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Nasal Carrier Rate of Antibiotic-Resistant Staphylococci: Influence of Hospitalization on Carrier Rate in Patients, and Their Household Contacts

Nasal Carrier Rate of Antibiotic-Resistant Staphylococci: Influence of Hospitalization on Carrier... Abstract Introduction It is a generally accepted fact today that the increase in the percentage of infections in hospitals caused by antibiotic-resistant staphylococci is largely due to cross infection in the hospitals with resistant microorganisms.1-17 It is also known that among hospital staff, nurses, and patients the percentage of carriers of pathogenic staphylococci in the pharynx and vestibulum nasi and the percentage of resistant strains in these carriers are increasing in relation to the period of their stay in hospital. However, there is only a little information in regard to the period that patients continue to carry the resistant staphylococci acquired in the hospital after discharge and how far transfer of these micro-organisms to house-hold contacts occurs. Dowling et al.18 found in Chicago that the carrier rate for staphylococci in the nose and/or throat of patients, counting all staphylococci irrespective of their ability to produce pigment or hemolysis and References 1. The bacteriophages were supplied by Dr. A. C. Ruys, Professor of Bacteriology at the University of Amsterdam, who also gave us the opportunity to study the technique of phage typing in her laboratory. 2. Statistical analysis of Tables 4 and 6 according to the X2-test shows that the differences in frequency of therapy between those leaving hospital with a sensitive and with a resistant Staphylococcus are statistically significant and that antibiotic therapy promotes colonization with a resistant Staphylococcus in a significant manner (P=0.001). 3. The small difference in frequency of therapy in this group of patients with the average figures for therapy frequency are statistically not significant (with use of the X2-test, P=0.80). 4. Statistical analysis of the data obtained at the various consecutive periods of examination shows that these differences in the rate of decrease of the strains originally present are statistically valid (P<0.05). 5. The difference between these figures is statistically significant according to the X2-test (P<0.001). 6. Barber, M.: Staphylococcal Infections Due to Penicillin-Resistant Strains , Brit. M. J. 2:863-865, 1947.Crossref 7. Barber, M.; Hayhoe, F. G. J., and Whitehead, J. E. M.: Penicillin-Resistant Staphylococcal Infection in a Maternity Hospital , Lancet 2:1120-1125, 1949.Crossref 8. Barber, M., and Burston, J.: Antibiotic-Resistant Staphylococcal Infection , Lancet 2:578-583, 1955.Crossref 9. Beigelman, P. M., and Rantz, L. A.: The Clinical Importance of Coagulase-Positive Penicillin-Resistant Staphylococcus Aureus , New England J. Med. 242:353-358, 1950.Crossref 10. Clarke, S. K. R.; Dalgleish, P. G., and Gillespie, W. A.: Hospital Cross-Infections with Staphylococci Resistant to Several Antibiotics , Lancet 1:1132-1135, 1952.Crossref 11. Finland, M.: Medical Progress: Emergence of Antibiotic-Resistant Bacteria , New England J. Med. 253:909-922, 1955.Crossref 12. Forbes, G. B.: Infection with Penicillin-Resistant Staphylococci in Hospital and General Practice , Brit. M. J. 2:569-571, 1949.Crossref 13. Goslings, W. R. O.; Tio Liong Hien, and Bots, A. W.: Infection with Antibiotic-Resistant Staphylococci , Acta med. scandinav. 152:439-458, 1955.Crossref 14. Lepper, M. H.; Dowling, H. F.; Jackson, G. G., and Hirsch, M. M.: Epidemiology of Penicillin- and Aureomycin-Resistant Staphylococci in a Hospital Population , A. M. A. Arch. Int. Med. 92:40-50, 1953.Crossref 15. Lowbury, E. J. L.; Topley, E., and Hood, A. M.: Chemotherapy for Staphylococcus Aureus in Burns , Lancet 1:1036-1042, 1952.Crossref 16. North, E. A., and Christie, R.: Observation on the Sensitivity of Staphylococci to Penicillin , M. J. Australia 2:44-46, 1945. 17. Reiss, E.; Pulaski, E. J.; Amspacher, W. H., and Conteras, A. A.: Penicillin Sensitivity of Staphylococci , New England J. Med. 246:611-612, 1952.Crossref 18. Rountree, P. M., and Thomson, E. F.: Incidence of Penicillin-Resistant and Streptomycin-Resistant Staphylococci in a Hospital , Lancet 2:501-504, 1949.Crossref 19. Rountree, P. M., and Barbour, R. H. G.: Nasal Carrier Rates of Staphylococcus Pyogenes in Hospital Nurses , J. Path. & Bact. 63:313-324, 1951. 20. Rountree, P. M.; Barbour, R. G. H., and Thomson, E. F.: Incidence of Penicillin-Resistant and Streptomycin-Resistant Staphylococci in a Hospital , Lancet 1:435-436, 1951. 21. Ruys, A. C., and Willems, G.: Onderzoekingen naar de verspreiding van staphylococcus pyogenes bij gezonden en zieken , Nederl. tijdschr. geneesk. 99:406-414, 1955. 22. Ruys, A. C.: Some Epidemiological Aspects of the Spread of Staphylococcus Pyogenes , Docum. med. geogr. et trop. 8:237-242, 1956. 23. Dowling, H. F.; Lepper, M. H., and Jackson, G. G.: Observations on the Epidemiological Spread of Antibiotic-Resistant Staphylococci, with Measurements of the Changes in Sensitivity to Penicillin and Aureomycin , Am. J. Pub. Health , 43: 860-868, 1953. 24. Rountree, P. M.; Freeman, B. M., and Barbour, R. H. G.: Nasal Carriage of Staphylococcus Aureus in the General Population and Its Relationship to Hospitalization and to Penicillin Therapy , M. J. Australia 2:457-460, 1954. 25. Martin, T. D. M., and Whitehead, J. E. M.: Carriage of Penicillin-Resistant Staph. Pyogenes in Healthy Adults , Brit. M. J. 1:173-175, 1949. 26. Rice, W. G., and Lonergan, A. M.: Penicillin-Resistant Staphylococci , Am. J. Clin. Path. 19:1083-1088, 1949. 27. Cadness-Graves, B.; Williams, R.; Harper, G. J., and Miles, A. A.: Slide-Test for Coagulase-Positive Staphylococci , Lancet 1:736-738, 1943. 28. Fisk, A.: The Technique of the Coagulase Test for Staphylococci , Brit. J. Exper. Path. 21: 311-314, 1940. 29. Hoette, I., and Struyk, A. P.: A Modified Method for Evaluation of Clinical Usefulness of Antibiotics , J. Lab. & Clin. Med. 51:638-653, 1958. 30. Williams, R. E. O., and Rippon, J. E.: Bacteriophage Typing of Staphylococcus Aureus , J. Hyg. 50:320-353, 1952. 31. Rountree, P. M., and Freeman, B. M.: Infections Caused by a Particular Phage Type of Staphylococcus Aureus , M. J. Australia 2:157-161, 1955. 32. Gould, J. C., and Allan, W. S. A.: Staphylococcus Pyogenes Cross-Infection , Lancet 2:988-989, 1954. 33. Szybalski, W.: "Natural" and "Artificial" Penicillin Resistance in Staphylococcus (Micrococcus Pyogenes Var. Aureus) , Antibiotics & Chemother. 3:915-919, 1953. 34. Lankford, R. A. F.: Selection of Penicillinase-Producing Staphylococcus , Bact. Proc. 41: 52, 1954. 35. Gould, J. C.: Origin of Penicillin-Resistant Staphylococcus Pyogenes , Nature, London 176: 176, 1955. 36. Miles, A. A.; Williams, R. E. O., and Clayton-Cooper, B.: The Carriage of Staphylococcus (Pyogenes) Aureus in Man and Its Relation to Wound Infection , J. Path. & Bact. 56:513-524, 1944. 37. Gould, J. C., and McKillop, E. J.: Carriage of Staphylococcus Pyogenes Var. Aureus in Human Nose , J. Hyg. 52:304-310, 1954. 38. McFarlan, A. M.: Incidence of Pathogenic Staphylococci in Nose , Brit. M. J. 2:939-941, 1938. 39. Gillespie, E. H.; Devenish, E. A., and Cowan, S. T.: Pathogenic Staphylococci , Lancet 2:870-873, 1939. 40. Le Cosquino de Bussy, I. J.; van Loghem, J. J., and Visser, A. K.: Dragers van pathogene staphylococci bij niet-zieken , Nederl. tijdschr. geneesk. 86:1273, 1942. 41. Hobbs, B. C., Carruthers, H. L., and Gough, J.: Sycosis Barbæ , Lancet 2:572-574, 1947. 42. Valentine, F. C. O., and Hall-Smith, S. P.: Superficial Staphylococcal Infection , Lancet 2:351-354, 1952. 43. Tulloch, L. G.: Nasal Carriage in Staphylococcal Skin Infections , Brit. M. J. 2:912-913, 1954. 44. Chabbert, Y., and Debruge, J.: La Résistance naturelle des staphylococques au chloramphénicol , Ann. Inst. Pasteur 91:225-230, 1956. 45. Gibson, C. D., Jr., and Thompson, W. C., Jr.: The response of Burn Wound Staphylococci to Alternating Programs of Antibiotic Therapy , Antibiotics Ann. , pp. 32-34, 1955-1956. 46. Barber, M., and Whitehead, J. E. M.: Bacteriophage Types in Penicillin-Resistant Staphylococcal Infection , Brit. M. J. 2:565-569, 1949. 47. Barber, M.; Wilson, B. D. R.; Rippon, J. E., and Williams, R. E. O.: Spread of Staphylococcus Aureus in a Maternity Department in the Absence of Severe Sepsis , J. Obst. & Gynaec. Brit. Emp. 60:476-482, 1953. 48. Brodie, J.; Kerr, M. R., and Sommerville, T.: The Hospital Staphylococcus , Lancet 1:19-20, 1956. 49. Knight, V.; White, A.; Foster, F., and Wenzel, T.: Effect of Antimicrobial Therapy and Hospitalization on Carrier-Rates , Ann. New York Acad. Sc. 65:206-221, 1956. 50. Wallmark, G.: Bacteriophage-Typing of Staphylococcus Aureus Pyogenes , Acta pathol. et microbiol. scandinav. 34:577-584, 1954. 51. Vogelsang, T. M.: The Incidence of Penicillin-Resistant Pathogenic Staphylococci Isolated from the Upper Respiratory Tract of Young Healthy Persons , Acta path. et microbiol. scandinav. 29:363-367, 1951. 52. Howe, C. W.: Post-Operative Wound Infections, Due to Staphylococcus Aureus , New England J. Med. 251:411-417, 1954. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png A.M.A. Archives of Internal Medicine American Medical Association

Nasal Carrier Rate of Antibiotic-Resistant Staphylococci: Influence of Hospitalization on Carrier Rate in Patients, and Their Household Contacts

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American Medical Association
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Copyright © 1958 American Medical Association. All Rights Reserved.
ISSN
0888-2479
DOI
10.1001/archinte.1958.00260220007002
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Abstract

Abstract Introduction It is a generally accepted fact today that the increase in the percentage of infections in hospitals caused by antibiotic-resistant staphylococci is largely due to cross infection in the hospitals with resistant microorganisms.1-17 It is also known that among hospital staff, nurses, and patients the percentage of carriers of pathogenic staphylococci in the pharynx and vestibulum nasi and the percentage of resistant strains in these carriers are increasing in relation to the period of their stay in hospital. However, there is only a little information in regard to the period that patients continue to carry the resistant staphylococci acquired in the hospital after discharge and how far transfer of these micro-organisms to house-hold contacts occurs. Dowling et al.18 found in Chicago that the carrier rate for staphylococci in the nose and/or throat of patients, counting all staphylococci irrespective of their ability to produce pigment or hemolysis and References 1. The bacteriophages were supplied by Dr. A. C. Ruys, Professor of Bacteriology at the University of Amsterdam, who also gave us the opportunity to study the technique of phage typing in her laboratory. 2. Statistical analysis of Tables 4 and 6 according to the X2-test shows that the differences in frequency of therapy between those leaving hospital with a sensitive and with a resistant Staphylococcus are statistically significant and that antibiotic therapy promotes colonization with a resistant Staphylococcus in a significant manner (P=0.001). 3. The small difference in frequency of therapy in this group of patients with the average figures for therapy frequency are statistically not significant (with use of the X2-test, P=0.80). 4. Statistical analysis of the data obtained at the various consecutive periods of examination shows that these differences in the rate of decrease of the strains originally present are statistically valid (P<0.05). 5. The difference between these figures is statistically significant according to the X2-test (P<0.001). 6. Barber, M.: Staphylococcal Infections Due to Penicillin-Resistant Strains , Brit. M. J. 2:863-865, 1947.Crossref 7. Barber, M.; Hayhoe, F. G. J., and Whitehead, J. E. M.: Penicillin-Resistant Staphylococcal Infection in a Maternity Hospital , Lancet 2:1120-1125, 1949.Crossref 8. Barber, M., and Burston, J.: Antibiotic-Resistant Staphylococcal Infection , Lancet 2:578-583, 1955.Crossref 9. Beigelman, P. M., and Rantz, L. A.: The Clinical Importance of Coagulase-Positive Penicillin-Resistant Staphylococcus Aureus , New England J. Med. 242:353-358, 1950.Crossref 10. Clarke, S. K. R.; Dalgleish, P. G., and Gillespie, W. A.: Hospital Cross-Infections with Staphylococci Resistant to Several Antibiotics , Lancet 1:1132-1135, 1952.Crossref 11. Finland, M.: Medical Progress: Emergence of Antibiotic-Resistant Bacteria , New England J. Med. 253:909-922, 1955.Crossref 12. Forbes, G. B.: Infection with Penicillin-Resistant Staphylococci in Hospital and General Practice , Brit. M. J. 2:569-571, 1949.Crossref 13. Goslings, W. R. O.; Tio Liong Hien, and Bots, A. W.: Infection with Antibiotic-Resistant Staphylococci , Acta med. scandinav. 152:439-458, 1955.Crossref 14. Lepper, M. H.; Dowling, H. F.; Jackson, G. G., and Hirsch, M. M.: Epidemiology of Penicillin- and Aureomycin-Resistant Staphylococci in a Hospital Population , A. M. A. Arch. Int. Med. 92:40-50, 1953.Crossref 15. Lowbury, E. J. L.; Topley, E., and Hood, A. M.: Chemotherapy for Staphylococcus Aureus in Burns , Lancet 1:1036-1042, 1952.Crossref 16. North, E. A., and Christie, R.: Observation on the Sensitivity of Staphylococci to Penicillin , M. J. Australia 2:44-46, 1945. 17. Reiss, E.; Pulaski, E. J.; Amspacher, W. H., and Conteras, A. A.: Penicillin Sensitivity of Staphylococci , New England J. Med. 246:611-612, 1952.Crossref 18. Rountree, P. M., and Thomson, E. F.: Incidence of Penicillin-Resistant and Streptomycin-Resistant Staphylococci in a Hospital , Lancet 2:501-504, 1949.Crossref 19. Rountree, P. M., and Barbour, R. H. G.: Nasal Carrier Rates of Staphylococcus Pyogenes in Hospital Nurses , J. Path. & Bact. 63:313-324, 1951. 20. Rountree, P. M.; Barbour, R. G. H., and Thomson, E. F.: Incidence of Penicillin-Resistant and Streptomycin-Resistant Staphylococci in a Hospital , Lancet 1:435-436, 1951. 21. Ruys, A. C., and Willems, G.: Onderzoekingen naar de verspreiding van staphylococcus pyogenes bij gezonden en zieken , Nederl. tijdschr. geneesk. 99:406-414, 1955. 22. Ruys, A. C.: Some Epidemiological Aspects of the Spread of Staphylococcus Pyogenes , Docum. med. geogr. et trop. 8:237-242, 1956. 23. Dowling, H. F.; Lepper, M. H., and Jackson, G. G.: Observations on the Epidemiological Spread of Antibiotic-Resistant Staphylococci, with Measurements of the Changes in Sensitivity to Penicillin and Aureomycin , Am. J. Pub. Health , 43: 860-868, 1953. 24. Rountree, P. M.; Freeman, B. M., and Barbour, R. H. G.: Nasal Carriage of Staphylococcus Aureus in the General Population and Its Relationship to Hospitalization and to Penicillin Therapy , M. J. Australia 2:457-460, 1954. 25. Martin, T. D. M., and Whitehead, J. E. M.: Carriage of Penicillin-Resistant Staph. Pyogenes in Healthy Adults , Brit. M. J. 1:173-175, 1949. 26. Rice, W. G., and Lonergan, A. M.: Penicillin-Resistant Staphylococci , Am. J. Clin. Path. 19:1083-1088, 1949. 27. Cadness-Graves, B.; Williams, R.; Harper, G. J., and Miles, A. A.: Slide-Test for Coagulase-Positive Staphylococci , Lancet 1:736-738, 1943. 28. Fisk, A.: The Technique of the Coagulase Test for Staphylococci , Brit. J. Exper. Path. 21: 311-314, 1940. 29. Hoette, I., and Struyk, A. P.: A Modified Method for Evaluation of Clinical Usefulness of Antibiotics , J. Lab. & Clin. Med. 51:638-653, 1958. 30. Williams, R. E. O., and Rippon, J. E.: Bacteriophage Typing of Staphylococcus Aureus , J. Hyg. 50:320-353, 1952. 31. Rountree, P. M., and Freeman, B. M.: Infections Caused by a Particular Phage Type of Staphylococcus Aureus , M. J. Australia 2:157-161, 1955. 32. Gould, J. C., and Allan, W. S. A.: Staphylococcus Pyogenes Cross-Infection , Lancet 2:988-989, 1954. 33. Szybalski, W.: "Natural" and "Artificial" Penicillin Resistance in Staphylococcus (Micrococcus Pyogenes Var. Aureus) , Antibiotics & Chemother. 3:915-919, 1953. 34. Lankford, R. A. F.: Selection of Penicillinase-Producing Staphylococcus , Bact. Proc. 41: 52, 1954. 35. Gould, J. C.: Origin of Penicillin-Resistant Staphylococcus Pyogenes , Nature, London 176: 176, 1955. 36. Miles, A. A.; Williams, R. E. O., and Clayton-Cooper, B.: The Carriage of Staphylococcus (Pyogenes) Aureus in Man and Its Relation to Wound Infection , J. Path. & Bact. 56:513-524, 1944. 37. Gould, J. C., and McKillop, E. J.: Carriage of Staphylococcus Pyogenes Var. Aureus in Human Nose , J. Hyg. 52:304-310, 1954. 38. McFarlan, A. M.: Incidence of Pathogenic Staphylococci in Nose , Brit. M. J. 2:939-941, 1938. 39. Gillespie, E. H.; Devenish, E. A., and Cowan, S. T.: Pathogenic Staphylococci , Lancet 2:870-873, 1939. 40. Le Cosquino de Bussy, I. J.; van Loghem, J. J., and Visser, A. K.: Dragers van pathogene staphylococci bij niet-zieken , Nederl. tijdschr. geneesk. 86:1273, 1942. 41. Hobbs, B. C., Carruthers, H. L., and Gough, J.: Sycosis Barbæ , Lancet 2:572-574, 1947. 42. Valentine, F. C. O., and Hall-Smith, S. P.: Superficial Staphylococcal Infection , Lancet 2:351-354, 1952. 43. Tulloch, L. G.: Nasal Carriage in Staphylococcal Skin Infections , Brit. M. J. 2:912-913, 1954. 44. Chabbert, Y., and Debruge, J.: La Résistance naturelle des staphylococques au chloramphénicol , Ann. Inst. Pasteur 91:225-230, 1956. 45. Gibson, C. D., Jr., and Thompson, W. C., Jr.: The response of Burn Wound Staphylococci to Alternating Programs of Antibiotic Therapy , Antibiotics Ann. , pp. 32-34, 1955-1956. 46. Barber, M., and Whitehead, J. E. M.: Bacteriophage Types in Penicillin-Resistant Staphylococcal Infection , Brit. M. J. 2:565-569, 1949. 47. Barber, M.; Wilson, B. D. R.; Rippon, J. E., and Williams, R. E. O.: Spread of Staphylococcus Aureus in a Maternity Department in the Absence of Severe Sepsis , J. Obst. & Gynaec. Brit. Emp. 60:476-482, 1953. 48. Brodie, J.; Kerr, M. R., and Sommerville, T.: The Hospital Staphylococcus , Lancet 1:19-20, 1956. 49. Knight, V.; White, A.; Foster, F., and Wenzel, T.: Effect of Antimicrobial Therapy and Hospitalization on Carrier-Rates , Ann. New York Acad. Sc. 65:206-221, 1956. 50. Wallmark, G.: Bacteriophage-Typing of Staphylococcus Aureus Pyogenes , Acta pathol. et microbiol. scandinav. 34:577-584, 1954. 51. Vogelsang, T. M.: The Incidence of Penicillin-Resistant Pathogenic Staphylococci Isolated from the Upper Respiratory Tract of Young Healthy Persons , Acta path. et microbiol. scandinav. 29:363-367, 1951. 52. Howe, C. W.: Post-Operative Wound Infections, Due to Staphylococcus Aureus , New England J. Med. 251:411-417, 1954.

Journal

A.M.A. Archives of Internal MedicineAmerican Medical Association

Published: Nov 1, 1958

References