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REVIEW

The Commonality of Risk Factors for Nosocomial Colonization and Infection with Antimicrobial-Resistant Staphylococcus aureus, Enterococcus, Gram-Negative Bacilli, Clostridium difficile, and Candida

Nasia Safdar, MD, and Dennis G. Maki, MD

4 June 2002 | Volume 136 Issue 11 | Pages 834-844

Recent years have witnessed a rapidly growing crisis in antimicrobial resistance, especially among microorganisms that cause nosocomial infection. To better understand common risk factors among multiresistant organisms, this review explores risk factors for nosocomial infection with methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Clostridium difficile, extended-spectrum ß-lactamase-producing gram-negative bacilli, and Candida. This review comprises data from 74 published studies; 53 (71%) were retrospective studies and addressed few risk factors or did not quantify risk. The analysis shows impressive commonality of risk factors across these diverse multiresistant organisms: advanced age; underlying diseases and severity of illness; inter-institutional transfer of the patient, especially from a nursing home; prolonged hospitalization; gastrointestinal surgery or transplantation; exposure to invasive devices of all types, especially central venous catheters; and exposure to antimicrobial drugs, especially cephalosporins.

More restricted use of antibiotics, especially cephalosporins, and strategies to prevent medical device-related infection and cross-infection in the hospital would yield benefit with all types of resistant organisms. Preemptive isolation of all patients with risk factors for infection by resistant organisms would very likely reduce secondary spread within the hospital. Conversely, programs that focus on only one organism or one antimicrobial drug are unlikely to succeed. Prospective studies of sufficient size that address all potential risk factors, especially individual anti-infective agents, and that use matched controls who are shown by surveillance cultures to be free of colonization by resistant organisms would enhance understanding of the epidemiology of antimicrobial resistance in institutions and guide efforts to develop more effective strategies for prevention.

Author and Article Information

From University of Wisconsin Hospital and Clinics, Madison, Wisconsin.

Presented in part at the Fourth International Decennial Conference on Nosocomial and Health-Care Associated Infections on 5 March 2000 in Atlanta, Georgia, and published in abstract form (Safdar N, Maki DG. An analysis of risk factors for nosocomial infection with antimicrobial-resistant pathogens: MRSA, VRE, C. difficile, ESBL-positive GNB, and Candida [Abstract]. Infect Control Hosp Epidemiol. 2000; 21:132).

Grant Support: In part by a gift for research in infection control from the Oscar Rennebohm Foundation of Madison, Wisconsin.

Requests for Single Reprints: Dennis G. Maki, MD, Department of Medicine, H4/572 University of Wisconsin Hospital and Clinics, 600 Highland Avenue, Madison, WI 53792.

Current Author Addresses: Drs. Safdar and Maki: Department of Medicine, University of Wisconsin Hospital and Clinics, 600 Highland Avenue, H4/572, Madison, WI, 53792.

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