495. High Prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) Nasal Carriage among TB Patients at a Rural Hospital in South Africa
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a serious global pathogen, but has not been well studied in resource-limited settings. TB patients (pts) in South Africa have high rates of HIV coinfection which may increase MRSA risk. Routine surveillance at a rural hospital in KwaZulu-Natal identified pts with MRSA, prompting an audit to determine the prevalence of MRSA colonization in TB pts.
Methods: Infection control staff collected nasal swabs on all consented pts within 24hours of admission to the TB wards from Nov 15-Dec 15, 2008. Cultures and susceptibility testing were performed by standard disk diffusion method. Repeat nasal swabs were obtained at 14 days. Demographic and clinical information were extracted from medical charts.
Results: Of 51 pts, 13 had S. aureus isolated on admission and 11 (85%) were MRSA. Among pts initially negative, 2 (5%) were positive for MRSA on day 14. Of those with MRSA on admission, 9 (82%) had been previously hospitalized; compared to 18 of 40 pts (45%) without MRSA (p=0.04). Eleven of 13 (85%) MRSA pts had HIV, median CD4 60 cells/mm3 (IQR 20-134). Of these, 8 (73%) had previously received cotrimoxazole (CTX). 17 MRSA isolates were recovered and all were resistant to CTX, ampicillin and gentamycin; 91% to tetracyclines. 100% were susceptible to vancomycin and 91% to fusidic acid.
Conclusion: This first report of MRSA in hospitalized TB pts from sub-Saharan Africa shows high admission prevalence and further acquisition during hospitalization. MRSA was found in immunosuppressed pts and was associated with previous hospitalization. Nosocomial transmission is suggested but further molecular investigation is required. Infection control strategies toward MRSA identification and containment must be addressed among HIV/TB patients in similar settings.
Kathryn Catterick, RN, ICM1, Gerald Friedland, MD, FIDSA, Scott Heysell, MD, MPH3, Sheela Shenoi, MD, MPH3, Tania Thomas, MD, MPH3 and  S. K. Heysell, None..
S. Shenoi, None..
K. Catterick, None..
T. A. Thomas, None..
G. Friedland, None., (1)Church of Scotland Hospital, Tugela Ferry, South Africa, (2)Yale University, New Haven, CT


K. Catterick, None

G. Friedland, None

S. Heysell, None

S. Shenoi, None

T. Thomas, None