The Prevalence of Methicillin-Resistant Staphylococcus aureus Colonization in Patients with Complicated Skin and Skin Structure Infections after Treatment with Linezolid or Vancomycin

Laura A. Puzniak¹, Kimbal D. Ford², David B. Huang¹

¹formerly Pfizer Inc., Collegeville, USA.
²Pfizer Inc., Collegeville, USA.

DOI: 10.4236/aid.2014.44026                

Abstract

Background: Complicated skin and skin structure infections (cSSSIs) due to Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), are associated with significant morbidity. Re-ducing MRSA carriage has been a focus of infection control interventions. The prevalence of MRSA colonization after successful treatment of a MRSA cSSSI is unknown. Methods: Secondary analysis of a randomized controlled trial comparing linezolid and vancomycin for the treatment of MRSA cSSSI. Adult patients that had a colonization culture, confirmed MRSA cSSSI, received at least one dose of study treatment, and had an outcome recorded at end of study. Patient, clinical characteristics and prevalence of colonization were compared by treatment regimens. A multivariate regression model identified predictors of MRSA colonization at EOS. Results: There were 456 patients evaluated. The prevalence of MRSA colonization was higher for vancomycin treated patients compared to linezolid treated patients at end of treatment (EOT) (28% vs. 5%, p < 0.001) and EOS (34% vs. 22%, p < 0.01). Independent predictors of colonization at EOS after treatment for a MRSA cSSSI included diagnosis, primarily driven by abscess, black race, treatment with vancomycin, MRSA mixed infection and male gender. Conclusion: Patients treated with linezolid for a cSSSI had less MRSA colonization at EOT and EOS compared to those treated with vancomycin. Multiple independent predictors of MRSA colonization were identified. Additional studies evaluating the relationship of MRSA colonization after treatment of cSSSI are needed.

Keywords

Staphylococcus aureus, Complicated Skin and Skin Structure Infection, Colonization, Linezolid

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Styers, D., Sheehan, D.J., Hogan, P. and Sahm, D.F. (2006) Laboratory-Based Surveillance of Current Antimicrobial Resistance Patterns and Trends among Staphylococcus aureus: 2005 Status in the United States. Annals of Clinical Microbiology and Antimicrobials, 9, 2.
[2]	Stryjewski, M.E. and Chambers, H.F. (2008) Skin and Soft-Tissue Infections Caused by Community-Acquired Methicillin-Resistant Staphylococcus aureus. Clinical Infectious Diseases, 46, S368-S377. http://dx.doi.org/10.1086/533593
[3]	van Belkum, A., Melles, D.C., Nouwen, J., van Leeuwen, W.B., van Wamel, W., Vos, M.C., Wertheim, H.F. and Verbrugh, H.A. (2009) Co-Evolutionary Aspects of Human Colonisation and Infection by Staphylococcus aureus. Infection, Genetics and Evolution, 9, 32-47. http://dx.doi.org/10.1016/j.meegid.2008.09.012
[4]	Abad, C.L., Pulia, M.S. and Safdar, N. (2013) Does the Nose Know? An Update on MRSA Decolonization Strategies. Current Infectious Disease Reports, 15, 455-464. http://dx.doi.org/10.1007/s11908-013-0364-y
[5]	Ruhe, J.J., de Guzman, L., Moss, M., Riley, W., Mildvan, D., Perlman, D.C. and Koll, B. (2011) Methicillin-Susceptible Staphylococcus aureus Nasal Colonization and the Risk of Subsequent Methicillin-Resistant Staphylococcus aureus Infections among Hospitalized Patients. Diagnostic Microbiology and Infectious Disease, 71, 163-166. http://dx.doi.org/10.1016/j.diagmicrobio.2011.05.011
[6]	von Eiff, C., Becker, K., Machka, K., Stammer, H. and Peters, G. (2001) Nasal Carriage as a Source of Staphylococcus aureus Bacteremia. The New England Journal of Medicine, 344, 11-16. http://dx.doi.org/10.1056/NEJM200101043440102
[7]	Wertheim, H.F., Melles, D.C., Vos, M.C., van Leeuwen, W., van Belkum, A., Verbrugh, H.A. and Nouwen, J.L. (2005) The Role of Nasal Carriage in Staphylococcus aureus Infections. The Lancet Infectious, 5, 751-762. http://dx.doi.org/10.1016/S1473-3099(05)70295-4
[8]	Yamamoto, T., Nishiyama, A., Takano, T., Yabe, S., Higuchi, W., Razvina, O. and Shi, D. (2010) Community-Acquired Methicillin-Resistant Staphylococcus aureus: Community Transmission, Pathogenesis, and Drug Resistance. Journal of Infection and Chemotherapy, 16, 225-254. http://dx.doi.org/10.1007/s10156-010-0045-9
[9]	Bessesen, M.T., Lopez, K., Guerin, K., Hendrickson, K., Williams, S., O’Connor-Wright, S., Granger, D. and Bunch, M. (2013) Comparison of Control Strategies for Methicillin-Resistant Staphylococcus aureus. American Journal of Infection Control, 41, 1048-1052. http://dx.doi.org/10.1016/j.ajic.2013.01.032
[10]	Miller, L.G., Eells, S.J., Taylor, A.R., David, M.Z., Ortiz, N., Zychowski, D., Kumar, N., Cruz, D., Boyle-Vavra, S. and Daum, R.S. (2012) Staphylococcus aureus Colonization among Household Contacts of Patinets with Skin Infections: Risk Factors, Strain Discordance and Complex Ecology. Clinical Infectious Diseases, 54, 1523-1535. http://dx.doi.org/10.1093/cid/cis213
[11]	Fritz, S.A., Camins, B.C., Eisenstein, K.A., Fritz, J.M., Epplin, E.K., Burnham, C.A., Dukes, J. and Storch, G.A. (2011) Effectiveness of Measures to Erradicate Staphylococcus aureus Carriage in Patients with Community-Associated Skin and Soft-Tissue Infections: A Randomized Trial. Infection Control and Hospital Epidemiology, 32, 972-880. http://dx.doi.org/10.1086/661285
[12]	Ammerlaan, H.S., Kluytmans, J.A., Berkhout, H., Buiting, A., de Brauwer, E.I., van den Broek, P.J., van Gelderen, P., Leenders, S.A., Ott, A., Richter, C., Spanjaard, L., Spijkerman, I.J., van Tiel, F.H., Voorn, G.P., Wulf, M.W., van Zeijl, J., Troelstra, A. and Bonten, M.J., MRSA Eradication Study Group (2011) Eradication of Carriage with Methicillin-Resistant Staphylococcus aureus: Effectiveness of a National Guideline. Journal of Antimicrobial Chemotherapy, 66, 2418-2424. http://dx.doi.org/10.1093/jac/dkr250
[13]	Ziakas, P.D., Anagnostou, T. and Mylonakis, E. (2014) The Prevalence and Significance of Methicillin-Resistant Staphylococcus aureus Colonization at Admission in the General ICU Setting: A Meta-Analysis of Published Studies. Critical Care Medicine, 42, 433-444. http://dx.doi.org/10.1097/CCM.0b013e3182a66bb8
[14]	Siegel, J.D., Rhinehart, E., Jackson, M. and Chairello, L. (2007) Healthcare Infection Control Practices Advisory Committee. Management of Multidrug-Resistant Organisms in Healthcare Settings, 2006. American Journal of Infection Control, 35, S165-S193. http://dx.doi.org/10.1016/j.ajic.2007.10.006
[15]	Lautenbach, E., Nachamkin, I., Hu, B., Fishman, N.O., Tolomeo, P., Prasad, P., Bilker, W.B. and Zaoutis, T.E. (2009) Surveillance Cultures for Detection of Methicillin-Resistant Staphylococcus aureus: Diagnostic Yield of Anatomic Sites and Comparison of Provider- and Patient-Collected Samples. Infection Control and Hospital Epidemiology, 30, 380-382. http://dx.doi.org/10.1086/596045
[16]	Grmek-Kosnik, I., Ihan, A., Dermota, U., Rems, M., Kosnik, M. and JornKolmos, H. (2005) Evaluation of Separate vs. Pooled Swab Cultures, Different Media, Broth Enrichment and Anatomical Sites of Screening for the Detection of Methicillin-Resistant Staphylococcus aureus from Clinical Specimens. Journal of Hospital Infection, 61, 155-161. http://dx.doi.org/10.1016/j.jhin.2005.01.032
[17]	Shurland, S.M., Stine, O.C., Venezia, R.A., Johnson, J.K., Zhan, M., Furuno, J.P., Miller, R.R., Johnson, T. and Roghmann, M.C. (2009) Colonization Sites of USA300 Methicillin-Resistant Staphylococcus aureus in Residents of Extended Care Facilities. Infection Control and Hospital Epidemiology, 30, 313-318. http://dx.doi.org/10.1086/596114
[18]	McKinnell, J.A., Huang, S.S., Eells, S.J., Cui, E. and Miller, L.G. (2013) Quantifying the Impact of Extranasal Testing of Body Sites for Methicillin-Resistant Staphylococcus aureus Colonization at the Time of Hospital or Intensive Care Unit Admission. Infection Control and Hospital Epidemiology, 34, 161-170. http://dx.doi.org/10.1086/669095
[19]	Itani, K.M., Dryden, M.S., Bhattacharyya, H., Kunkel, M.J., Baruch, A.M. and Weigelt, J.A. (2010) Efficacy and Safety of Linezolid versus Vancomycin for the Treatment of Complicated Skin and Soft-Tissue Infections Proven to Be Caused by Methicillin-Resistant Staphylococcus aureus. The American Journal of Surgery, 199, 804-816. http://dx.doi.org/10.1016/j.amjsurg.2009.08.045
[20]	Gee, T., Ellis, R., Marshall, G., Andrews, J., Ashby, J. and Wise, R. (2001) Pharmacokinetics and Tissue Penetration of Linezolid Following Multiple Oral Doses. Antimicrobial Agents and Chemotherapy, 45, 1843-1846. http://dx.doi.org/10.1128/AAC.45.6.1843-1846.2001
[21]	Stein, G.E. and Wells, E.M. (2010) The Importance of Tissue Penetration in Achieving Successful Antimicrobial Treatment of Nosocomial Pneumonia and Complicated Skin and Soft-Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus: Vancomycin and Linezolid. Current Medical Research and Opinion, 26, 571-588. http://dx.doi.org/10.1185/03007990903512057
[22]	Rybak, M.J., Lomaestro, B.M., Rotschafer, J.C., Moellering Jr., R.C., Craig, W.A., Billeter, M., Dalovisio, J.R. and Levine, D.P. (2009) Therapeutic Monitoring of Vancomycin in Adults Summary of Consensus Recommendations from the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, and the Society of Infectious Diseases Pharmacists. Pharmacotherapy, 29, 1275-1279. http://dx.doi.org/10.1592/phco.29.11.1275
[23]	Chen, C.C. and Pass, S.E. (2013) Risk Factors for and Impact of Methicillin-Resistant Staphylococcus aureus Nasal Colonization in Patients in a Medical Intensive Care Unit. American Journal of Infection Control, 41, 1100-1101. http://dx.doi.org/10.1016/j.ajic.2013.01.035
[24]	Stevens, A.M., Hennessy, T., Baggett, H.C., Bruden, D., Parks, D. and Klejka, J. (2010) Methicillin-Resistant Staphylococus aureus Carriage and Risk Factors for Skin Infections, Southwestern Alaska, USA. Emerging Infectious Diseases, 16, 797-803. http://dx.doi.org/10.3201/eid1605.091851
[25]	Patel, M., Weinheimer, J.D., Waites, K.B. and Baddley, J.W. (2008) Active Surveillance to Determine the Impact of Methicillin-Resistant Staphylococcus aureus Colonization on Patients in Intensive Care Units of a Veterans Affairs Medical Center. Infection Control and Hospital Epidemiology, 29, 503-509. http://dx.doi.org/10.1086/588161
[26]	Varshney, A.K. (2010) Augumented Production of Panton Leukocidin Toxin in Methicillin-Resistant and Susceptible Staphylococcus aureus Is Associated with Worse Outcome in Murine Skin Infection Model. The Journal of Infectious Diseases, 201, 92-96. http://dx.doi.org/10.1086/648613
[27]	Lopez, M.B., Gonzalez, C.G., Orellana, M.A., Chaves, F. and Rojo, P. (2013) Staphylococcus aureus Abscesses: Methicillin-Resistance or Panton-Valentine Leukocidin Presence? Archives of Disease in Childhood, 98, 608-610. http://dx.doi.org/10.1136/archdischild-2012-302695
[28]	Huang, D.B., Reisman, A. and Hogan, P. (2010) Clinical Outcomes by Methicillin-Resistant Staphylococcus aureus Staphylococcal Cassestte Chromosome Mec Type: Isolates Recovered from a Phase IV Clinical trial of Linezolid and Vancomycin for Complicated Skin and Skin Structure Infections. Antimicrobial Agents and Chemotherapy, 54, 4036-4037. http://dx.doi.org/10.1128/AAC.00044-10
[29]	Frank, D.N., Feazel, L.M., Bessesen, M.T., Price, C.S., Janoff, E.N. and Pace, N.R. (2010) The Human Nasal Microbiota and Staphylococcus aureus Carriage. PLoS One, 17, e10598.