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Open Access Highly Accessed Research article

Prevalence and factors associated with wound colonization by Staphylococcus spp. and Staphylococcus aureus in hospitalized patients in inland northeastern Brazil: a cross-sectional study

Gilmara Celli Maia Almeida12*, Marquiony Marques dos Santos2, Nara Grazieli Martins Lima1, Thiago André Cidral3, Maria Celeste Nunes Melo3 and Kenio Costa Lima4

Author Affiliations

1 Department of Dentistry, University of State of Rio Grande do Norte, Caico, Brazil

2 Microbiology Laboratory, University of State of Rio Grande do Norte, Caico, Brazil

3 Department of Microbiology and Parasitology, Federal University of Rio Grande do Norte, Natal, Brazil

4 Postgraduate Public Health, Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Brazil

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BMC Infectious Diseases 2014, 14:328  doi:10.1186/1471-2334-14-328

Published: 13 June 2014

Abstract

Background

Infections by Staphylococcus spp. are often associated with wounds, especially in hospitalized patients. Wounds may be the source of bacteria causing cross-contamination, and are a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) infection. The aim of this study was to investigate the prevalence of wound colonization by Staphylococcus spp., especially S. aureus and MRSA, in hospitalized patients, and to identify the factors associated with such colonization.

Methods

This cross-sectional study enrolled patients with wounds who were hospitalized in a remote and underdeveloped inland region of northeastern Brazil with extreme poverty. Samples were collected using sterile swabs with 0.85% saline solution, and coagulase-negative Staphylococcus spp., S. aureus, and MRSA were identified using standard laboratory procedures. Data regarding the sociodemographic characteristics, antibiotic use, and comorbidities of the patients were collected using the medical records and a questionnaire.

Results

A total of 125 wounds were analyzed. The patients had a mean age of 63.88 years and a mean 3.84 years of school education. Eighty-one wounds (64.80%) were colonized by Staphylococcus spp. Twenty-five wounds (20%) were colonized by S. aureus, 32% of which were colonized by MRSA. Wound colonization by Staphylococcus spp. was associated with pneumonia or other respiratory disease (p = 0.03). Wound colonization by S. aureus was associated with nasal colonization by S. aureus (p < 0.001), fewer days of prior antibiotic use (p = 0.04), admission to a medical ward (p = 0.02), and age >65 years (p = 0.05). Among patients with wound colonization by MRSA, 37.50% had a history of prior antibiotic use, 75% had two or more comorbidities, 25% had cancer or diabetes, 50% had cardiovascular disease, and 50% died.

Conclusions

Wounds can be the source of Staphylococcus spp. infection, and high proportions of wounds are colonized by S. aureus and MRSA. Nasal colonization by S. aureus may be a source for wound colonization by S. aureus, illustrating the importance of preventing cross-contamination in hospital environments, especially among elderly patients. Wounds should be carefully managed to prevent microbial spread, thereby assisting patient recovery and reducing healthcare costs.

Keywords:
Staphylococcus spp; Staphylococcus aureus; MRSA; Wounds; Hospitalization