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Protective Effect of Methicillin-Susceptible Staphylococcus aureus Carriage against Methicillin-Resistant S. aureus Acquisition in Nursing Homes: A Prospective Cross-Sectional Study

Published online by Cambridge University Press:  10 May 2016

Rupak Datta ,
Victor Quan ,
Diane Kim ,
Ellena M. Peterson ,
Courtney Reynolds ,
Hildy Meyers ,
Michele Cheung  and
Susan S. Huang
Rupak Datta*
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Victor Quan
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Diane Kim
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Ellena M. Peterson
Affiliation:
Department of Pathology and Laboratory Medicine, University of California Irvine School of Medicine, Irvine, California
Courtney Reynolds
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California
Hildy Meyers
Affiliation:
Epidemiology and Assessment Program, Orange County Health Care Agency, Santa Ana, California
Michele Cheung
Affiliation:
Epidemiology and Assessment Program, Orange County Health Care Agency, Santa Ana, California
Susan S. Huang
Affiliation:
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California Channing Laboratory, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
*
Health Policy Research Institute, University of California, Irvine School of Medicine, 100 Theory, Suite 110, Irvine, CA 92627 ([email protected]).
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Abstract

Objective.

To evaluate whether an ecologic inverse association exists between methicillin-susceptible Staphylococcus aureus (MSSA) prevalence and methicillin-resistant S. aureus (MRSA) prevalence in nursing homes.

Methods.

We conducted a secondary analysis of a prospective cross-sectional study of S. aureus prevalence in 26 nursing homes across Orange County, California, from 2008–2011. Admission prevalence was assessed using bilateral nares swabs collected from all new residents within 3 days of admission until 100 swabs were obtained. Point prevalence was assessed from a representative sample of 100 residents. Swab samples were plated on 5% sheep blood agar and Spectra MRSA chromogenic agar. If MRSA was detected, no further tests were performed. If MRSA was not detected, blood agar was evaluated for MSSA growth. We evaluated the association between MRSA and MSSA admission and point prevalence using correlation and linear regression testing.

Results.

We collected 3,806 total swabs. MRSA and MSSA admission prevalence were not correlated (r = −0.40, P = .09). However, MRSA and MSSA point prevalence were negatively correlated regardless of whether MSSA prevalence was measured among all residents sampled (r = −0.67, P = .0002) or among those who did not harbor MRSA (r = −0.41, P = .04). This effect persisted in regression models adjusted for the percentage of residents with diabetes (β = −0.73, P = .04), skin lesions (β = −1.17, P = .002), or invasive devices (β = −1.4, P = .0006).

Conclusions.

The inverse association between MRSA and MSSA point prevalence and minimal association on admission prevalence suggest MSSA carriage may protect against MRSA acquisition in nursing homes. The minimal association on admission prevalence further suggests competition may occur during nursing home stays.

Infect Control Hosp Epidemiol 2014;35(10):1257–1262

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 10 , October 2014 , pp. 1257 - 1262
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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