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hankal. ~·crl.tilatiull. no 1%) Reason'tnr leU .admÏ~i(}l1. tlO ,
Jltr>-i:~1: ~.1...'11:,; ...'''(1 wll,.n :1I,w W'1:'i": .:<~~lt'i. ' >11 '~'1;hiR j ,",'ll~'tLof".(,H\-<"l~1' Kt:-U::mj~,~ibn .mu 'l~ lm_in3lJe :;:l1~n'j;I'J ,J':; d~l~rcnÎlled .=' !-. ih.~ F~rld:aibe:. ·ri' .jb:o;nvt>iÎl·_MYJ l!lI'fXJilll: 1'1 Ir- nl1<\,~"r'_1lOf,1 th~ ;:;lti!~. :'h~ 1.1,\1 1;:1;A ~ ?['.111\"-:: 5 dfll!:l. rel:'Or:lI'U.'jr.';'· ';~".>l <i.winl: ~ "'J<!. ,-'Orn '1I~I:.:<:h rhf.l' Ii;l!! f:~.'r. ;x~iE,lT::l-::'ci :-<'\~,.'~1 ',iIIU:~ "'" l' cl, t> :tABLE DE\l(xi Th~ {)::-fEGA ;. _' <1:.?·.1 ~'·"'f~c:.l,l "r l:tm:inum:û r:.-)lIitl;~.n~! ]1I~I ,.iM I:.C,',:cr~· ' :<1 .,ht:.:IÎr..e~ ~. W-1JiI'1: ,il (.l\lJ:o:·!;~ .' "",~ ICl: morla1ilY: SliPS Tl, p.36 ,
sIon (OR, 2.89) Further study is needed to deve10p atld vaU o9t d<>le a score aIlowing us to discrimin<>le patients al: risk fur iY1RSA wlonization on admlssi<}IL Previous studies have reported lhat higher severity of illness 00 admis"i~n was a predlspo"ing factor fur the acquisition ofnoMtomial infections. h ,r:5 H.igher severity of illness on admission and M:RSA cùlonizauonwere round to be inde-pendent nsk -factors for the Qccurre:t1ce of S aurrns (cither MSSA or MRSAJ infections EJghty·tbree perceot of the inkt'lL'<1 patients wcrc prcviOllSIy or sim" lIaoeously col· onized \Vith MRSA. Severa! siumes found nasal S "wellS cardage ta he a risk factor for acq:uiring.s aurettS infections. in medical 1 fl.ltl and SUl'gicaP~:t! patients High~leYeJ nasal carriage oi S 111mi was found to be ail independent risk fa<:tor for developiofi ,ur!Jfcal·sile infections wilh S àurellS,21 ft is tUllikeij" !hat the pwpensity of MRSA to tâvor S aurl!U' ioiections is ltigher til:illl1ll't of MSS.Ic The spe· cifie mIe of-rvrRSA]n favnring-S au}'eus inleoctions in the ICU probably 18 due tn the hlgh number of p-'&ient.;:; who receivt'Ù anumicrobîals in the leU. Most of thr .antib~creri~ alli ut:!iCd an: iR'live againsl 'MSSA ~trains an cl mJght prevent MSSA infe~tions_l5 In 109t>, for 5~,~ of the pati.eut;.,.rcU--d<lY~. the patients received al leasl une antinticrobiai atlÎv(' a!fainst MSS,", (co-amnxkl:w. tazobacrum. third-generation C'C'phalosporins, imipenem, fluoroquinolones. or QX3.d1HnL Our database did tWI provide indiviriuai information ahout the use of thes.e antimi<.:rubials, ~nd furrher :Study tS ne-ed· C' d to contitm \his h)'1}othrsi;;;. The LTude rnurtaJit.y in Dur lCO ~..,)hr.l1"t was 2:2'i',; mol'tality rates amQng the pr.il.icnt~ \Vith l;.'ùlonization .and infection were :~~:t\'1 and 43'X., respecLiveiy_ Factors in<1l.:pend,'ntly as.'1oCÎmeri with rCE mortalitywen: thû$c prevlüusly reported in reu patients: sC'\I(>rity 1)[ tllrH.~S8 t)n admis...:;iotl and need for mechnnical \1entilatiorL.t311lt:' relation befween MR."iA colonization .and morrality" deserves f1Jrtber enm· meut AlthOt,gh ;h~ crud~ !CU mortality ai MRSA"'ùlo- ni:1.ed palient::; was sigHwcantly higher than for non·cuitl~ nized patient...:; (33W~ v'S 2f.r%) , we l'ouml lhat acquisition of MRSA did not JnJJuenc~ mürtality in .leU pati~nt.'l;. eVr=n iD. the presence uf an inJection, Ulis r,sut! migh! he beClllse patients frw of MRSA iniections !:oHld have .3nother nosoeùmial inie'l'tiorl 01' otner rlyn:amic' eve-nts occurring duriQ~ feu star that could In11.uel'lce outcom'f.'.J4 Out s.tudy asst~:ssed only lhe comK"l1W::~H:_e'Sof MT<$,'\ çolonization and infectiou. Few sttldle$ have amùyzed separately l!te çoltlllJzed (nan.it1fet:ted) and it1fected p.'lIlenh> with MRSA as a (actar fur lCU mnrta1ily. In a etudy by Gire« et <>1' " (ha! differenti· ated carriage (nne MRSA·positiVé nasal or oetaneottS sam· ple), caionization (ane MR$A.p<>sitive clinIcatpIe without sigllS of infeetiQn), and MIlSA infection, the Inortallty (33% vs 38% ln our study) among carrier patieIJ[' W-dS sig· niikantly 1""" tfum the mortality in MRSAoeoloaized ar MRSA~llfucted patients (45% vs ;;Î%, respectiveiy) In a sntali population of buro patients, a rnse-control ,tudy dld not deroonStrole " difference in rnortality betweeo cola· nized and infeeted patienrs whh rvOESA" Yaneomycm "se was Jargely dependent 00 wheth"" or not MIlSA was ""demie in the unit The canee,." tha! glywpeptide use shoulcl be a public health priority has in<ensilied since the fust report of glycopeptid.,.intermed~ ate S aureus. being isolated in 1996. 1i Moreover; vallcomycin use was demonstrated as a nsk.factor for acquiriug vancomycin-fë$.ÎStailt ertterococci2~ ln 1995, the Huspital Infection Control Practiées Advisory Committeerecnmmendations for the control of van.t"omycin·resiSEant enterococci emphasized' vnncom;.rcin restriction as crucial tti prevent the sptead of vançomycin tesistance.:t' Sevl'rai methods have béen proposed ta restrict IlaIlcomyéin U"", such as a vam:omycin continuation form, JI} Stop ordtIt·:J,3 but the effects of these appe'reG to be transiem"l1 Ollrstlldy showed ti"t MRSA carnage inl1uenced p;1ycupepûde USe in both ntm-colorUzed and colnolzed patients,e-ven when :In infection was not d"mollotratèd. Ulis sllggests <hat the be,t appro""h to Iunit lhespread of gfycopt'ptidc n'SÎstam.'l' wiB be {pitf' recfnt ~tudies showing: !he bencfils of n:dudng I"fRSA ca.rrjflg~:':' A reC'ent cO':.'!t·benelîl analysb demuu~tràtt'd th-at a .\II{Sf\ tOlHrol proR:ram was beneiklat cumparc, u1iiblé mode!. 'Ne found thot MRSA cok> nimtion wasrecovered more'nfteninp.aûems re:terr~-d from wards (QR, 2.79) atld1llpaûem nu i~lit::lti{Hl wIll'n \ifRSA cnloni7.;ltînn on admi::;sion rang:~ù frlJ!U 1% tu 7',~J,3~ An antibiolic·cuntro[ pmg:ranl could be ilnnthldS ;} n'3k fa(,~tür ror Ml{SA l~ûl(Jnii.a.tion. but prior ùuoroquinolone use w~s jdenrified as a risk factor for the acquisition üfMR5A co]onizarinn_~ui TH conclusion. our :'Itudy demQn~trJ.led thal Ml& ,
(;OI:rioM r{\, S DM ,
Cepûùilli!iQ[ mt"miL'.imn-f'l!'S~r.n.nt !'Itl-mns al Staphylc ,
Kitcis r.m. C'Xlr.rot.4.. l1msi:t}F. ~ :J;l~ Fflllow IIp (j;f 3. Q~ oothn=ak ot mcÛ1ldllin'r~~ru ;U,!"aÜtS of StriMyimMOOlS ~itt'll~,< (M'RSA)With d~cr~, ~~)lihlltly ,
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re:sulls rtt tht! EHrtJ!*$1 Prn'a1cnce ut lc1l:'t"t1üft io Tnl:etUi'M':: Ci!N" OErrOstu,gy, EPTC TiUfo:fMûnna1 AdvisUry C<)I,lndl1ee. /AM-l L''FECTION CONTROL ,INn HOSl'lTAL El'lDE.\lIOLOGV NO\'ember 2DOl 199547 ,
t41fJW S. :iiU1tn~:r 10: AJt.L"W SilJJ~llât'4 At.' 1.iLè P'hJ~j(.lÏt"..gic ~()r~ .(SAI'S rn /}1l.l:J.:d (lü fi Eümpe:tn/North Amcrkun muJOCell'l!f $ttldy, JA}4A 1!!'J3::!1o-.:.:I957, 2003. ,
EvtllUllIJOn 0:' l:m!nc'h~k 1~f11ti(lt;II':s-fof' !1l~ diagnos:s f,)f nosm:ontial ~l,ltf1l.)nt.l. Am Jlfn.pirCrit Cart MMllOOfi~l5Z23t-24il 1}. llmtôitJf, Mb~ B. G"ldgt~.m J'W. COfrlcol LRe;(vpr.lfl!aJ l:lf dlsr.J! diag· nos.tic ~ti:n:Jt!Î<J1t th;> diagno, olnO'blXonà<ù D1ii:'\unnfria. Oust ,
sst:m C. Abn.)il~ F; t,{:gram1 P.: l>ia1",rnosls l.t.! r:t'I~till v'"ntl1:S t~thi'~ùr-rdtJtcd i.mt.'t:,WIF {.1'irit·~ll~-,pl of qllilTI!'ÎtatiVe lip n.tUurl;';<' ArcJi IrHffJrMi'ii 19, E7:4T:~7'h'( ,
'1niJô 'oVRf.::llmn TG, Hi.--..rM TC, H~gh"sJM. ClX.: 1dm@lJ]n lUr tlt~;U't1lt1ia.l infl'Ctlons.1HXH_ A;on Iltrfn:: OiKl.I'W I9S8;tfr.l~, pp.8-9 ,
a121o; t'llU: o-f mct.hjdtJîn'r1.!"~:i~'J,i.lH' S!uf!,i')1(Ir!iCr.1-lJî rlUYt'lH. Ami brfm t~llJ1frof t~3:11~il)·74, !it Ciron E, J'ulm!!"' l':, ;;;"i(fand e Ciu.'lm 1' . fuUJ!'-P.:il$5<}1l C ::dC'CUYI: ,",(~:"t'l"{11rIJ; üi ~"tI.frit'i't {Ill' Cl-itlll'O! Di mdbjdHm'R"",i~'J;Wl StfJ,èhyJiiÙO:.'C!/S I11NYlll (,\fI6t\r :r, higli-ti;;k htl-Epitil iU'P.-.:ll' ''-l'lrh ,
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NA l~imm1:m;;I!' JE, 'N:ti!:!IlT [W Pnn:u'r 'FA, Li'''''rl'lK Ph:ys;lo!ôgic 3!ldChronic I-lt'aHh EYoiliu~Ltir_m: <l vay'}ioklgka .lty b-a!\oeé t·.1"~5itk, ntlon $:.~tem. Cri! Cart Med IBIHi-9,S~H'5'97 ,
RrJf1r1:l{tltl$: M. Lopez-LuqUC' A, :khauinu- CMl";; S:. Gal'i'czc.\''anr-il:-R lrtlJLle1\~llf ftallo(~fl:mL1i ïnrec.'lirm on rnort, intensWc L"1In: unit. Cr.Î1Ca'li1 AfM, p.55, 1994. ,
Cus aUrnQ in ht,l:'n jPl(l{'1tt'l, 1'\1~y-rdl tht" tu~ l' &~ 19!)j1;2;f:39s.;l97, Zfl, fridkin Si{.. Edwan'ls JR.1.1fl JE, T"nover Fe, 1;' 1 111. n ..rt'fmJrtants.J-i\'llflCOmW:m U~' ln ;ntliJlt inrJ:',ftù, ML"(hitilIin.r~!ti~u.t1: S!aph~oJl1~OCtt': 1i Ei, ! 1~5, 1999. ,
ltl.1l 1: Y:lDl1tl K Oguri r, r~r;u'.w PC M(~~!1ÎdUin-re~jstml! Slapkytrll'W'I:I.i,iGU7l'Wi -,;t:r"ain with n.'ihl-t'~d "<lll ,
1 AS1\.;-nOW PM, HiiOJJJaJi<lhl~,l:;:dùd"l«d 'Mlh \':Jnî:,;mtY-c:aH'{',-ib;iilnJ f"l1("rn~·llCt";lI {<tloni-allkm in lw~'11.'itrie.. 11Iy \tFntikitJ:'f1 P'âW:~l:!!. Cnl Cau' Mt4t Imt11ii:mil.G.. !I:l.IL 1']. HfwpilaJ inkr.iJoll (\,mrni F'r:1it'til't~ f\dvtslJry CUllmtirU"t:', Cl'~tl? l\mLruI al~il p,"'~'t'nrhjn __ Prr'vcnting tru:~1.tl't'!:Jd iA VilUn,ll1wÎfl i'I,.;i:flti1ncT: a r~'pllrl !Plill IUt'-Hüs,f.liml [.rttrt~!:ton C{l:ltr(~l Pt;;.-_'r~~6, ~j::'~<ifl( rvtkTi'«n'-ifinj~m5 tn Hü~itlb. bUNI (';puml Hoe;p Epiritmi{111~itlS:j;;:V~), p.1 ,
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* Staff Physici::m. leU, S.aint Louis Tc ,
Polyvalent leu. Ddafont.aine Hospital, Saint Denis, France. § § St;.ûf Physician. Surgical Jeu Antoine Bédère Tcadling Hospital. 1111 St.affPhysidan. Medical ICU, Bich:l.t-Chmde Bemard Teaching Hospic:ù , Parîs.FrJ.ncc. ~# Indh-iduals participating in the OlITCOi\OEREA SPJdl' Group arc listed in the Appcndix. Reccived from the McdicaiKlJ, AVicenne Hospit"ll, Bobigny, Fr-d.nce; SurgicaJ ICU, Antoine Bé'C1ère Hospital, and the Medical !CU, Saint-Louis Hospiral Wyeth.tedertc, Pute:lUx-P.aris la Défense. France, and centre National de Recherche Scientifique, 2002. ,
de Lassence; Servi\..-e de Ré'd.nimation Médic.aie, Hôpital touis Mourier, 92701 Colombes Cedex, Fr:J.I1cc. Address ekctronic mail m: amaud.de·lassence@ourcomcrea.org. Jndividual arode reprims mal' be purchased through thèJoumal Web site ,
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The following is the lis! of people who belong to the OUTCOME- Study Group, inçluding aU authors of the present manuscript Scientific committce: ]e'J.n-François Timsit, M.o., Staff Physician, leU, Hôpital Bichat ,
Professor. lCU, Hôpital Avicenne, p.56 ,
Staff Physidan, leU, Hôpital des Diaconesses Staff Physician, ICU, Hôpital Saint]oseph, Parl'>, Fr.tnce~ Fr.lnçois L' Attending Physician, leU, Hôpital Bichat, Biostatistical and infonnatical expertise: Sylvie Chevte.t, Ph.D., ProfessoT, DBL.'i, Hôpital Saint Louis Supelec. Fr.lUee. Invcstigators of the OuteomeRea Data Basetnce; Marie Thuon...~, 1:1.D.. Staff Physician M.D., Slaff Physidan. JeU, CH de Dourdan ,
Attending Physici-all, leU, Hôpital Saint Joseph ,
Attending Physicmn, lCU Attending Physid:ln, Hôpital Bichat ,
60120 54003 Nancy cedex -Tél ,