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Systematic Review of Measurement and Adjustment for Colonization Pressure in Studies of Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci, and Clostridium difficile Acquisition

Adebola O. Ajao MPH, Anthony D. Harris MD MPH, Mary-Claire Roghmann MD MS, J. Kristie Johnson PhD, Min Zhan PhD, Jessina C. McGregor >PhD and Jon P. Furuno PhD
Infection Control and Hospital Epidemiology
Vol. 32, No. 5 (May 2011), pp. 481-489
DOI: 10.1086/659403
Stable URL: http://www.jstor.org/stable/10.1086/659403
Page Count: 9
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Systematic Review of Measurement and Adjustment for Colonization Pressure in Studies of Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci, and Clostridium difficile Acquisition
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Abstract

Objective. Colonization pressure is an important infection control metric. The aim of this study was to describe the definition and measurement of and adjustment for colonization pressure in nosocomial-acquisition risk factor studies of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and Clostridium difficile.Methods. We performed a computerized search of studies of nosocomial MRSA, VRE, and C. difficile acquisition published before July 1, 2009, through MEDLINE. Studies were included if a study outcome was MRSA, VRE, or C. difficile acquisition; the authors identified risk factors associated with MRSA, VRE, or C. difficile acquisition; and the study measured colonization pressure.Results. The initial MEDLINE search yielded 505 articles. Sixty-six of these were identified as studies of nosocomial MRSA, VRE, or C. difficile acquisition; of these, 18 (27%) measured colonization pressure and were included in the final review. The definition of colonization pressure varied considerably between studies: the proportion of MRSA- or VRE-positive patients (5 studies), the proportion of MRSA- or VRE-positive patient-days (6 studies), or the total or mean number of MRSA-, VRE-, or C. difficile–positive patients or patient-days (7 studies) in the unit over periods of varying length. In 10 of 13 studies, colonization pressure was independently associated with MRSA, VRE, or C. difficile acquisition.Conclusion. There is a need for a simple and consistent method to quantify colonization pressure in both research and routine clinical care to accurately assess the effect of colonization pressure on cross-transmission of antibiotic-resistant bacteria.

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