Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Adult Patients Visiting Emergency Department in a Medical Center in Taiwan

Within the past 10 years, methicillin-resistant Staphylococcus aureus (MRSA) has not only been a hospital pathogen but also a community pathogen. To understand the carriage rate of methicillin-resistant Staphylococcus aureus (MRSA) among the adult patients visiting emergency department (ED), we conducted this study.From May 21 to August 12, 2009, a total of 502 adult patients visiting emergency department (ED) of a tertiary care hospital in northern Taiwan were recruited in this study and surveyed for nasal carriage of MRSA. A questionnaire regarding the risk factors for MRSA acquisition was also obtained. The overall prevalence of MRSA nasal carriage among the patients was 3.8%. The carriage rate was significantly higher in patients with risk factors for MRSA acquisition (5.94%) than those without risk factors (2.12%). Patients with urinary complaints, diabetes mellitus, chronic kidney disease and current percutaneous tube usage were significantly associated with MRSA colonization. By multiple logistic regression analysis, only current usage of catheters or tubes was the independent predictor for MRSA nasal colonization. Of the 19 MRSA, most isolates belonged to one of two linages, characterized as sequence type (ST) 239 (32%) and ST 59 (58%). The latter linage, accounting for 83% of 6 isolates from patients without risk factors, is a community-associated (CA) clone in Taiwan, while the former linage is among healthcare-associated clones.A substantial proportion of patients visiting ED, particularly with current usage of percutaneous catheter or tubes, in northern Taiwan carried MRSA, mostly community strains, in nares

Comparison of nasal <i>Staphylococcus aureus</i> and methicillin-resistant <i>S. aureus</i> (MRSA) colonization rate between subjects using catheters/tubes or not.

<p>Comparison of nasal <i>Staphylococcus aureus</i> and methicillin-resistant <i>S. aureus</i> (MRSA) colonization rate between subjects using catheters/tubes or not.</p

Distribution of PFGE pattern and other molecular characteristics of 19 methicillin-resistant <i>Staphylococcus aureus</i>, stratified by with or without risk factors.

<p>*included its variants IIIa and IIIb.</p><p>MLST, multilocus sequence type; SCC<i>mec</i>, staphylococcal chromosome cassette type; PVL, Panton-Valentine leukocidin; UT, untypeable.</p

Comparison of nasal <i>Staphylococcus aureus</i> and methicillin-resistant <i>S. aureus</i> (MRSA) colonization rate between adult patients with and without risk factors.

<p>Comparison of nasal <i>Staphylococcus aureus</i> and methicillin-resistant <i>S. aureus</i> (MRSA) colonization rate between adult patients with and without risk factors.</p

Association of methicillin-resistant <i>S. aureus</i> (MRSA) colonization with demographic and clinical characteristics of patients visiting emergency department.

a<p>Fisher's exact test instead of Pearson's chi-square test was performed when any expected count was less than 5 by statistical analysis.</p>b<p>Low social economic status was defines as patients other than those with education level above senior high and a monthly income more than 50,000 NT.</p>c<p>Including wound or surgical site culture, blood culture, sputum culture, and urine culture.</p>d<p>Including Foley, port A, percutaneous drainage tubes, and catheter for dialysis.</p>e<p>The chief complaints were classified according to the systems of the body affected.</p