Detection and treatment of antibiotic-resistant bacterial carriage in a surgical intensive care unit: a 6-year prospective survey

Infect Control Hosp Epidemiol. 2005 Feb;26(2):161-5. doi: 10.1086/502521.


Objective: To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).

Design: Prospective survey of 2235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E).

Setting: A surgical ICU in a tertiary-care teaching hospital.

Patients: All admitted patients.

Interventions: Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.

Results: The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBLE decreased from 5.5 cases per 1000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.

Conclusions: MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Carrier State / diagnosis
  • Carrier State / drug therapy
  • Carrier State / epidemiology*
  • Cross Infection / diagnosis
  • Cross Infection / epidemiology*
  • France / epidemiology
  • Humans
  • Infection Control / methods*
  • Intensive Care Units
  • Length of Stay
  • Methicillin Resistance*
  • Mupirocin / therapeutic use
  • Prospective Studies
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology*
  • Staphylococcus aureus / isolation & purification*
  • Time Factors


  • Anti-Bacterial Agents
  • Mupirocin