Hostname: page-component-78c5997874-ndw9j Total loading time: 0 Render date: 2024-11-17T13:11:38.371Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of the Methicillin-Resistant Staphylococcus aureus Acquisition among Rehabilitation and Nursing Home Residents

Published online by Cambridge University Press:  02 January 2015

Jon P. Furuno ,
Simone M. Shurland ,
Min Zhan ,
J. Kristie Johnson ,
Richard A. Venezia ,
Anthony D. Harris  and
Mary-Claire Roghmann
Jon P. Furuno*
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Simone M. Shurland
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
Min Zhan
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland
J. Kristie Johnson
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Richard A. Venezia
Affiliation:
Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
Anthony D. Harris
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
Mary-Claire Roghmann
Affiliation:
Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
*
Department of Epidemiology and Public Health, University of Maryland School of Medicine, 685 W. Baltimore St., Room 334C, Baltimore, MD, 21201 ([email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To assess risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among extended care residents focusing on level of care (residential vs rehabilitation) and room placement with an MRSA-positive resident.

Design.

Prospective cohort study.

Setting.

Extended care units at 2 healthcare systems in Maryland.

Participants.

Four hundred forty-three residents with no history of MRSA and negative MRSA surveillance cultures of the anterior nares and areas of skin breakdown at enrollment.

Methods.

Follow-up cultures were collected every 4 weeks and/or at discharge for a period of 12 weeks. Study data were collected by a research nurse from the medical staff and the electronic medical records. Cox proportional hazards modeling was used to calculate adjusted hazards ratios (aHRs) and 95% confidence intervals (CIs).

Results.

Residents in rehabilitation care had 4-fold higher risk of MRSA acquisition compared with residents in residential care (hazard ratio [HR], 4. [95% CI, 2.2-8.8]). Being bedbound was significantly associated with MRSA acquisition in both populations (residential care, aHR, 4.3 [95% CI, 1.5-12.2]; rehabilitation care, aHR, 4.8 [95% CI, 1.2-18.7]). Having an MRSA-positive roommate was not significantly associated with acquisition in either population (residential care, aHR, 1.4 [95% CI, 0.5-3.9]; rehabilitation care, aHR, 0.5 [95% CI, 0.1-2.2]); based on concordant spa typing, only 2 of 8 residents who acquired MRSA and had room placement with an MRSA-positive resident acquired their MRSA isolate from their roommate.

Conclusion.

Residents in rehabilitation care appear at higher risk and have different risk factors for MRSA acquisition compared to those in residential care.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 3 , March 2011 , pp. 244 - 249
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.Google Scholar
2.Lucet, JC, Grenet, K, Armand-Lefevre, L, et al.High prevalence of carriage of methicillin-resistant Staphylococcus aureus at hospital admission in elderly patients: implications for infection control strategies. Infect Control Hosp Epidemiol 2005;26:121–126.Google Scholar
3.Muder, RR, Brennen, C, Wagener, MM, et al.Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
4.Furuno, JP, Hebden, JN, Standiford, HC, et al.Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility. Am J Infect Control 2008;36:468–471.Google Scholar
5.McClelland, RS, Fowler, VG Jr, Sanders, LL, et al.Staphylococcus aureus bacteremia among elderly vs younger adult patients: comparison of clinical features and mortality. Arch Intern Med 1999;159:1244–1247.Google Scholar
6.Shurland, SM, Stine, OC, Venezia, RA, et al.Colonization sites of USA300 methicillin-resistant Staphylococcus aureus in residents of extended care facilities. Infect Control Hosp Epidemiol 2009;30:313–318.Google Scholar
7.Mulhausen, PL, Harrell, LJ, Weinberger, M, Kochersberger, GG, Feussner, JR. Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. Am J Med 1996;100:24–31.CrossRefGoogle ScholarPubMed
8.Trick, WE, Weinstein, RA, DeMarais, PL, et al.Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52:2003–2009.Google Scholar
9.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Health Care Infection Control Practices Advisory Committee. 2007 guideline for isolation precautions: preventing transmission of infectious agents in health care settings. Am J Infect Control 2007;35(suppl 2):65–164.Google Scholar
10.Smith, PW, Bennett, G, Bradley, S, et al.SHEA/APIC guideline: infection prevention and control in the long-term care facility. Infect Control Hosp Epidemiol 2008;29:785–814.Google Scholar
11.Harmsen, D, Claus, H, Witte, W, et al.Typing of methicillin-resistant Staphylococcus aureus in a university hospital setting by using novel software for spa repeat determination and database management. J Clin Microbiol 2003;41:5442–5448.Google Scholar
12. Ridom SpaServer home page, http://www.ridom.de/spaserver.Google Scholar
13.Deyo, RA, Cherkin, DC, Ciol, MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol 1992;45:613–619.Google Scholar
14.Morgan, DJ, Diekema, DJ, Sepkowitz, K, Perencevich, EN. Adverse outcomes associated with Contact Precautions: a review of the literature. Am J Infect Control 2009;37:85–93.CrossRefGoogle ScholarPubMed