%] of 45; P=.0 2). Central venous catheter use was associated independently with S au reus infections in the carriers (OR, 4.1; CI95, 2.8-6.1). Mortality wa s significantly higher in carriers who developed S aureus infections a s compared to those who did not (57% vs 13%; P=.022); S aureus infecti on was an independent predictor of mortality in the carriers (OR, 8.7; CI95, 1.2-63.8). CONCLUSIONS: Colonization of the anterior nares was a significant predictor of S aureus infection in patients with cirrhos is (Infect Control Hosp Epidemiol 1998;19: 328-332).